Ascitic fluid cytology ppt

If the ascitic fluid is as brown as molasses and the bilirubin concentration is greater than the serum value, the patient probably has a ruptured gallbladder or perforated duodenal ulcer 11. Cell count and differential • The cell count with differential is the single most helpful test performed on ascitic fluid to evaluate for infection FLUID CYTOLOGY: SLIDE SEMINAR IAC-KC CON-2015 - FLUID CYTOLOGY: SLIDE SEMINAR IAC-KC CON-2015 Dr. N. Siddaraju Professor Department of Pathology JIPMER, Pondicherry Case-1: What are these cells in ascitic fluid sample Cytology exam: useful in identifying malignancy or abnormal morphological cells. 3- PERITONEAL FLUID Abnormal. accumulation of fluid (effusion) in peritoneal. cavity: Ascites Ascites: a condition in which fluid accumulates within. the peritoneal space. Must have an accumulation of > 100ml (several 100) before effusion can be detected on.

Peritoneal fluid: A peritoneal effusion is the accumulation of peritoneal fluid, also called ascites, in the abdominal cavity. Laboratory testing of serous fluid: Macroscopic examination: - Serous body fluids normally resemble serum, clear and pale yellow The history of serous effusion cytology can be traced back to the 19 th century. Lucke and Klebs were apparently the first investigators who recognized the presence of malignant cells in an ascitic fluid in 1867. In 1882 Quincke was credited for detailed descriptions of ovarian and lung cancer cells in serous effusions

Myeloma cells in ascitic fluid - 2

Ascitic fluid analysis - SlideShar

Effusion Cytology PowerPoint PPT Presentations - PowerSho

  1. A 54-year-old woman with no prior history of malignancy presented with a large cecal mass, ascites and bilateral pleural effusions. Pleural fluid was submitted for cytological evaluation. The virtual slide and 4 static images are provided. The virtual slide provided is a Pap-stained cytospin
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  3. Shidham VB, Atkinson BF (eds) Cytopathologic Diagnosis of Serous Fluids. Saunders Elsevier. 2006 Tao L-C. Cytopathology of Malignant Effusions. The ASCP Theory and Practice of Cytopathology Series Volume 6. ASCP. Chicago. 1996 Motherby H et al. Diagnostic accuracy of effusion cytology. Diagnostic Cytopathology 1999;20:350-7
  4. e other body fluids including pleural, ascitic and cyst fluid, as well as fine needle aspiration specimens from sites such as lymph nodes, breast, thyroid and liver. Pleural, pericardial and ascitic fluid Aspirated fluids are commonly sampled when looking for a malignancy
  5. An ascitic fluid total protein value less than 2.5 g/dL is consistent with ascites from cirrhosis or nephrotic syndrome, whereas a high ascitic fluid protein value greater than 2.5 g/dL is seen in persons who have a cardiac cause of ascites. Cell Count and Cultures: Routinely, a cell count and differential should be performed on ascitic fluid
  6. gradient (SAAG). (Quality of evidence: moderate; Rec-ommendation: strong) 1.3. Ascites fluid analysis for cytology, amylase, brain natriuretic peptide (BNP) and adenosine dea
  7. Top Tips for ascitic tap (paracentesis) Always send the most fluid to cytology, especially if malignancy is suspected. The more fluid sent, the higher the diagnostic yield. Never dispose of unused fluid, put it in an extra pot and add to the cytology sample. If you want to gain a larger sample use a 50ml syringe to aspirate fluid

7 - Cytology of Body Fluid Cytopathology Cerebrospinal

The various samples include pleural fluid, peritoneal/ascitic fluid, pericardial fluid, peritoneal washing, and rarely pleural washing. Essential The fluid is collected in a sterile/nonsterile clean dry container with proper labeling and identification which includes the name of the patient and hospital registration number View and Download PowerPoint Presentations on Pericardial Fluid Examination PPT. Find PowerPoint Presentations and Slides using the power of XPowerPoint.com, find free presentations research about Pericardial Fluid Examination PPT. About 15 results (0.55 milliseconds) Sponsored Link

