Question:medium
A patient has ascitic fluid with a serum-ascites albumin gradient (SAAG) greater than 1.1 g/dL and an ascitic total protein concentration of 2.8 g/dL. The most likely cause is:
A patient has ascitic fluid with a serum-ascites albumin gradient (SAAG) greater than 1.1 g/dL and an ascitic total protein concentration of 2.8 g/dL. The most likely cause is:
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High SAAG plus high ascitic protein (>2.5 g/dL) points to a cardiac, not cirrhotic, cause.
Updated On: Jun 24, 2026
- Nephritic syndrome
- Cardiac failure
- Tuberculosis
- Portal hypertension
Show Solution
The Correct Option is B
Solution and Explanation
Step 1: Two numbers define this ascites: a SAAG above 1.1 g/dL and a fluid protein of 2.8 g/dL. Reading them together is the key.
Step 2: A SAAG above 1.1 g/dL is a marker of raised portal sinusoidal pressure, which is seen in both cirrhosis and right-sided heart failure. So the gradient alone narrows it to these two.
Step 3: The discriminator is the protein level. In heart failure the liver sinusoids are not destroyed, so the transudate carries plenty of protein and the value climbs past 2.5 g/dL. In cirrhosis the diseased sinusoids hold protein back, keeping fluid protein low. A protein of 2.8 g/dL therefore signals the cardiac pattern.
Step 4: Low-SAAG causes such as tuberculous peritonitis and nephritic syndrome are ruled out by the high gradient, and cirrhotic portal hypertension is ruled out by the high protein.
\[\boxed{\text{Cardiac failure}}\]
Step 2: A SAAG above 1.1 g/dL is a marker of raised portal sinusoidal pressure, which is seen in both cirrhosis and right-sided heart failure. So the gradient alone narrows it to these two.
Step 3: The discriminator is the protein level. In heart failure the liver sinusoids are not destroyed, so the transudate carries plenty of protein and the value climbs past 2.5 g/dL. In cirrhosis the diseased sinusoids hold protein back, keeping fluid protein low. A protein of 2.8 g/dL therefore signals the cardiac pattern.
Step 4: Low-SAAG causes such as tuberculous peritonitis and nephritic syndrome are ruled out by the high gradient, and cirrhotic portal hypertension is ruled out by the high protein.
\[\boxed{\text{Cardiac failure}}\]
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