Deciphering the SAAG - Serum to Ascites Albumin Gradient
Ascites is either made in the liver sinusoid (hepatic lymph) or not by the liver
The hepatic sinusoid is designed to keep albumin in the blood
The diseased hepatic sinusoid becomes even less likely to allow albumin to escape blood into the hepatic lymph (due to capillarization and fibrosis)

High SAAG ≥ 1.1:
• Aka not much albumin in the fluid
• Ascites is hepatic lymph!!!
• Produced by a sinusoid with (ie Portal Hypertension):
   ↑ hydrostatic pressure 
   ↓ oncotic pressure
Low SAAG ≤ 1.1:
 • Ascites albumin is close to plasma
 • Because the ascites is plasma!
 • Extrahepatic source: Malignancy, Infection (TB), Trauma, Pancreatitis etc...

Dr. Scott Matherly @liverprof

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