Select the target population:
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Perform the following studies:
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Determine likely etiology for ascites: | |||||
Diagnosis | Fluid cell count◊ | Fluid total protein | High fluid triglyceride level§ | Fluid cytology | Imaging features |
SAAG <1.1 g/dL¥ | |||||
Peritoneal carcinomatosis | High with predominantly lymphocytes | ≥2.5 g/dL | No | Positive‡ | Peritoneal and omental implants |
Malignancy-related chylous ascites | High with predominantly lymphocytes | ≥2.5 g/dL | Yes | Negative | Abdominal lymphadenopathy |
SAAG ≥1.1 g/dL¥ | |||||
Massive liver metastases with portal hypertension | Low | <2.5 g/dL | No | Negative | >50% liver replacement by tumor |
Hepatocellular carcinoma with cirrhosis | Low | <2.5 g/dL | No | Negative | Focal lesion(s) in cirrhotic liver† |
Malignancy-related Budd-Chiari syndrome | Low | Variable | No | Negative | Extrinsic tumor compression causing narrowing and/or thrombus of the hepatic vein |
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