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centesis of the belly to remove fluid for diagnosis (同)paracentesis

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/06/10 16:52:07」(JST)

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Illustration depicting Paracentesis

Paracentesis (from Greek κεντάω, "to pierce") is a form of body fluid sampling procedure, generally referring to peritoneocentesis (also called laparocentesis) in which the peritoneal cavity is punctured by a needle to sample peritoneal fluid.^[1]^[2]

Indications

It is used for a number of reasons:

to relieve abdominal pressure from ascites
to diagnose spontaneous bacterial peritonitis and other infections (e.g. abdominal TB)
to diagnose metastatic cancer
to diagnose blood in peritoneal space in trauma
to puncture the tympanic membrane for diagnostic purposes, such as taking a bacterial swab from the middle ear (tympanocentesis).
to reduce intra-ocular pressure in central retinal artery occlusion (oculocaentesi) and any hyphaema in the anterior chamber of the eye where blood does not get absorbed in a weeks time.

Paracentesis for ascites

The procedure is often performed in a doctor's office or an outpatient clinic. In an expert's hands it is usually very safe, although there is a small risk of infection, excessive bleeding or perforating a loop of bowel. These last two risks can be minimized greatly with the use of ultrasound guidance.

The patient is requested to urinate before the procedure; alternately, a Foley catheter is used to empty the bladder. The patient is positioned in the bed with the head elevated at 45-60 degrees to allow fluid to accumulate in lower abdomen. After cleaning the side of the abdomen with an antiseptic solution, the physician numbs a small area of skin and inserts a large-bore needle with a plastic sheath 2 to 5 cm (1 to 2 in) in length to reach the peritoneal (ascitic) fluid. The needle is removed, leaving the plastic sheath to allow drainage of the fluid. The fluid is drained by gravity, a syringe or by connection to a vacuum bottle. Several litres of fluid may be drained during the procedure; however, if more than two litres are to be drained it will usually be done over the course of several treatments. If fluid drainage is more than 5 litres, patients may receive intravenous serum albumin (25% albumin, 8g/L) to prevent hypotension (low blood pressure). After the desired level of drainage is complete, the plastic sheath is removed and the puncture site bandaged. The plastic sheath can be left in place with a flow control valve and protective dressing if further treatments are expected to be necessary.

The procedure generally is not painful and does not require sedation. The patient is usually discharged within several hours following post-procedure observation provided that blood pressure is otherwise normal and the patient experiences no dizziness.^[1]^[3]^[4]

Ascitic fluid analysis

The serum-ascites albumin gradient can help determine the cause of the ascites. The ascitic white blood cell count can help determine if the ascites is infected.

Contraindications

Mild hematologic abnormalities do not increase the risk of bleeding.^[5]^[6] The risk of bleeding may be increased if:^[7]

prothrombin time > 21 seconds
international normalized ratio > 1.6
platelet count < 50,000 per cubic millimeter.

Absolute contraindication is acute abdomen that requires surgery. Relative contraindications are:

Pregnancy
Distended urinary bladder
Abdominal wall cellulitis
Distended bowel
Intra-abdominal adhesions.^[1]

References

^ ^a ^b ^c Paracentesis at eMedicine
^ Farlex dictionary > paracentesis, citing:
- Gale Encyclopedia of Medicine. Copyright 2008
- The American Heritage Medical Dictionary Copyright 2007
- McGraw-Hill Concise Dictionary of Modern Medicine. Copyright 2002
^ http://patients.dartmouth-hitchcock.org/gi/paracentesis.html^{[full citation needed]}
^ http://apps.med.buffalo.edu/procedures/paracentesis.asp?p=15^{[full citation needed]}
^ McVay, PA; Toy, PT (1991). "Lack of increased bleeding after paracentesis and thoracentesis in patients with mild coagulation abnormalities". Transfusion 31 (2): 164–71. doi:10.1046/j.1537-2995.1991.31291142949.x. PMID 1996485.
^ Moore, K P; Aithal, G. P. (2006). "Guidelines on the management of ascites in cirrhosis". Gut 55: vi1–12. doi:10.1136/gut.2006.099580. PMC 1860002. PMID 16966752.
^ Ginès, Pere; Cárdenas, Andrés; Arroyo, Vicente; Rodés, Juan (2004). "Management of Cirrhosis and Ascites". New England Journal of Medicine 350 (16): 1646–54. doi:10.1056/NEJMra035021. PMID 15084697.

