Cancer · UKMLA & AKT
Malignant ascites
A free high-yield preview for the UKMLA Applied Knowledge Test, covering how to recognise this condition. The full SA Note notes add investigations, management and complications, with practice questions on this topic.
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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