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The serum-ascites albumin gradient or gap (SAAG) is a calculation used in medicine to help determine the cause of ascites. [1] The SAAG may be a better discriminant than the older method of classifying ascites fluid as a transudate versus exudate.
Transudate is extravascular fluid with low protein content and a low specific gravity (< 1.012). It has low nucleated cell counts (less than 500 to 1000 per microliter) and the primary cell types are mononuclear cells: macrophages, lymphocytes and mesothelial cells. For instance, an ultrafiltrate of blood plasma is transudate.
An accurate diagnosis of the cause of the effusion, transudate versus exudate, relies on a comparison of the chemistries in the pleural fluid to those in the blood, using Light's criteria. According to Light's criteria (Light, et al. 1972), a pleural effusion is likely exudative if at least one of the following exists: [31]
The Rivalta Test is a simple, inexpensive method that can be used in resource-limited settings to differentiate a transudate from an exudate. [1] It is a simple, inexpensive method that does not require special laboratory equipment and can be easily performed in private practice.
An exudate is a fluid released by an organism through pores or a wound, a process known as exuding or exudation. [1] Exudate is derived from exude 'to ooze' [ 2 ] from Latin exsūdāre 'to (ooze out) sweat' ( ex- 'out' and sūdāre 'to sweat').
Transudate vs. exudate. Transudate: Exudate: Main causes ↑ hydrostatic pressure, ↓ colloid osmotic pressure: Inflammation-Increased vascular permeability:
The serum-ascites albumin gradient (SAAG) is probably a better discriminant than older measures (transudate versus exudate) for the causes of ascites. [12] A high gradient (> 1.1 g/dL) indicates the ascites is due to portal hypertension. A low gradient (< 1.1 g/dL) indicates ascites of non-portal hypertensive as a cause. [13]
The fluid is a transudate and similar to fluid found in ascites. [4] There may be a higher protein and albumin content in hepatic hydrothorax due to the pleura absorbing the water. [ 5 ] To rule out heart-related causes of pleural effusion, an echocardiogram can be performed.