What are nonperitoneal causes of ascites?

Updated: Jul 30, 2018
  • Author: David C Wolf, MD, FACP, FACG, AGAF, FAASLD; Chief Editor: BS Anand, MD  more...
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Attributing ascites to diseases of nonperitoneal or peritoneal origin is more useful. Thanks to the work of Bruce Runyon, the serum-ascites albumin gradient (SAAG) has come into common clinical use for differentiating these conditions. Nonperitoneal diseases produce ascites with a SAAG greater than 1.1 g/dL. (See Table 1, below.) [12]

Table 1. Nonperitoneal Causes of Ascites [13] (Open Table in a new window)

Causes of Nonperitoneal Ascites


Intrahepatic portal hypertension


Fulminant hepatic failure

Veno-occlusive disease

Extrahepatic portal hypertension

Hepatic vein obstruction (ie, Budd-Chiari syndrome)

Congestive heart failure


Nephrotic syndrome

Protein-losing enteropathy, Malnutrition

Miscellaneous disorders


Ovarian tumors

Pancreatic ascites

Biliary ascites


Secondary to malignancy

Secondary to trauma

Secondary to portal hypertension

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