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Gastroenterology
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Ascites Evaluation
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SAAG splits portal hypertension from non-portal causes.
Decision
Outcome
Decision
New ascites. First step?
✓
Diagnostic paracentesis with cell count, culture, albumin, total protein
✗
Empirical diuretics
Decision
SAAG = serum albumin − ascitic albumin?
✓
≥1.1 → portal hypertension (cirrhosis, CHF, Budd–Chiari)
✓
<1.1 → non-portal (TB, malignancy, pancreatic, nephrotic)
Decision
Total protein in ascites?
✓
<2.5 → cirrhosis
✓
≥2.5 → cardiac (CHF), Budd–Chiari
Outcome
Diet, diuretics (spironolactone + furosemide), LVP with albumin if needed
Daily wt loss target 0.5 kg (without edema) or 1 kg (with edema).
Outcome
Treat heart failure
Outcome
Workup: TB (AFB, ADA), malignancy (cytology), pancreatic (amylase), nephrotic