Ascites fluid cytology is not a good diagnostic test for HCC, even when the diagnosis is strongly suspected on clinical and radiological grounds. Atypical epithelioid cells seen in ascites fluid specimens from cirrhotic patients are more likely to represent reactive mesothelial changes than peritoneal spread of HCC In dogs, the pericardial sac contains about 0.3 ml, and the pleural and peritoneal cavities 0-15 ml of clear, straw-colored fluid of pH 7.4, specific gravity 1.016, protein content less than 3.0 g/dl and cell count less than 3000/microliter. Fat can be cleared from chylous fluid with NaOH and ether. Three characteristics of an exudate, ie, an ascitic fluid lactic dehydrogenase (LDH) level of greater than 400 Sigma units (SU), an ascitic fluid-serum LDH ratio of greater than 0.6, and an ascitic fluid-serum protein ratio of greater than 0.5, were studied in a prospective fashion to determine their usefulness in the differential diagnosis of ascites

Malignant Ascites. Definition abnormal accumulation of fluid in. the peritoneal cavity as a consequence of cancer. Commonly caused by cancers of. Breast, bronchus, ovary, stomach, pancreas, colon. 20 of cases have tumors of unknown primary. Survival poor usually less than 3 months ascitic fluid Appearance: The gross appearance of the ascitic fluid can be helpful in the differential diagnosis. Turbid or cloudy: infected fluid. Milky: Triglyceride concentration of greater than 200mg/dl (often greater than 1000mg/dl), malignancy is usually most common cause, but cirrhosis may present with chylous fluid. Pink or Bloody: Pink fluid usually traumatic tap 7- Cytology of Body Fluid.ppt. CPC Pleural Effusion. THE BLOOD. Cavagnaro Body Fluid Analysis2008 4 16 2 to 3pm Ho. Cells, Human. hib. Prostate & Leukemia. =Serum albumin ascitic fluid albumin If the gradient is >1.1: Portal HTN (drives fluids into peritoneum) SBP, cirrhosis, Alcoholic hepatitis, CHF If the gradient is < 1.1: (protein leaks. Other studies of ascitic fluid to be considered ; Lactate An ascites lactate level of gt25 mg/dL was found to be 100 sensitive and specific in predicting active SBP in a retrospective analysis. pH In the same study, the combination of an ascites fluid pH of lt7.35 and PMN count of gt500 cells/mL was 100 sensitive and 96 specific

Ascites Cirrhosis Vasodilatio

  1. al) cavity and the fluid thus accumulated is referred to as ascetic fluid. •Ascitic fluid-•Cell count and differential count •LDH •Albu
  2. Accumulation of fluid between the peritoneal membranes is called ascites, and the fluid is commonly referred to as ascitic fluid rather than peritoneal fluid. In addition to the causes of transudative effusions discussed previously, hepatic disorders such as cirrhosis are frequent causes o ascitic transudates
  3. Ascites is abnormal excessive accumulation of fluid in peritoneal cavity It is the most common of the 3 major complications of cirrhosis (ascites, hepatic encephalopathy and bleeding varices) (Hepatology 1987;7:122) It is also one of 5 parameters of the Child-Pugh score, the most widely used system for liver function assessment (Medicine (Baltimore) 2016;95:e2877
  4. Ascitic fluid analysis (Specific additional investigations) Microbiology for AFB, PCR and culture for mycobacteria - only if there is high index of cadtuberculosis Cytology - suspicion of peritoneal carcinomatosis Lactate dehydrogenase >225mU/L, glucose <50mg/dL, total protein >1g/dL and multipl
  5. emia (e.g., due to nephrotic syndrome).Other conditions resulting in ascites include chronic heart failure, inflammation of abdo

Ascites: is an accumulation of fluid within the peritoneal cavity of the abdomen and can occur in association with many conditions such as cancer, cirrhosis of the liver, congestive cardiac failure, and protein depletion1. 1.2. Paracentesis: is the procedure of removing ascitic fluid from the abdominal cavity A liquid concept - do classic preparations of body cavity fluid perform differently than ThinPrep cases? Observations from the College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytology. Arch Pathol Lab Med. 2008; 132: 1716-18 Generally 100mls should be infused for each 2000mls of ascites drained. Volume replacement is not routinely required for malignant ascites unless the patient becomes hypotensive during drainage (but suggest 250ml colloid fluid challenge if required).Send fluid for urgent cell count, MC&S, LDH, protein and cytology

