Management Tree Diagnostics / Emergency Medicine Peer reviewed

Peritoneal Effusion
abdominocentesis &
Peritoneal Effusion characterization of fluid

Pure transudate Modified transudate Chylous effusion (very rare)

• Clear, colorless • Clear, straw colored • White/opaque
• TP <2.5 g/dL • TP >2.5 g/dL • TP >2 g/dL
• <1000 cells/µL • 1000–7000 cells/µL • variable cell count
• Mononuclear cells • Mononuclear cells, increasing • Predominantly small
predominate numbers of neutrophils, lymphocytes
lymphocytes • Effusion triglycerides > serum
triglycerides

Low albumin (<1.5–

1.8 g/dL)?
Portal hypertension FasT, chest radiographs
• Liver disease
• right-sided heart failure
Yes No (auscultation, echocardiogram,
chest radiographs) Trauma or thoracic duct rupture?

• Liver failure/disease
• addison’s disease
No Yes
• Protein-losing
nephropathy
• Protein-losing
enteropathy • Treat as necessary
• surgery if indicated
• Monitor

• abdominal Us abdominal Us normal?

• Bile acids
• resting cortisol levels
• Urinalysis (UP:C if
• Effusion creatinine >2¥ serum
indicated) No Yes creatinine
• vitamin B12/folate
• Effusion potassium >1.4¥ serum
potassium

• vasculitis (rare)
• rickettsial disease
• Immune-mediated
disease
Uroabdomen (transudate/modified
transudate)

Pancreatitis Hepatic splenic/ neoplasia

disease intestinal surgery may be indicated
torsion

FAST = focused assessment with sonography for trauma,

supportive Biopsy + FIP = feline infectious peritonitis, PT = prothrombin time,
surgery Chemotherapy
treatment bile acids PTT = partial thromboplastin time, TP = total protein,
UP:C = urine protein:creatinine, US = ultrasound

18 cliniciansbrief.com • October 2013

 Gretchen Statz, DVM, DACVECC
Internal Medicine Consultant
Antech Diagnostics

Exudate Hemorrhagic effusion Malignant effusion

• Turbid, hemorrhagic to purulent • PCv >10% • Light yellow, clear to cloudy
• TP >2.5 g/dL (often >3 g/dL) • TP >2.5 g/dL • TP >2.5 g/dL
• >5000 cells/µL • variable cell count • variable cell count
• neutrophils predominate • similar to peripheral blood, • neoplastic cells identified
does not clot

neoplasia

• Intracellular bacteria present? FasT, chest radiographs

• Peripheral blood glucose
>20 mg/dL higher than glucose abdominal Us, chest
in abdominal fluid (also seen in radiographs, CT
neoplastic effusions)?
Trauma?
• Positive culture (needs
treatment before results)?
surgery ± chemotherapy

• Treat as necessary
No Yes No Yes • abdominal pressure wrap
• surgery if indicated
• Monitor

severely elevated PT/PTT?

nonseptic FIP PCr- septic
effusion positive effusion
effusion

No Yes

Effusion Emergency Coagulopathy Ingestion of

bilirubin > surgery ± anticoagulant
FIP ruptured/damaged rodenticide
serum abdominal
bilirubin vascular neoplasia/
Us
organ Plasma +
vitamin K Decontamination
Treat as ± emesis ±
Bile necessary vitamin K
peritonitis Cats: Dogs:
• neoplasia • neoplasia
Diagnosis
• Hepatic diseases (hemangio-
• Hemorrhagic sarcoma) Differential
surgery cyst • splenic Diagnosis
• ruptured hematoma
Investigation See Aids &
bladder • splenic torsion
Resources, back
Treatment page, for refer-
Treat as necessary (eg, surgery ± imaging)
ences & suggested
results
reading.

October 2013 • clinician’s brief 19