Protein Loss from Repeated Ascitic Drainage — SCE Palliative Medicine MCQ

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ModerateGI SymptomsProtein Loss from Repeated Ascitic DrainageSCE Palliative Medicine

A 65‑year‑old woman with advanced ovarian cancer has a large malignant ascitic collection. She has had an indwelling peritoneal drain for 6 months with regular home drainage. Her serum albumin has fallen from 26 g/L to 16 g/L over this period. What is the most likely explanation for the decline in albumin?

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Correct answer: C — Protein loss through repeated ascitic drainage – each litre of malignant ascites contains substantial protein, which is removed during drainage

Explanation lettering: C = shown as A · E = shown as B · A = shown as C · B = shown as D · D = shown as E

Malignant ascites is typically protein‑rich (exudative). Repeated drainage removes not only fluid but also large amounts of protein, including albumin, leading to progressive hypoalbuminaemia. NICE guidance explicitly lists hypoalbuminaemia as a recognised disadvantage of repeated large‑volume paracentesis in malignant ascites, and RCOG highlights that alternatives (such as peritoneovenous shunts) help avoid fluid and protein loss. Development of nephrotic syndrome (B) would involve heavy proteinuria and renal findings absent here. Laboratory error (C) is unlikely to explain a significant decline over months. Complete liver failure (D) would have additional clinical signs and synthetic dysfunction. There is no mechanism whereby the drain chemically destroys albumin (E); the albumin is removed, not destroyed.

Reference: NICE HealthTech guidance scope: PleurX peritoneal catheter drainage system, NICE (disadvantages include hypoalbuminaemia); RCOG Scientific Impact Paper No. 45, Management of Ascites in Ovarian Cancer Patients (loss of fluid and protein). https://www.nice.org.uk/guidance/htg282/documents/pleurx-peritoneal-catheter-drainage-system-scope2