Cancer · UKMLA & AKT
Malignant ascites
A free high-yield preview for the UKMLA Applied Knowledge Test. Below are the key points to recognise malignant ascites — the full SA Note notes add investigations, management, complications and 10 practice questions.
Key high-yield points
- SAAG = serum albumin minus ascitic fluid albumin (serum sample taken simultaneously)
- SAAG >11 g/L - transudate; portal hypertension (e.g. cirrhosis, cardiac failure)
- SAAG <11 g/L - exudate; malignancy, infection (TB, SBP), pancreatitis, nephrotic syndrome
- Malignant ascites is almost always exudative (SAAG <11 g/L) - mechanism is increased capillary permeability (VEGF-driven) and lymphatic obstruction by tumour deposits, NOT elevated portal pressure
- Exception: extensive hepatic metastases can raise portal pressure and reduce albumin synthesis, producing a mixed picture with SAAG approaching or exceeding 11 g/L
Cirrhosis (SAAG >11 g/L) is the most common cause of ascites overall. Portal hypertension + hypoalbuminaemia = transudative ascites. Caput medusae, jaundice, and encephalopathy point to cirrhosis rather than malignancy.
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