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Alcoholic cirrhosis
18%
2/11
Cryptogenic cirrhosis
27%
3/11
Heart failure
Pancreatitis
36%
4/11
Vascular occlusion
0%
0/11
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This patient has ascites on ultrasound and a serum albumin ascites gradient (SAAG) of -0.8 g/dL which puts it into the category of non-portal hypertensive ascites. Pancreatitis is the only cause of non-portal hypertensive ascites listed above. In patients with new-onset ascites of unknown origin, peritoneal fluid should be sent for evaluation. The SAAG can help differentiate ascites of portal hypertensive causes (SAAG > 1.1 g/dL) from non–portal hypertensive (SAAG < 1.1 g/dL) causes. Portal hypertensive causes of ascites include cirrhosis, alcoholic hepatitis, heart failure, large hepatic metastases, vascular occlusions, fatty liver disease of pregnancy, and myxedema. Non-portal hypertensive causes of ascites include peritoneal carcinomatosis, peritoneal tuberculosis, pancreatitis, serositis, nephrotic syndrome, and bowel obstruction. Figure A is an ultrasound demonstrating free fluid in the abdomen which is concerning for ascites. Incorrect Answers: Answers 1-3 & 5: Alcoholic hepatitis, cryptogenic cirrhosis, heart failure, and vascular occlusion all represent a portal hypertensive cause of ascites and would have a SAAG > 1.1 g/dL. Bullet Summary: A high SAAG (> 1.1 g/dL) represents a portal hypertensive etiology of ascites and a low SAAG (< 1.1 g/dL) represents a non-portal hypertensive etiology of ascites.
4.8
(9)
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