American Board of Internal Medicine (ABIM) Certification Practice Exam

Which condition is indicated when SAAG is greater than or equal to 1.1 g/dL and total protein is also greater than or equal to 2.5 g/dL?

1. Myxedema

2. Cardiac ascites

3. Cirrhosis

4. Infection

The correct answer is: Cardiac ascites

In the context of evaluating ascitic fluid, the Serum-Ascites Albumin Gradient (SAAG) is a crucial measurement used to differentiate between causes of ascites. When the SAAG is greater than or equal to 1.1 g/dL, it typically indicates that the ascites is due to portal hypertension. This saag value points toward conditions such as cirrhosis, heart failure, or other forms of hepatic or cardiac-related ascites. Furthermore, the total protein concentration in the ascitic fluid helps classify the fluid as transudate or exudate. A total protein level of greater than or equal to 2.5 g/dL in conjunction with a high SAAG suggests that the ascites is likely due to conditions like cardiac ascites, which results from congestive heart failure leading to increased pressure in the portal venous system, thus causing fluid accumulation in the abdominal cavity. In this scenario, both the high SAAG (indicating portal hypertension) and the elevated total protein concentration (suggesting exudative process) align effectively with cardiac ascites as the most probable diagnosis. Conditions like myxedema, cirrhosis, and infection would not present this specific combination of SAAG and total protein levels