Malignant Ascites — RACP Adult Medicine MCQ

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ModerateGastroenterologyMalignant AscitesRACP Adult Medicine

A 65-year-old woman with ovarian cancer has progressive abdominal distension. Ascitic fluid: SAAG 5 g/L (<11), total protein 48 g/L, WCC 500 (70% lymphocytes), LDH elevated. Cytology shows adenocarcinoma cells. What is the most likely cause?

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Correct answer: A — Peritoneal carcinomatosis

SAAG <11 g/L (non-portal hypertensive), high total protein (>25 g/L), lymphocytic predominance, elevated LDH, and positive cytology is peritoneal carcinomatosis. Ovarian, gastric, and colorectal cancers are common causes. Cytology sensitivity is ~60% on first tap, increasing with repeat samples and larger volumes (>200 mL). Management is directed at underlying malignancy.

Reference: GESA – 2024 – Ascites; eTG Gastrointestinal 2024