(PDF) Analysis of Ascitic Fluid for Cytological and

between obtaining the ascitic fluid and cytology processing as well as obtaining at least 50 ml ascitic fluid, or even 1000 ml if the first test was negative.27 The sensitivity of cytology in patients with hepatocellular carcinoma and ascites is low (~27%).28 Diagnostic laparoscopy If the conventional work-up fails to disclose the cause o Chylous ascites refers to the accumulation of lipid-rich lymph in the peritoneal cavity due to disruption of the lymphatic system secondary to traumatic injury or obstruction. Worldwide, abdominal malignancy, cirrhosis, and tuberculosis are the commonest causes of CA in adults, the latter being most prevalent in developing countries, whereas congenital abnormalities of the lymphatic system and. Ascites is the medical term to describe the accumulation of fluid in the abdomen. Ascites is often associated with severe liver disease, but its causes may vary. Ascites usually presents with marked swelling of the patients' abdomen, increased abdominal girth and sudden weight gain. If left untreated, this condition will compromise the. BODY FLUIDS All body cavity fluids should be collected in a fresh state. These specimens consist of: 1. Thoracentesis (pleural fluid) 2. Paracentesis (abdominal fluid, ascites fluid) 3. Pericardial fluid 4. Pelvic washings BRONCHIAL SPECIMENS Bronchial Brushing: Collect the brush tip in a container of Cytolyt. Cytolyt solution is provided b

Notes. Note 1: Physician statement of Peritoneal Cytology can be used to code this data item when no other information is available. Note 2: Peritoneal cytology may also be called peritoneal ascitic fluid instead of peritoneal washing or pelvic washing. Note 3: Cytologic examination for malignant cells may be performed on ascites (fluid that. The presence of malignant cells on ascitic fluid smear cytology may be the first indication of malignancy in around half of all patients with peritoneal carcinomatosis and is generally regarded as a poor prognostic sign.[10 11 12 15] Malignancies of the FGT, primarily from the ovary in 12 cases, and peritoneal carcinomatosis (9) with primaries.

Ascitic Fluid Analysis Ascites Interpretation Geeky Medic

  1. al pain,nausea,vomiting,jaundice • Liver.
  2. ed for cancer cells. Fluids from 13 of the 15 patients with neoplasm involving the pericardium were decisively positive. There were no false positive reports. Three patients had malignancy localized to the chest, but not metastatic to the pericardium. Effusions from these three patients contained no tumor cells
  3. gradient (SAAG) is necessary to deter
  4. 14 Cryo PPT 880 15 Fresh Frozen Plasma (FFP) 600 16 Platelet Concentrate 600 17 Whole Blood and Packed Cell (RBC) 1200 194 Ascitic Fluid for Cytology 440 195 Ascitic Fluid for Malignant Cell 440 196 BAL Fluid for Cytology 440 197 BAL Fluid for Haemosiderin Laden Macrophage 550 198 Brush Cytology 44

Fluids - Cytolog

Transudate and exudate ppt. Transudate Exudate appearance of the fluid Colour- clear and pale yellow (filtrates of plasma and contain only very little cellular material compared to an exudate) cloudy or turbid and they show a variety of colours depending on the constituents and their concentrations Ex. yellow, brown, greenish, and even red( lot of red blood cells are present 11 Title: Body Fluid Author: Tarek Last modified by: Tarek Created Date: 10/1/2015 2:50:12 AM Document presentation format: Widescreen Other titles: Calibri Arial Calibri Light Times New Roman PMingLiU Microsoft JhengHei Wingdings Office Theme Body Fluid Accumulation of fluids in body cavities PowerPoint Presentation Diagnostic role of effusion cytology PowerPoint Presentation Examination of body. FINE NEEDLE ASPIRATION CYTOLOGY This is frequently used to provide a rapid diagnosis with or without the use of imaging from ascitic fluid, ovarian tumours, lymph nodes, vulva cysts etc. Advantages of FNA over open surgical biopsy Diagnosis with a simple, cheaper, outpatient procedur Definition and Etiology. Ascites is defined as the accumulation of fluid in the peritoneal cavity. It is a common clinical finding, with various extraperitoneal and peritoneal causes (), but it most often results from liver cirrhosis.The development of ascites in a cirrhotic patient generally heralds deterioration in clinical status and portends a poor prognosis EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis European Association for the Study of the Liver1 Ascites is the most common complication of cirrhosis, and 60

