Gastroenterology: serum-ascites albumin gradient: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Gastroenterology: serum-ascites albumin gradient

Sample item

Serum albumin is 3.0 g/dL and ascitic fluid albumin is 0.8 g/dL with protein 1.0 g/dL. Which conclusion is correct?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. SAAG is 2.2, indicating portal hypertension such as cirrhosis

SAAG is serum albumin minus ascitic albumin, here 3.0 minus 0.8 equals 2.2 g/dL. A gradient of 1.1 or more indicates portal hypertension from cirrhosis, heart failure or Budd-Chiari. Low SAAG ascites is seen in peritoneal TB, carcinomatosis and nephrotic syndrome.

Option by option

  • A. SAAG is 2.2, indicating portal hypertension such as cirrhosis (correct)

    Correct. A SAAG above 1.1 means portal hypertension.

  • B. SAAG is 0.8, indicating peritoneal tuberculosis

    The gradient is 2.2, not 0.8.

  • C. SAAG below 1.1 means portal hypertension

    Portal hypertension is a SAAG of 1.1 or more, not below.

  • D. Fluid is exudative and malignant

    Low protein with high gradient supports cirrhosis.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is A, SAAG is 2.2, indicating portal hypertension such as cirrhosis. SAAG is serum albumin minus ascitic albumin, here 3.

Why is "SAAG is 0.8, indicating peritoneal tuberculosis" not the answer?

The gradient is 2.2, not 0.8.

Why is "SAAG below 1.1 means portal hypertension" not the answer?

Portal hypertension is a SAAG of 1.1 or more, not below.

Why is "Fluid is exudative and malignant" not the answer?

Low protein with high gradient supports cirrhosis.

What concept does this question test?

It tests Gastroenterology: serum-ascites albumin gradient in General Medicine. 0 minus 0.8 equals 2.2 g/dL. A gradient of 1.1 or more indicates portal hypertension from cirrhosis, heart failure or Budd-Chiari. Low SAAG ascites is seen in peritoneal TB, carcinomatosis and nephrotic syndrome.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Gastroenterology: serum-ascites albumin gradient?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.