Paracentesis: pick the pocket

Question 1Where is the inferior epigastric artery, and why does it matter?

1. aIn the midline only
2. bIn the abdominal wall near the rectus sheath, so enter lateral to the rectus and check with colour Doppler
3. cBehind the bladder, so it does not matter
4. dInside the liver

Question 2A pocket looks deep in transverse but narrow in sagittal. What next?

1. aAsk the patient to sit up after marking
2. bSweep further or choose another pocket, because the target must be adequate in both planes
3. cUse a longer needle
4. dDrain it anyway

Question 3Why not move the patient between marking and needling?

1. aIt changes the colour Doppler settings
2. bThe fluid and bowel shift, so the mark no longer matches the pocket
3. cIt makes no difference
4. dIt increases the risk of infection

Question 4Which probe is best for looking for abdominal wall vessels?

1. aA phased-array probe without colour
2. bNo probe is needed
3. cA linear probe with colour Doppler
4. dAn endocavitary probe

Question 5Ascitic fluid shows more than 250 neutrophils per cubic millimetre. What does this suggest?

1. aSpontaneous bacterial peritonitis
2. bHeart failure
3. cNormal ascites
4. dPancreatitis