ROSH Gastrointestinal Practice Exam

In patients with a known history of liver disease, which complication is often assessed through ascitic fluid analysis?

1. Neutrophil count

2. Red blood cell count

3. Protein levels

4. Cellular morphology

The correct answer is: Neutrophil count

In patients with a known history of liver disease, assessing the neutrophil count in ascitic fluid analysis is crucial because it helps identify the presence of spontaneous bacterial peritonitis (SBP). Ascites, which often develops in patients with liver cirrhosis or severe liver disease, can become infected, leading to significant morbidity and potentially mortality. A neutrophil count greater than a specific threshold (typically 250 cells/mm³) in the ascitic fluid strongly suggests the diagnosis of SBP. Prompt recognition and treatment of this condition are critical because SBP can lead to serious complications if left untreated. While assessing protein levels in the ascitic fluid can provide information about the patient's prognosis and the likely etiology of the ascites, it does not directly indicate the presence of infection. Similarly, red blood cell count and cellular morphology are useful in certain contexts but are not routinely assessed to evaluate for infectious complications like SBP. Thus, measuring the neutrophil count is a key component of ascitic fluid analysis in this clinical setting.