American Board of Internal Medicine (ABIM) Certification Practice Exam

A SAAG of greater than or equal to 1.1 g/dL with total protein less than 2.5 g/dL is indicative of which condition?

1. Nephrotic syndrome

2. Cirrhosis

3. Cardiac ascites

4. Pancreatic ascites

The correct answer is: Cirrhosis

A serum-ascites albumin gradient (SAAG) of greater than or equal to 1.1 g/dL suggests that the ascitic fluid is primarily transudative in nature. This typically indicates that the ascites is due to conditions involving portal hypertension, which often occurs with liver cirrhosis. In cases of cirrhosis, the liver's inability to produce adequate proteins, alongside portal hypertension, leads to the accumulation of fluid in the abdominal cavity. The total protein level in the ascitic fluid being less than 2.5 g/dL supports the diagnosis of transudative ascites, which is often seen with conditions like cirrhosis. Additionally, this presentation differentiates cirrhosis from other causes of ascites that may have a higher total protein level, such as malignancies or infections, which typically produce exudative ascitic fluid. Hence, the specific combination of a SAAG ≥ 1.1 g/dL and total protein < 2.5 g/dL is a strong indicator of cirrhosis as the underlying etiology of the ascites.