Ascitic fluid analysis

INTRODUCTION. Abdominal paracentesis is a simple bedside or clinic procedure in which a needle is inserted into the peritoneal cavity and ascitic fluid is removed [ 1 ]. Diagnostic paracentesis refers to the removal of a small quantity of fluid for testing. Therapeutic paracentesis refers to the removal of five liters or more of fluid to reduce. The serum ascites albumin gradient (SAAG) can determine which patients with liver disease have portal hypertension. A cutoff level of 1.1 has bene validated to determine who has portal hypertension. Obtaining ascites fluid is relatively simple and safe in experienced operators. The constituents of ascites fluid offer a less-invasive method for. Ascites fluid cytology was negative. During transjugular liver biopsy, the portosystemic pressure gradient was 17 mm Hg. The liver biopsy showed extensive infiltration of the hepatic sinusoids with κ light chain-restricted plasma cells (panel B), thus explaining her portal hypertension and ascites 1 INTRODUCTION. Ascites is the pathological accumulation of fluid in the peritoneal cavity. The aetiology of ascites include liver cirrhosis, peritoneal carcinomatosis, congestive heart failure, tuberculous peritonitis, renal diseases, hepatic vascular diseases, pancreatitis, etc. 1 In some cases, it is challenging to determine the cause of ascites. . Appropriate ascitic fluid analysis is the. Fluid samples from the eye should be transported immediately to the Cytopathology Lab for processing. The delivery to the Cytopathology Lab is delayed, the fluid samples must be refrigerated. Effusions-Ascites, pleural OR pericardial: If a specimen can be transported promptly to the lab, we prefer fresh fluid. If it cannot be immediately.

Question: A 78-year-old man was admitted to our department with a history of excessive weight gain (8 kg/mo), anorexia, and edema of the lower extremities. The patient had been regularly followed since undergoing liver resection for colorectal liver metastasis 7 years previously, and had had no evidence of recurrence. He had a past medical history of diabetes mellitus, hyperuricemia, chronic. Laboratory Studies. In patients with new-onset ascites of unknown origin, peritoneal fluid should be sent for cell count, albumin level, culture, total protein, Gram stain, and cytology. Note the following: Inspection: Most ascitic fluid is transparent and tinged yellow Prospective and retrospective studies have documented a higher level of sensitivity for biliary brushings compared with exfoliative cytology in the detection of biliary carcinomas. 13 A review of the literature shows that duct brushing cytology has an overall sensitivity of 26% to 88.9%, a specificity of 80% to 100%, and an overall accuracy of.

PPT - Serous Fluid PowerPoint presentation free to

The most common site of metastasis to ascitic fluid in females is from a mullerian (ovarian) primary, whereas in males it is from the gastrointestinal tract. Metastatic Merkel cell carcinoma (MCC) to the ascitic fluid is extremely rare and may present as a diagnostic challenge on effusion cytology The yield for cytology is around 60%. 21 The majority of MPEs will be detected within two attempts at sampling and further specimens are unlikely to yield new positive results. 40 The British Thoracic Society guidelines suggest that a sample of at least 50 mL of PF should be sent for cytological testing. 21 The most common types of malignancies. 1. Introduction. Chylous ascites is an uncommon form of ascites, defined as leakage of the lipid-rich lymph into the peritoneal cavity. [] It is described as milky, cloudy and turbid peritoneal fluid often seen during the process of abdominal paracentesisChylous ascites is a rare condition (<1%) defined by the presence of high concentration of triglycerides in the ascitic fluid (>200 mg/dl) Biswas B, Sharma SK, Negi RS, et al. Pleural effusion: Role of pleural fluid cytology, adenosine deaminase level, and pleural biopsy in diagnosis. J Cytol 2016; 33:159. Porcel JM, Esquerda A, Bielsa S. Diagnostic performance of adenosine deaminase activity in pleural fluid: a single-center experience with over 2100 consecutive patients (1 point each for multilocular nature, solid areas, bilaterality metastasis, ascites,) Ascitic fluid cytology, FNAC of solid tumor has a questionable role; Situation 1: At Secondary Hospital / Non-Metro situation: Optimal Standards of Treatment in Situations where technology and resources are limited