External links

Paracentesis - a step-by-step procedure guide. Clinical Notes.
WebMD: Patient guide

English Journal

Calcium carbonate obstructive urolithiasis in a red kangaroo (Macropus rufus).

Lindemann DM, Gamble KC, Corner S.SourceLincoln Park Zoo, 2001 North Clark, Chicago, Illinois 60614, USA. dana.lindemann@gmail.com
Journal of zoo and wildlife medicine : official publication of the American Association of Zoo Veterinarians.J Zoo Wildl Med.2013 Mar;44(1):196-9.
A 6-yr-old male red kangaroo (Macropus rufus) presented for a history of inappetance, abnormal behavior, and unconfirmed elimination for 6 hr prior to presentation. Based on abdominal ultrasound, abdominocentesis, and cystocentesis, a presumptive diagnosis of urinary tract obstruction with uroabdome
PMID 23505728

An unusual cause of spontaneous bacterial peritonitis due to Campylobacter fetus with alcoholic liver cirrhosis.

Hadano Y, Iwata H.SourceDepartment of General Internal Medicine and Infectious Diseases, Rakuwakai Otowa Hospital, Kyoto, Japan. hatayoshiyoshi@gmail.com
BMJ case reports.BMJ Case Rep.2013 Feb 14;2013. pii: bcr2012008406. doi: 10.1136/bcr-2012-008406.
A 40-year-old man with severe alcoholic liver cirrhosis with a 2-day history of fatigue and abdominal pain was admitted. He reported eating sushi and sliced raw chicken a few days previously. His abdomen was distended, with shifting dullness. Based on the patient's history, physical examination and
PMID 23417384

Effects of repeated transvaginal aspiration of immature follicles on mare health and ovarian status.

Velez IC, Arnold C, Jacobson CC, Norris JD, Choi YH, Edwards JF, Hayden SS, Hinrichs K.SourceCollege of Veterinary Medicine & Biomedical Sciences, Texas A&M University, TX, USA.
Equine veterinary journal.Equine Vet J.2012 Dec;44 Suppl 43:78-83. doi: 10.1111/j.2042-3306.2012.00606.x.
REASONS FOR PERFORMING STUDY: Transvaginal ultrasound-guided follicle aspiration (TVA) is performed clinically but there is little information available on complications associated with this procedure.OBJECTIVES: It is possible that TVA is associated with damage to the ovary and may induce peritonit
PMID 23186194

Japanese Journal

遅発性難治性胆汁漏により汎発性腹膜炎を呈した生体肝移植ドナーの１例 : 胆汁漏に対するランデブー法の有用性

Kimura Koichi,Ikegami Toru,Yamashita Yo-ichi,Saeki Hiroshi,Oki Eiji,Yoshizumi Tomoharu,Uchiyama Hideaki,Kawanaka Hirofumi,Soejima Yuji,Morita Masaru,Shirabe Ken,Ikeda Tetsuo,Maehara Yoshihiko
Fukuoka Acta Medica 104(9), 309-314, 2013-09-25
… Physical examination suggested panperitonitis, and abdominocentesis showed bilious ascites. …
NAID 120005372096

慢性膵炎に合併した腹腔内出血・膵液瘻に集学的加療が奏効した1例

福原誠一郎,中村雄二,山岸由幸,石橋由佳,樋口肇,鈴木秀和,日比紀文
Progress of Digestive Endoscopy 82(1), 224-225, 2013
… Abdominocentesis revealed hemorrhagic ascites, and CT showed extravasation from the dorsal pancreatic artery. …
NAID 130004652834

腹膜再発を来した虫垂原発腺内分泌細胞癌の1例

青笹季文,森田大作,岡敦夫,帖地憲太郎
日本消化器外科学会雑誌 45(7), 772-777, 2012
我々は2011年WHO分類でmixed adenoneuroendocrine carcinoma（以下，MANECと略記）に相当する虫垂原発腺内分泌細胞癌の1例を経験したので報告する．症例は48歳の男性で，急性虫垂炎の診断で虫垂切除術を施行，神経内分泌化の傾向を有する虫垂腺癌と診断したため回盲部切除を再施行，追加切除標本には病理組織学的に腫瘍細胞の遺残などを認めなかった．再手術から3年6か月後， …
NAID 130004560854

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