Finally, thrombosis of any of the major systemic veins is a contraindication since even if the surgery is possible the patient has already shown a tendency to venous thrombosis, which will be exacerbated by the presence of the indwelling catheter. Furthermore, the longer the patient remains in hospital the greater the risk. Secondly, because a patient has cirrhosis and ascites it does not automatically follow that the former is the cause of the later. Other possible diagnoses include malignancy and unsuspected infections such as tuberculosis, etc. In this aspect the albumin gradient between plasma and ascites is helpful diagnostically.
L indicates it is non-portal hypertension related.
The only controversial area here is whether paracentesis should be performed in the office for any patient first presenting with ascites. It can certainly be performed as an office procedure. However, it is as yet unclear whether in this situation the diagnostic yield is sufficiently high to make this cost effective. Indeed the morbidity and mortality of culture negative and culture positive peritonitis are the same. Third generation cephalosporins are adequate for treatment of all but the occasional anerobic and unexpected bacterial infections, since the common infections with coliforms, strep pneumonia, etc., are sensitive to this group of antibiotics.