Ascites and Peritonitis
John F. Pohl, Christopher Jolley, Daniel Gelfond in Pediatric Gastroenterology, 2014
The serum-ascites albumin gradient (SAAG) divides ascites into low and high gradient categories. The gradient is simply the difference between the serum and ascitic fluid albumin concentrations and gives an index of portal pressure. A high gradient (>1.1 g/dl [>11 g/l]) is caused by an abnormally high hydrostatic pressure between the portal bed and ascitic fluid and is secondary to portal hypertension. A low gradient (<1.1 g/dl [<11 g/l]) is unlikely to be caused by portal hypertension and can be seen in nephrotic syndrome, biliary ascites, pancreatic ascites, and serositis. A falsely low SAAG can be seen in patients with chylous ascites. The exudate/transudate classification is inferior to the SAAG method, and therefore, the total protein concentration is rarely used to determine etiology of ascites.
Gastroenterology and hepatology
Fazal-I-Akbar Danish in Essential Lists of Differential Diagnoses for MRCP with diagnostic hints, 2017
Transudative ascites (protein <2.5 g/dL or serum-ascites albumin gradient >1.1):1 Liver disease (cirrhosis).2 Congestion (right heart failure; constrictive pericarditis; pericardial effusion; inferior vena cava obstruction; Budd–Chiari’s syndrome, i.e. hepatic veins obstruction).3 Hypoproteinaemia (nephrotic syndrome; starvation; protein-losing enteropathy, etc).4 Meigs’ syndrome.
Ascites
Mervyn Dean, Juan-Diego Harris, Claud Regnard, Jo Hockley in Symptom Relief in Palliative Care, 2018
Patients with liver metastases (and resulting portal hypertension) are most likely to respond to diuretics,6 and a serum-ascites albumin gradient > 11 g/l is a simple way of selecting such patients.7 The use of spironolactone and furose-mide in combination is well established.7–10 However, diuretics can cause electrolyte disturbances and hypotension. They also need to be used with caution in patients with poor renal or hepatic function.
Clinical presentation of peritoneal tuberculosis
Published in Baylor University Medical Center Proceedings, 2023
Nazli Begum Ozturk, Christos Tsagkaris, Naile Dolek, Raim Iliaz
Laboratory tests showed a mild anemia, with a hemoglobin of 13.0 g/dL (reference range, 13.1–17.2 g/dL), erythrocyte sedimentation rate of 34 mm/h (0–15 mm/h), and C-reactive protein of 34.46 mg/L (<5 mg/L). Abdominal ultrasound revealed the presence of free abdominal fluid and diffuse heterogeneous granular liver parenchyma, supporting the diagnosis of chronic liver disease. Liver tests were within normal limits, and tests for hepatitis A, B, and C and HIV were negative. A diagnostic paracentesis showed a serum ascites albumin gradient (SAAG) of 0.2 g/dL and ascitic fluid white blood cells of 1.70 × 103 cells/dL (91.8% lymphocytes). Ascitic fluid cytology was negative for malignant cells. An ascitic fluid acid-fast bacilli (AFB) test and mycobacterial culture were negative. The adenosine deaminase (ADA) level in ascitic fluid was elevated at 108.5 U/L (0–40 U/L). The Quantiferon test was positive.
Chylous ascites in cirrhosis from retroperitoneal lymphoma
Published in Baylor University Medical Center Proceedings, 2021
Rahul Hegde, Ayah Megahed, Prabin Sharma, Anas Bamashmos, Ian Karol
A 74-year-old man with morbid obesity (body mass index 41 kg/m2), nonalcoholic steatohepatitis cirrhosis, coronary artery disease, heart failure with preserved ejection fraction, chronic atrial fibrillation, and obstructive sleep apnea presented with a month-long history of abdominal distension and dyspnea. On admission, he was afebrile and hemodynamically stable. Pulmonary edema was absent. Abdominal ultrasound demonstrated a large amount of ascites and a coarse heterogeneous liver. Paracentesis yielded approximately 4 L of milky white ascitic fluid (Figure 1). High triglycerides (341 mg/dL) in the fluid confirmed the diagnosis of chylous ascites. Other findings on fluid analysis included an albumin of 2.7 g/dL (serum ascites albumin gradient >1.1 g/dL), 7300 cells/μL, and 70% neutrophils. Given the high number of neutrophilic cells, the patient was empirically treated with a short course of intravenous ceftriaxone, although final culture results were negative for microbial growth. Ascites fluid cytology was negative for malignant cells, with only inflammatory cells seen. The patient reported no significant recent weight loss, night sweats, or fever and initially it was believed that the chylous ascites was spontaneous, secondary to the patient’s cirrhosis. Subsequently, the patient again had increasing abdominal distention on day 4 of his hospital course, and another paracentesis drained 2 L of chylous fluid.
Peritoneal carcinomatosis, unilateral malignant pleural effusion with bilateral hydronephrosis post-radical gastrectomy in a signet-ring gastric cancer patient: a case report
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Yuting Huang, Moemen Eltelbany, R. Dobbin Chow, Aseem Sood
Chest tube placement and diagnostic paracentesis were performed. A large volume of yellowish serous pleural effusion and ascites with similar features were noted. Body fluid total protein 3.9 g/dL, albumin 1.8 g/dL, LDH 322 units/L, the serum LDH 316 units/L, and serum total protein 6.1 g/dL. These results met Light's Criteria for an exudative pleural effusion [3], suggesting an exudative pleural effusion. The serum-ascites albumin gradient (SAAG) is 0.7; indicating peritoneal fluid was not due to portal hypertension [4]. Cytology of peritoneal fluid was negative for malignant cells.