Paracentesis

efinition
Paracentesis is a procedure during which fluid from the abdomen is removed through a
needle.
Purpose
There are two reasons to take fluid out of the abdomen. One is to analyze it. The other is to
relieve pressure.
Liquid that accumulates in the abdomen is called ascites. Ascites seeps out of organs for
several reasons related either to disease in the organ or fluid pressures that are changing.
Liver disease
All the blood flowing through the intestines passes through the liver on its way back to the
heart. When progressive disease such as alcohol damage or hepatitis destroys enough liver
tissue, the scarring that results shrinks the liver and constricts the blood flow. Such scarring
of the liver is called cirrhosis. Pressure builds up in the intestinal circulation, slowing flow
and pushing fluid into the tissues. Slowly the fluid accumulates in areas with the lowest
pressure and greatest capacity. The free space around abdominal organs receives most of
it. This space is called the peritoneal space because it is enclosed by a thin membrane
called the peritoneum. The peritoneum wraps around nearly every organ in the abdomen,
providing many folds and spaces for the fluid to gather.
Infections
Peritonitis is an infection of the peritoneum. nfection changes the dynamics of body fluids,
causing them to seep into tissues and spaces. Peritonitis can develop in several ways.
Many abdominal organs contain germs that do not belong elsewhere in the body. f they
spill their contents into the peritoneum, infection is the result. The gall bladder, the stomach,
any part of the intestine, and most especially the appendixall cause peritonitis when they
leak or rupture. Tuberculosis can infect many organs in the body; it is not confined to the
lungs. Tuberculous peritonitis causes ascites.
Other infIammations
Peritoneal fluid is not just produced by infections. The pancreas can cause a massive sterile
peritonitis when it leaks its digestive enzymes into the abdomen.
Cancer
Any cancer that begins in or spreads to the abdomen can leak fluid. One particular tumor of
the ovary that leaks fluid, the resulting presentation of the disease, is Meigs' syndrome.
Kidney disease
Since the kidneys are intimately involved with the body's fluid balance, diseases of the
kidney often cause excessive fluid to accumulate. Nephrosis and nephrotic syndrome are
the general terms for diseases that cause the kidneys to retain water and provoke its
movement into body tissues and spaces.
Heart faiIure
The ultimate source of fluid pressure in the body is the heart, which generates blood
pressure. All other pressures in the body are related to blood pressure. As the heart starts
to fail, blood backs up, waiting to be pumped. This increases back pressure upstream,
particularly below the heart where gravity is also pulling blood away from the heart. The
extra fluid from heart failure is first noticed in the feet and ankles, where gravitational effects
are most potent. n the abdomen, the liver swells first, then it and other abdominal organs
start to leak.
PIeuraI fIuid
The other major body cavity is the chest. The tissue in the chest corresponding to the
peritoneum is called the pleura, and the space contained within the pleura, between the ribs
and the lungs, is called the pleural space. Fluid is often found in both cavities, and fluid from
one cavity can find its way into the other.
Fluid that accumulates in the abdomen creates abnormal pressures on organs in the
abdomen. Digestion is hindered; blood flow is slowed. Pressure upward on the chest
compromises breathing. The kidneys function poorly in the presence of such external
pressures and may even fail with tense, massive ascites.
escription
During paracentesis, special needles puncture the abdominal wall, being careful not to hit
internal organs. f fluid is needed only for analysis, just a bit is removed. f pressure relief is
an additional goal, many quarts may be removed. Rapid removal of large amounts of fluid
can cause blood pressure to drop suddenly. For this reason, the physician will often leave a
tube in place so that fluid can be removed slowly, giving the circulation time to adapt.
A related procedure called culpocentesis removes ascitic fluid from the very bottom of the
abdominal cavity through the back of the vagina. This is used mostly to diagnose female
genital disorders like ectopic pregnancy that bleed or exude fluid into the peritoneal space.
Fluid is sent to the laboratory for testing, where cancer and blood cells can be detected,
infections identified, and chemical analysis can direct further investigations.
Aftercare
An adhesive bandage and perhaps a single stitch close the hole. Nothing more is required.
Risks
Risks are negligible. t is remotely possible that an organ could be punctured and bleed or
that an infection could be introduced.
NormaI resuIts
A diagnosis of the cause and/or relief from accumulated fluid pressure are the expected
results.
AbnormaI resuIts
Fluid will continue to accumulate until the cause is corrected. Repeat procedures may be
needed