An improved diagnostic approach to ascites has recently been described.1-4 It is based on the observation that portal pressure is directly proportional to the gradient of oncotic pressure between the splanchnic capillaries and ascites.3-5 The albumin concentration of bodily fluid is the main determinant of its oncotic pressure.6 The gradient of albumin concentration between serum and ascites (Albs-a) has empirically been established to be ≥1.1 g/dL (11 g/L) in the presence of portal hypertension, and <1.1 g/dL (11 g/L) in its absence.1,2,4
The cause of ascites associated with portal hypertension (Albs-a ≥1.1 g/dL [11 g/L]) is almost always cirrhosis or cardiac disease (right ventricular failure or constrictive pericarditis). The causes of ascites not associated with portal hypertension (Albs-a <1.1 g/dL [11 g/L]) are diverse: leaking ducts (thoracic, pancreatic, biliary); peritoneal implants (cancer or tuberculosis); myxedema; systemic lupus erythematosus; certain benign ovarian diseases; and severe hypoalbuminemia. Further
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