serum-ascites albumin gradient

同

SAAG、血清-腹水アルブミン濃度勾配

関

門脈圧亢進症

• 血清アルブミン - 腹水アルブミン

≧1.1g/dL 門脈圧亢進症に関連

＜1.1g/dL 門脈圧亢進症と関係なし

WordNet

1. a book of blank pages with pockets or envelopes; for organizing photographs or stamp collections etc
2. one or more recordings issued together; originally released on 12-inch phonograph records (usually with attractive record covers) and later on cassette audiotape and compact disc (同)record album
3. a graded change in the magnitude of some physical quantity or dimension
4. the property possessed by a line or surface that departs from the horizontal; "a five-degree gradient" (同)slope
5. a simple water-soluble protein found in many animal tissues and liquids (同)albumen
6. an amber, watery fluid, rich in proteins, that separates out when blood coagulates (同)blood_serum
7. accumulation of serous fluid in peritoneal cavity

PrepTutorEJDIC

1. (写真・切手・切り抜きなどを貼る)『アルバム』 / (いくつかの曲・劇などを収録した)組レコード,アルバム / 画帳
2. (道路・鉄道などの)勾配(こうばい),傾斜度,グラジエント・斜面
3. アルブミン(蛋白質の一種)
4. リンパ液 / 血清

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/09/14 23:24:28」(JST)

wiki en

[Wiki en表示]

Pathophysiology sample values

BMP/ELECTROLYTES:
Na+ = 140	Cl− = 100	BUN = 20	/
			Glu = 150
K+ = 4	CO2 = 22	PCr = 1.0	\
ARTERIAL BLOOD GAS:
HCO3− = 24	paCO2 = 40	paO2 = 95	pH = 7.40
ALVEOLAR GAS:
	pACO2 = 36	pAO2 = 105	A-a g = 10
OTHER:
Ca = 9.5	Mg2+ = 2.0	PO4 = 1
CK = 55	BE = −0.36	AG = 16
SERUM OSMOLARITY/RENAL:
PMO = 300	PCO = 295	POG = 5	BUN:Cr = 20
URINALYSIS:
UNa+ = 80	UCl− = 100	UAG = 5	FENa = 0.95
UK+ = 25	USG = 1.01	UCr = 60	UO = 800
PROTEIN/GI/LIVER FUNCTION TESTS:
LDH = 100	TP = 7.6	AST = 25	TBIL = 0.7
ALP = 71	Alb = 4.0	ALT = 40	BC = 0.5
		AST/ALT = 0.6	BU = 0.2
AF alb = 3.0	SAAG = 1.0		SOG = 60
CSF:
CSF alb = 30	CSF glu = 60	CSF/S alb = 7.5	CSF/S glu = 0.4

The serum-ascites albumin gradient or gap (SAAG) is a calculation used in medicine to help determine the cause of ascites. The SAAG may be a better discriminant than the older method of classifying ascites fluid as a transudate versus exudate.

The formula is as follows:

SAAG = (serum albumin) - (albumin level of ascitic fluid).

Ideally, the two values should be measured at the same time.

This phenomenon is the result of Starling's forces between the fluid of the circulatory system and ascitic fluid. Under normal circumstances the SAAG is < 1.7 because serum oncotic pressure (pulling fluid back into circulation) is exactly counterbalanced by the serum hydrostatic pressure (which pushes fluid out of the circulatory system). This balance is disturbed in certain diseases (such as the Budd-Chiari syndrome, heart failure, or liver cirrhosis) that increase the hydrostatic pressure in the circulatory system. The increase in hydrostatic pressure causes more fluid to leave the circulation into the peritoneal space (ascites). The SAAG subsequently increases because there is more free fluid leaving the circulation, concentrating the serum albumin. The albumin does not move across membrane spaces easily because it is a large molecule.

Differential

High gradient

A high gradient (> 1.1 g/dL, >11g/L) indicates the ascites is due to portal hypertension, either liver related or non-liver related, with approximately 97% accuracy. This is due to increased hydrostatic pressure within the blood vessels of the hepatic portal system, which in turn forces water into the peritoneal cavity but leaves proteins such as albumin within the vasculature.

