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Ascites Differential Diagnosis Table - Serum Ascites Albumin Gradient (SAAG)

SAAG ≥ 1.1:
 • Cirrhosis
 • Portal
Albumin Gradient ... ≥ 1.1: • Cirrhosis ... • Portal vein ... #Table #Serum #Albumin ... #hepatology
Diagnosis of ascites according to the serum ascites albumin gradient (SAAG)
SAAG ≥ 1.1:
 - Ascitic protein
albumin gradient ... (SAAG) SAAG ≥ ... protein ≤ 2.5 g/dL: Cirrhosis ... #ascites #albumin ... #gradient #hepatology
Ascites - Differential Diagnosis and Workup Algorithm

•
Perform paracentesis:
 • Cell count and diff 
 • Total
protein • Fluid albumin ... and serum albumin ... • Calculate SAAG ... total protein ... gastroenterology #hepatology
Deciphering the SAAG - Serum to Ascites Albumin Gradient
Ascites is either made in the liver sinusoid
Deciphering the SAAG ... fibrosis) High SAAG ... sinusoid with (ie Portal ... liverprof #Diagnosis #Hepatology ... #SAAG #Ascites
Serum Ascites Albumin Gradient (SAAG) - Differential Diagnosis
High albumin gradient (>1.1 g/dl):
 - Cirrhosis	
 - Alcoholic
Serum Ascites Albumin ... Gradient (SAAG) ... >1.1 g/dl): - Cirrhosis ... syndrome) - Portal ... Differential #Diagnosis #hepatology
Causes of Ascites
Normal Peritoneum
Portal hypertension (SAAG > 1.1 g/dL)
  1. Hepatic congestionl
Normal Peritoneum ... Portal hypertension ... disease - Cirrhosis ... Portal vein occlusion ... #differential #hepatology
Portal Hypertension - Differential Diagnosis
Portal Pressure = the pressure difference between the pressure in the portal
HTN: ascites (SAAG ... Clues to non-cirrhotic ... Ascites protein ... INR, bilirubin, albumin ... Diagnosis #causes #hepatology
Indications for Albumin for Management of Cirrhosis
 • Large volume paracentesis (>5 liter) - 8g per
Indications for Albumin ... for Management ... of Cirrhosis • ... 8g per liter of ascites ... #hepatology
Complications of Portal Hypertension
 • Hepatic Encephalopathy
 • Pulmonary: Hepatopulmonary syndrome, Portopulmonary hypertension, Hepatic hydrothorax
 •
Complications of Portal ... Encephalopathy • Pulmonary ... hydrothorax • Cirrhotic ... Hepatorenal syndrome • Ascites ... Complications #hepatology
Ascites - Diagnosis and Management Summary
Paracentesis studies: cell count + differential, albumin, protein, culture
 • Serum-ascites-albumin-gradient
and Management ... culture • Serum-ascites-albumin-gradient ... (SAAG): > 1.1 g ... /dL suggests portal ... #Summary #Hepatology