How do you differentiate portal-hypertensive ascites from multifactorial volume overload when imaging shows only small-volume ascites in cirrhosis with concomitant cardiac/renal dysfunction?

Primarily, try to get a sample of the fluid; even just 50-60 cc of fluid can be enough to run diagnostic studies to assess the etiology of portal hypertension. Other helpful tests would be a TTE and checking for proteinuria to try to pinpoint whether the heart or the kidneys are more problematic tha...

Ascites fluid analysis is a good starting place, and why new onset ascites that is tappable should be analyzed to calculate the SAAG and quantify the total protein of the ascites.

SAAG >1.1 g/dL with total protein <2.5 g/dL is consistent with portal htn and cirrhosis.

SAAG >1.1 g/dL with total protei...