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The serum-ascites albumin gradient or gap (SAAG) is a calculation used in medicine to help determine the cause of ascites. [1] The SAAG may be a better discriminant than the older method of classifying ascites fluid as a transudate versus exudate. [2] The formula is as follows: SAAG = (serum albumin) − (albumin level of ascitic fluid).
The serum-ascites albumin gradient (SAAG) is probably a better discriminant than older measures (transudate versus exudate) for the causes of ascites. [12] A high gradient (> 1.1 g/dL) indicates the ascites is due to portal hypertension. A low gradient (< 1.1 g/dL) indicates ascites of non-portal hypertensive as a cause. [13]
Spontaneous bacterial peritonitis (SBP) is the development of a bacterial infection in the peritoneum, despite the absence of an obvious source for the infection. [1] It is specifically an infection of the ascitic fluid – an increased volume of peritoneal fluid. [2] Ascites is most commonly a complication of cirrhosis of the liver. [1]
The serum-ascites albumin gradient (SAAG) is the most useful index for evaluating peritoneal fluid and can help distinguish ascites caused by portal hypertension (cirrhosis, portal vein thrombosis, Budd-Chiari syndrome, etc.) from other causes of ascites. SAAG is calculated by subtracting the albumin measure of ascitic fluid from the serum value.
Primary peritonitis is the diffuse bacterial infection of the peritoneum while the integrity of the gastrointestinal tract is preserved (in cases of ascites); secondary peritonitis is the infection of peritoneum where the integrity of gastrointestinal tract is compromised; tertiary peritonitis is reinfection of peritoneum 48 hours after ...
However, peritonitis may also be caused by the rare case of a sterile foreign body inadvertently left in the abdomen after surgery (e.g., gauze, sponge). Much rarer non-infectious causes may include familial Mediterranean fever, TNF receptor associated periodic syndrome, porphyria, and systemic lupus erythematosus.
There is a difference in the organisms which cause secondary peritonitis compared to those that cause tertiary peritonitis and this can be referred to as a microbial shift. Some microfloral organisms have demonstrated multi-drug resistance highlighting the difficulty in treating the condition and so there is a poor prognosis.
Causes such as bacterial and fungal infections are associated with diffuse abdominal pain, intraperitoneal fluid accumulation, weight loss, fevers, and night sweats. The most common radiographic feature among patients with suspected tuberculous peritonitis was septated compartments of ascitic fluid on ultrasound and abnormal chest X-ray ...