Important causes of high SAAG ascites (> 1.1 g/dL, >11 g/L) include: - cirrhosis of the liver - heart failure, - Budd-Chiari syndrome - Portal vein thrombosis - Idiopathic portal fibrosis

Low gradient

A low gradient (< 1.1 g/dL, <11 g/L) indicates causes of ascites not associated with increased portal pressure. - tuberculosis - pancreatitis - infections - serositis - Various types of peritoneal cancers (peritoneal carcinomatosis), - pulmonary infarcts. - nephrotic syndrome

SAAG vs Total ascities protein

		SAAG
		<1.1	>1.1
Total Protein	<2.5	Nephrotic syndrome	Cirrhosis
	>2.5	Cancer, TB	Right HF, Budd-chiari

References

UpToDate Contents

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• 1. 成人における腹水の診断および評価 evaluation of adults with ascites
• 2. 成人における特発性細菌性腹膜炎：診断 spontaneous bacterial peritonitis in adults diagnosis
• 3. 悪性腫瘍関連腹水 malignancy related ascites
• 4. 結核性腹膜炎 tuberculous peritonitis
• 5. 乳糜性、血性、および膵性腹水 chylous bloody and pancreatic ascites

English Journal

• Retraction note: New proposal for the serum ascites albumin gradient cut-off value in Chinese ascitic patients.

• [No authors listed]
• Diagnostic pathology.Diagn Pathol.2015 Mar 26;10:12. doi: 10.1186/s13000-015-0236-x.
• PMID 25881285

• Coccidioidomycosis Masquerading as Eosinophilic Ascites.

• Alavi K1, Atla PR1, Haq T1, Sheikh MY1.
• Case reports in gastrointestinal medicine.Case Rep Gastrointest Med.2015;2015:891910. doi: 10.1155/2015/891910. Epub 2015 Jul 21.
• Endemic to the southwestern parts of the United States, coccidioidomycosis, also known as "Valley Fever," is a common fungal infection that primarily affects the lungs in both acute and chronic forms. Disseminated coccidioidomycosis is the most severe but very uncommon and usually occurs in immunoco
• PMID 26266062

• Hypothyroidism Enhanced Portal Hypertension in a Patient with Alcoholic Liver Cirrhosis, Resulting in the Development of Ascites.

• Kakisaka K1, Endo K, Suzuki A, Hayashi S, Abe T, Yoshida Y, Oikawa T, Miyamoto Y, Sawara K, Ishida K, Kuroda H, Takikawa Y.
• Internal medicine (Tokyo, Japan).Intern Med.2015;54(18):2327-31. doi: 10.2169/internalmedicine.54.4594. Epub 2015 Sep 15.
• A man diagnosed with alcoholic liver cirrhosis complained of abdominal distention due to massive ascites. The ascites did not resolve with diuretic agents. The serum-ascites albumin gradient value of 1.9 g/dL and the total protein level in the ascites of 3.1 g/dL indicated the ascites to have been c
• PMID 26370856

Japanese Journal

• Hypothyroidism Enhanced Portal Hypertension in a Patient with Alcoholic Liver Cirrhosis, Resulting in the Development of Ascites

• Internal Medicine 54(18), 2327-2331, 2015
• NAID 130005099682

• 消化器症状に対する緩和的IVR:－がん性腹水－

• 日本インターベンショナルラジオロジー学会雑誌 29(4), 357-366, 2014
• NAID 130005085063

• Severe Ascites with Hypothyroidism and Elevated CA125 Concentration: A Case Report

• Endocrine Journal 54(5), 751-755, 2007
• NAID 130004443313

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★リンクテーブル★

リンク元	「SAAG」
関連記事	「gradient」

「SAAG」

　　[★] serum-ascites albumin gradient

「gradient」

　　[★]

• 勾配、グラジエント

関

ramp、slope