Diagnosis and Management of Ascites - Core Concept

Peritonitis is inflammation of the peritoneal cavity and is most commonly the result of gastrointestinal rupture, perforation, or dehiscence in small animals.. Clinical signs in patients with peritonitis may be mild to severe and are often nonspecific. • Abdominocentesis is the preferred diagnostic method for confirming peritonitis The primary origin of malignant ascites can be any site beyond the peritoneum; the most common origins in our cohort were ovary, stomach, and pancreaticobiliary tract. With optimal interpretation, fluid cytology could meet clinical demands by alleviating diagnostic and therapeutic conundra. However, the interpretation of fluid cytology in third. Specimen Requirements: Collect a minimum of 3 mL of CSF. If flow cytometry for lymphoma/leukemia is required, provide as much specimen as possible (CSF for flow cytometry must be submitted fresh)

Cytology of Body Fluid | Cytopathology | Cerebrospinal Fluid

An ascitic fluid neutrophil count of >500 cells/mL is the single best predictor of SBP. 1 Slide 32 Pleural fluid--- glucose Pleural fluid--- amylase Pleural fluid--- lactic acid dehydrogenase Pleural fluid--- cytology Pleural effusion--- bacteriology Pleural fluid--- pH and pCO2 Hemothorax Pleural Fluid Hct Slide 41 Slide 42 Pleural fluid. Cytology should be performed to differentiate malignancy-related from non-malignant ascites. II-2. 1. Grade of evidence. Patients with cirrhosis and low ascitic fluid protein concentration (<10 g/L) and/or high serum bilirubin levels are at high risk of developing a first episode of SBP1

PPT - Approach to peritoneal fluid analysis PowerPoint

Ascitic tap (paracentesis) - Oxford Medical Educatio

Pericardial effusion Obstruction of lymphatic drainage or fluid from tumour on pericardium Tamponade - tachycardia, hypotension, JVP, oedema Echocardiogram Urgent discussion with cardiothoracics Percardiocentesis - fluid for cytology Pericardial window Complete pericardial stripping Treat underlying cause Case 7 Lymphangitis Carcinomatosa. The normal pleura is a thin translucent membrane consisting of 1-mesothelium, 2-thin layer of subendothelial connective tissue rich in lymphatics, arteries veins and nerves 3. Smears- Smears are made from blood, bone marrow or any fluid such as pleural or ascitic fluid. These are immediately fixed in alcohol to presence the cellular structures are then stained. Smears are also made by crushing soft tissue between two slides or an impression smear in made by pressing a clean slide in contact with the mois Whole Blood Cytology (Cytopathology) Plasma Aspiration, Fine Needle Serum Aspiration, Cyst Fluids Urine Submission of slide Fecal (Stool) Tips on making smears Body Fluid Body Cavity Fluids Cerebrospinal Spinal Fluid Breast Nipple Secretions Synovial Fluid Brushing Specimens.


Papanicolaou x100 oil immersion) Ovarian cancer cells in abdominal effusion. Isolated and pseudopapillary groups of neoplastic cells associated to psammoma bodies and inflammatory cells. CA125 (on the left) and Napsin A (right) resulted positive by immunocytochemistry. (Papanicolaou x400, x200) Malignant pleural effusion cell Paracentesis procedure may be done in a health care provider's office, treatment room, or hospital. Ascitic fluid may be used to help determine the cause of ascites, as well as to evaluate for infection or presence of cancer. Ascites is the build-up of fluid in the space between the lining of the abdomen and abdominal organs 2. Ascitic fluid Physiologically, the volume of peritoneal fluid is small. The term 'ascites' refers to an abnormal accumulation of fluid in the perito-neal cavity, and the fluid is commonly referred to as 'ascitic fluid' rather than 'peritoneal fluid'. Since the underlying primary disease could be benign or malignant

Guidelines on the management of ascites in cirrhosi

• Peritoneal fluid leak, infection (peritonitis), perforated viscous, hemorrhage, renal failure, and hypotension Diagnostic studies: • Document color and turbidity of fluid • Send fluid for cell count, differential (lavender top); albumin, total protein (tiger or gol Exudates appear due to an active accumulation of fluid within the body cavities, associated with damaged capillary walls. There are two main causes of exudates: Inflammatory processes; Malignant cell infiltration; Specimen Requirements. When sending a serous effusion (including peritoneal, ascites, pleural and pericardial samples) to Cytology Malignant effusions are usually greater than 500 ml; are often first evidence of malignancy. For lung, breast and ovarian metastases, 92% of pleural effusions are ipsilateral to primary lesion. Inflammatory pleural effusion: Either serous, serofibrinous or fibrinous. Due to inflammation in lung (tuberculosis, pneumonia, infarct, abscess. used to absorb all fluid in case of breakage • For cold transportation conditions, ice or dry ice shall be placed outside the secondary receptacle. Wet ice shall be placed in a leak-proof container. • (iii) an outer packaging of adequate strength for its capacity, mass and intended use. 24

