American Board of Internal Medicine (ABIM) Certification Practice Exam

A serum-ascites albumin gradient (SAAG) of 1.1 g/dL indicates what type of ascites?

1. Infectious cause of ascites

2. Malignant cause of ascites

3. Cardiac cause of ascites

4. Hepatic cause of ascites

The correct answer is: Cardiac cause of ascites

A serum-ascites albumin gradient (SAAG) of 1.1 g/dL indicates that the ascites is due to portal hypertension, which is most commonly associated with hepatic causes, such as cirrhosis or liver failure. In this context, SAAG values help differentiate between the types of ascites based on the underlying pathophysiology. In general, a SAAG ≥ 1.1 g/dL suggests that the ascites is caused by conditions related to portal hypertension, such as liver disease. Conversely, a SAAG < 1.1 g/dL typically indicates ascites due to conditions like malignancy or infections, which do not primarily involve increased pressure in the portal system. Therefore, the presence of a SAAG of 1.1 g/dL strongly points to a hepatic cause of ascites rather than a cardiac cause. While cardiac issues can lead to ascites, the mechanism is different and usually involves transudative processes that do not elevate the SAAG to this level. Thus, the conclusion drawn from the measured SAAG is that the ascitic fluid accumulation is primarily related to hepatic factors.