Select the target population: - Patients with ascites and suspected or established malignancy*
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Perform the following studies: - Diagnostic paracentesis¶Δ
- Serum albumin
- Abdominal imaging (eg, computed tomography scan, magnetic resonance imaging)
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Determine likely etiology for ascites: |
Diagnosis | Fluid cell count◊ | Fluid total protein | High fluid triglyceride level§ | Fluid cytology | Imaging features |
SAAG <1.1 g/dL¥ |
Peritoneal carcinomatosis | High with predominantly lymphocytes | ≥2.5 g/dL | No | Positive‡ | Peritoneal and omental implants |
Malignancy-related chylous ascites | High with predominantly lymphocytes | ≥2.5 g/dL | Yes | Negative | Abdominal lymphadenopathy |
SAAG ≥1.1 g/dL¥ |
Massive liver metastases with portal hypertension | Low | <2.5 g/dL | No | Negative | >50% liver replacement by tumor |
Hepatocellular carcinoma with cirrhosis | Low | <2.5 g/dL | No | Negative | Focal lesion(s) in cirrhotic liver† |
Malignancy-related Budd-Chiari syndrome | Low | Variable | No | Negative | Extrinsic tumor compression causing narrowing and/or thrombus of the hepatic vein |