ROSH Gastrointestinal Practice Exam

Which ascitic fluid neutrophil count indicates the need for intravenous antibiotics?

1. Ascitic fluid neutrophil count of 300 cells/mcL

2. Ascitic fluid pH of 7.35

3. AST of 340 U/L

4. Peripheral white blood cell count of 15,000 cells/mcL

The correct answer is: Peripheral white blood cell count of 15,000 cells/mcL

The need for intravenous antibiotics in the context of ascitic fluid analysis is typically indicated by elevated neutrophil counts in the fluid. A neutrophil count above 250 cells/mcL is considered significant and suggests the presence of infection, such as spontaneous bacterial peritonitis (SBP). The specific count of 300 cells/mcL is notably higher than the threshold of 250 cells/mcL, indicating that treatment with intravenous antibiotics is warranted due to the likelihood of an infectious process. Hence, in a clinical setting, this neutrophil count serves as a critical marker influencing the management of patients with ascitic fluid findings, supporting the diagnosis and timely treatment of SBP. In contrast, while parameters like ascitic fluid pH, AST levels, and peripheral white blood cell counts provide valuable information about the patient’s status, they do not specifically indicate the need for antibiotics in the same direct manner as neutrophil counts in ascitic fluid analysis do. Therefore, the level of neutrophils in ascitic fluid is the primary focus when assessing for infections that require immediate intervention.