serumascites

Serumascites is the accumulation of fluid within the peritoneal cavity. While not a standard term in many texts, it is commonly discussed in the context of ascites and its evaluation, particularly using the serum-ascites albumin gradient (SAAG). In clinical practice, ascites is usually described and analyzed rather than labeled as serumascites.

Causes and pathophysiology

Ascites results from conditions that increase abdominal fluid production or impede fluid removal. The most common cause is portal hypertension, frequently due to cirrhosis, but it can also arise from heart failure, Budd-Chiari syndrome, or sinistral venous outflow obstruction. Other etiologies include malignancy with peritoneal involvement, bacterial peritonitis, tuberculosis peritonitis, pancreatitis, nephrotic syndrome, and severe hypoalbuminemia. Mechanisms involve increased hydrostatic pressure, decreased oncotic pressure, lymphatic disruption, and inflammatory changes that promote fluid leakage into the peritoneal space.

Diagnosis

Diagnosis relies on clinical evaluation and imaging, followed by diagnostic paracentesis. Ascitic fluid is analyzed for total protein, cell counts, Gram stain and culture, and albumin. The SAAG is calculated as serum albumin minus ascitic fluid albumin. A SAAG of 1.1 g/dL or higher indicates portal hypertension-related ascites; a lower value points to non-portal hypertensive causes. Protein concentration helps classify the fluid and guide further testing.

Management

Treatment targets the underlying cause and symptom relief. Sodium restriction and diuretics (typically spironolactone, often with furosemide) are first-line. Large-volume paracentesis provides rapid relief for symptomatic ascites, often with albumin infusion to prevent circulatory dysfunction. Refractory cases may require transjugular intrahepatic portosystemic shunt (TIPS) or consideration of liver transplantation. Monitoring for complications such as spontaneous bacterial peritonitis is essential.

Prognosis

Prognosis depends on the underlying disease. Ascites, especially from advanced cirrhosis or malignancy, portends significant morbidity and mortality if not effectively managed.