Low SAAG Malignant Ascites Management — SCE Palliative Medicine MCQ

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ModerateGI SymptomsLow SAAG Malignant Ascites ManagementSCE Palliative Medicine

A 70‑year‑old woman with advanced ovarian cancer develops ascites with an SAAG <11 g/L. Her serum albumin is 20 g/L. What does the low SAAG indicate and what is the treatment implication?

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Correct answer: E — Low SAAG (<11 g/L) indicates malignant peritoneal (exudative) ascites—this responds poorly to diuretics; repeated paracentesis is the mainstay of symptomatic management

Option E is correct. SAAG <11 g/L signifies exudative ascites, most commonly from peritoneal carcinomatosis in ovarian cancer; such fluid accumulation is due to local peritoneal disease rather than systemic fluid retention, so diuretics are largely ineffective, and therapeutic repeated paracentesis is indicated. Option B is wrong—portal hypertension produces a high SAAG. Option D is false—SAAG is a key diagnostic tool. Option C underplays the clinical significance of malignant ascites. Option A (cardiac cause) is not consistent with a low SAAG context.

Reference: NHS Right Decisions Acute Oncology Guidelines: Malignant Ascites (2025); RCOG Scientific Impact Paper No. 45: Management of Ascites in Ovarian Cancer Patients (2014), https://www.rightdecisions.scot.nhs.uk/acute-oncology-guidelines/oncological-emergencies/malignant-ascites/

Low SAAG Malignant Ascites Management — SCE Palliative Medicine MCQ

A 70‑year‑old woman with advanced ovarian cancer develops ascites with an SAAG <11 g/L. Her serum albumin is 20 g/L. What does the low SAAG indicate and what is the treatment implication?

A 70‑year‑old woman with advanced ovarian cancer develops ascites with an SAAG <11 g/L. Her serum albumin is 20 g/L. What does the low SAAG indicate and what is the treatment implication?