Hepatic encephalopathy (HE) is a neuropsychiatric syndrome that occurs only with significant liver dysfunction and has a potential for full reversibility. Two distinct forms can be identified in patients with cirrhosis. The overt form, which is easy to diagnose, and the subclinical form. The prevalence of subclinical HE in cirrhosis ranges from 30% to 84%; this wide variation is due to. Ascitic fluid cytology has a low negative predictive value. Although the test for acid-fast bacilli in the peritoneal fluid is highly specific for the diagnosis, it lacks sensitivity. There are high false-negative rates for tuberculosis skin tests. New diagnostic procedures like PCR assay for bacteria could help to identify this subject, since. A 30-degree laparoscope through an umbilical port is recommended. If present, ascitic fluid is aspirated and sent for cytology. In the absence of ascites, 200 cc of normal saline can be instilled into the peritoneal cavity and aspirated from the pelvis and bilateral subdiaphragmatic spaces for cytologic examination [1]. Full inspection of the. of pleural fluid (0.1 mL per kg) rests within staining, cytology, and pH measurement. Light's criteria should be used to differentiate exudative from transudative ascites, caput medusae. We describe a 69-year-old dialysis-dependent patient who developed intractable ascites after zone 2 aortic reconstruction for a type IA thoracic endovascular aneurysm repair endoleak. Investigation as to the cause of ascites revealed a unique set of clinical circumstances leading to intractable bloody ascites. Investigation included imaging and invasive testing to diagnose the culprit mechanism

Exfoliative cytology involves examination of specimens that contain cells exfoliated from body cavities and surface. It is further subdivided into gynaecological cytology (Pap/cervical smears) and non-gynaecological cytology (pleural fluid, peritoneal fluid, cerebrospinal fluid, urine, sputum, brushing, etc) Analyses of ascitic fluid showed an adenosine deaminase concentration of 136·5 U/L. Although ascites culture and PCR for Mycobacterium tuberculosis were negative, caseating granulomas with Langhans giant cells were detected in specimens of omentum. Based on these clinical findings, we made a diagnosis of tuberculous peritonitis EUS-guided fine-needle aspiration of the ascitic fluid as well as the peritoneal deposits (Figure B, arrow) and the thickened omentum was performed. The fluid aspirated was slimy. The fluid was exudative with high protein, low adenosine deaminase, and negative malignant cytology

Cytopathology Of Cerebrospinal Fluid[1]Power Point[Haematology] Cytology Atlas of Organ Biopsies and

The analysis of body fluids, including nucleated blood cell count and differential count, can provide valuable diagnostic information. This chapter is not intended as a comprehensive treatment of all body fluids, but it covers cell counting and morphologic hematology. The fluids discussed in this chapter include cerebrospinal fluid (CSF. They play a very important role in diagnosis, differentiation and classification of Leukemias. These stains can be. 1) cytochemical stains ie they use cellular enzymatic reactions to impart staining. or. 2) Immunocytochemical stains ie they identify cell specific antigens with the help of antibodies. Not every lab is equipped with cytogenetics. cerebrospinal fluid and lumber puncture fluid , Ascitic fluid, Pleural fluid for cytology. Tumor marker test: Tumor markers are 2 types , 1.Tumor associated markers are those that may increase any. Pleural fluid testing evaluates this liquid to determine the cause of the increased fluid. The two main reasons for fluid buildup in the pleural space are: An imbalance between the pressure of the liquid within your blood vessels, which drives fluid out of blood vessels, and the amount of protein in your blood, which keeps fluid in blood vessels Fine needle aspiration cytology, peritoneal biopsy, ascitic fluid assessment with PCR assay and QuantiFeron - TB test are all effective in reaching a conclusion with the diagnosis.(4