The aim of this study was to evaluate the etiology of ascites ultrasonographically using laboratory paracentesis results as a reference. A total of 53 patients with ascites were examined ultrasonographically using 3.5 MHz probe, during the period from 2012 up to 2013. The ascites volume, texture, total protein, total albumin, and Serum Ascites Albumin Gradient (SAAG) levels were evaluated and correlated with the underlying causes. The result of this study showed that the etiology of ascites was liver cirrhosis 23 (43.4%) followed by cancers 10 (18.9%), inflammations 8 (15.1%), renal diseases 7 (13.2%), heart diseases 3 (5.7%), portal hypertension 1.0 (0.53%) and urinary bladder Schistosomiasis 1.0 (0.53%). The ascites was detected in sub hepatic area in one patient, in the hepato renal in 9 patients, in the vesico ureteric in16 patients and occupying the intraperitoneal space with fully distention was found in 27 patients. Association between ascites characters, patient diagnostic etiology and paracentesis results were found to be significant at p<0.05. In conclusion the volume of ascites and etiology were directly associated with the SAAG therefore ultrasound can be suggested as a safe noninvasive imaging method for diagnosis the etiological factors of ascites.