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Table of Contents
Ascites is the accumulation of ascitic fluid in the peritoneal cavity.
Many diseases can cause ascites, but the most common is portal hypertension, which is usually due to cirrhosis.
Ascites does not typically become clinically detectable until there are at least 500mLs of fluid present.
If large amounts of fluid accumulate, the abdomen can become very distended and tense, causing the patient to feel short of breath (due to diaphragmatic splinting).
Analysis of ascitic fluid can help determine the underlying cause and identify signs of infection.
A sample of fluid is typically obtained using a needle and syringe (known as an “ascitic tap” or “paracentesis”) and sent for analysis.
The Serum Ascitic Albumin Gradient (SAAG) indirectly measures portal pressure and can be used to determine if ascites is due to portal hypertension.
A high SAAG (>1.1g/dL) suggests the ascitic fluid is a transudate.
A low SAAG (<1.1g/dL) suggests the ascitic fluid is an exudate.
NB: A transudate commonly results from increased pressure in the portal vein.
NB: An exudate commonly results from inflammation or malignancy.
An alternative way of differentiating between an exudate and transudate is using lactate dehydrogenase activity (LDH), which is also measured from ascitic fluid.
This has largely been replaced by the use of SAAG.