Curriculum for Specialty Certificate Examination in Gastroenterology

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Tuesday 20 November 2012

The serum-ascites albumin gradient


SAAG is a calculation used in medicine to help determine the cause of ascites.
SAAG = (albumin concentration of serum) - (albumin concentration of ascitic fluid).

High gradient
A high gradient (> 1.1 g/dL) indicates the ascites is due to portal hypertension with 97% accuracy.
Important causes of high SAAG ascites (> 1.1 g/dL) include:
high protein (> 2.5): heart failure, Budd Chiari syndrome
low protein (< 2.5): cirrhosis of the liver, nephrotic syndrome

Low gradient
A low gradient (< 1.1 g/dL ) indicates causes of ascites not associated with increased portal pressure such as tuberculosis, pancreatitis, nephrotic syndrome and various types of peritoneal cancer.



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