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Ascitic Fluid

Serum-Ascites Albumin Gradient



  • The serum-ascites albumin gradient (SAAG) is used to differentiate between portal hypertension and other causes of ascites.
    • Formula

    • SAAG = [serum albumin] - [ascitic albumin]

Elevated Serum-Ascites Albumin Gradient

  • Elevated SAAG (≥1.1 g/dL) is indicative of portal hypertension.
    • Causes of Ascites with Elevated SAAG

    • Cirrhosis
    • Cardiac ascites
    • Alcoholic hepatitis
    • Massive liver metastasis
    • Fulminant hepatic failure
    • Portal venous thrombosis

Reduced Serum-Ascites Albumin Gradient

  • Ascites with a low SAAG (<1.1 g/dL) is suggestive of a non-portal hypertension cause of ascites.
    • Causes of Ascites with Reduced SAAG

    • Infection - bacterial peritonitis, pancreatitis, TB
    • Malignancy
    • Nephrotic syndrome
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