Differential Diagnosis

The patient's presentation of abdominal distention, yellow sclera (indicative of jaundice), and vague epigastric abdominal pain, along with the results from the paracentesis, suggests a condition affecting the liver. The serum-ascites albumin gradient (SAAG) can help differentiate the cause of ascites. A high gradient (>1.1 g/dL) typically indicates portal hypertension, often due to liver cirrhosis, while a low gradient (<1.1 g/dL) suggests non-portal hypertensive causes.

• Single Most Likely Diagnosis

  • Liver Cirrhosis: The patient's symptoms of abdominal distention (ascites), jaundice (yellow sclera), and the results from the paracentesis (Serum albumin 30, Ascites albumin 14) suggest a high SAAG, indicating portal hypertension, which is commonly caused by liver cirrhosis. The ascites protein level of 10 also supports this diagnosis, as cirrhosis typically leads to a low ascitic protein concentration.

• Other Likely Diagnoses

  • Congestive Heart Failure: This condition can cause ascites due to increased venous pressure leading to fluid leakage into the peritoneal cavity. However, the presence of jaundice and the specific albumin and protein levels in ascites make heart failure less likely than liver cirrhosis.
  • Nephrotic Syndrome: While nephrotic syndrome can cause ascites, it is typically associated with very low serum albumin levels (<2.5 g/dL) due to heavy proteinuria, which is not the case here (serum albumin 30).

• Do Not Miss Diagnoses

  • Spontaneous Bacterial Peritonitis (SBP): Although not directly suggested by the provided information, any patient with ascites is at risk for SBP, a condition that requires prompt diagnosis and treatment to prevent high mortality. The diagnosis of SBP is typically made by analyzing the ascitic fluid for a high neutrophil count.
  • Malignancy: Certain malignancies can cause ascites, either by metastasizing to the peritoneum or by causing portal or hepatic vein thrombosis. While less likely given the information, malignancy is a critical diagnosis not to miss due to its implications for treatment and prognosis.

• Rare Diagnoses

  • Acute Pancreatitis: While acute pancreatitis can cause abdominal pain and ascites, the presence of jaundice and the specific findings from the paracentesis make this a less likely diagnosis. Ascites in acute pancreatitis is typically associated with a high ascitic protein concentration and evidence of pancreatic inflammation.
  • Budd-Chiari Syndrome: This rare condition, caused by hepatic vein thrombosis, can lead to ascites and liver dysfunction. However, it is less common than liver cirrhosis and would typically require specific imaging studies for diagnosis.