High SAAG (serum-ascites albumin gradient) ascites is seen in all except:
Correct Answer: Nephrotic syndrome
Description: Ref: Harrison s 18th editionExplanation:The SAAG is useful for distinguishing ascites caused by portal hypertension from nonportal hypertensive ascites.The SAAG reflects the pressure within the hepatic sinusoids and correlates with the hepatic venous pressure gradient.The SAAG is calculated by subtracting the ascitic albumin from the serum albumin and does not change with diuresis.SAAG > 1.1 g/dLThis reflects the presence of portal hypertension and indicates that the ascites is from an increased pressure in the hepatic sinusoids.According to Starling's law. a high SAAG reflects the oncotic pressure that counterbalances the portal pressure.Possible causes include:Cirrhosis Cardiac ascitesFluid overload due to chronic renal failure Sinusoidal obstruction syndrome (vc ii oocc I u si ve d ise ase)Massive liver metastasisHepatic vein thrombosis (Budd-Chiari syndrome).SAAG <1.1 g/dLIt indicates that the ascites is not related to portal hypertension as in tuberculous peritonitis, peritoneal carcinomatosis, or pancreatic ascites.In nephrotic syndrome, due to reduced oncotic pressure (serum albumin). SAAG is < l.l g/dL.
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