Which statement best describes ascites in PLE?

• A. Ascites is never present
• B. Ascites is always present and diagnostic
• C. Ascites may be present with PLE
• D. Ascites excludes PLE

Answer: (C)

The main concept is that protein-losing enteropathy causes loss of proteins, especially albumin, into the gut, which lowers the blood’s oncotic pressure. When oncotic pressure drops, fluid can shift into the abdominal cavity, leading to ascites. But ascites is not required for PLE to exist, and it is not specific to PLE. Some patients with PLE have little or no ascites, while others may have substantial ascites. Conversely, ascites can arise from many other conditions such as liver disease, heart failure, or nephrotic syndromes. So the best statement is that ascites may be present with PLE: it can occur, but it is neither universal nor diagnostic of PLE.