Runyon used the total bilirubin concentration in ascitic fluid to diagnose choleperitoneum (release or leakage of bile into peritoneal fluid). The author is from the Long Beach Veterans Administration Medical Center in Long Beach, California.



(1) total bilirubin in ascites fluid in mg/dL

(2) total bilirubin in serum in mg/dL


ratio of ascites fluid bilirubin to serum bilirubin =

= (ascites fluid bilirubin in mg/dL) / (serum bilirubin in mg/dL)


Features of choleperitoneum:

(1) total bilirubin in the ascites fluid > 6 mg/dL

(2) ratio of ascites to serum bilirubin > 1.0



• In the implementation a ratio >= 1.1 is used, just to allow for minor variations in concentrations and methods.



• A high serum bilirubin may reduce the effectiveness of these criteria.

• Hemorrhage into the fluid in vivo or during fluid collection may affect the results if it is enough to dilute the fluid significantly.


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