Cirrhotic Ascites — RACP Adult Medicine MCQ

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EasyGastroenterologyCirrhotic AscitesRACP Adult Medicine

A 55-year-old man with alcoholic cirrhosis has tense ascites. Diagnostic paracentesis: SAAG 18 g/L (>11), total protein 15 g/L, WCC 80 cells/μL (<250 PMNs), culture negative. What is the most likely cause of ascites?

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Correct answer: B — Portal hypertension (cirrhotic ascites)

SAAG ≥11 g/L indicates portal hypertension. Low total protein (<25 g/L) and low WCC with negative culture in cirrhosis is uncomplicated cirrhotic ascites. Management: sodium restriction (2 g/day), diuretics (spironolactone ± furosemide), and serial paracentesis with albumin replacement for refractory ascites. SBP prophylaxis (norfloxacin) if ascitic protein <15 g/L.

Reference: GESA – 2024 – Ascites Management; EASL 2024