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Management and Complications of Cirrhosis and Ascites

Ascites Workup Algorithm
Ascites Management
Refractory Ascites
Hyponatremia
Spontaneous Bacterial Peritonitis (SBP)
Hepatic Hydrothorax
AKI in
Management and Complications ... Ascites Workup Algorithm ... #Ascites #Complications ... diagnosis #management #gastroenterology ... #hepatology
Ascites - Differential Diagnosis
Chronic liver disease (cirrhosis or chronic hepatitis) - 80%
Underlying malignancy - 10%
Congestive heart
liver disease (cirrhosis ... 10% Congestive heart ... failure - 3-5% ... , Pancreatic, Biliary ... Differential #Diagnosis #hepatology
Common Etiologies of Cirrhosis

Inflammation

 - Hepatitis B (15 percent)

 - Hepatitis C (47 percent)

 - Schistosomiasis
Etiologies of Cirrhosis ... congenital - Primary biliary ... disease Congestive heart ... failure (chronic ... #Differential #Hepatology
Diagnosis of ascites according to the serum ascites albumin gradient (SAAG)
SAAG ≥ 1.1:
 - Ascitic protein
protein ≤ 2.5 g/dL: Cirrhosis ... protein ≥ 2.5 g/dL: Heart ... failure/constrictive ... syndrome SAAG < 1.1: Biliary ... albumin #gradient #hepatology
Hepatomegaly - Differential Diagnosis Algorithm
Malignant
 • Primary Carcinoma
 • Metastases
 • Lymphoma
 • Leukemia
 • Polycythemia
Congestive • Right Heart ... Failure • Budd-Chiari ... Cholangitis • Primary Biliary ... Cirrhosis #Hepatomegaly ... #Causes #Hepatology
Causes of Ascites - Differential Diagnosis Algorithm
Portal Hypertension - Prehepatic:
 • Portal vein thrombosis
 • Splenic
- Hepatic: • Cirrhosis ... • Acute liver failure ... • Primary biliary ... Post-Hepatic: • Heart ... #Hepatology #causes
Abnormal Liver Function Tests - Differential Diagnosis Algorithm for Transaminitis
Hepatocellular Pattern (ALT or AST > ALP):
Differential Diagnosis Algorithm ... Congenital, Others, Cirrhosis ... - CBD stone, Biliary ... Transaminitis #Algorithm ... #diagnosis #hepatology
Elevated Liver Enzymes - Differential Diagnosis Algorithm
Severe ALT > 15x ULN
 • Viral
 • Drugs/Toxins
 •
Differential Diagnosis Algorithm ... disease US — Normal ... Infiltrative • Cirrhosis ... Duct Stone • Biliary ... Others #LFTs #Hepatology
Portal Hypertension - Differential Diagnosis
Portal Pressure = the pressure difference between the pressure in the portal
Clues to non-cirrhotic ... causes including R heart ... failure and constrictive ... pregnancy • Primary biliary ... Diagnosis #causes #hepatology
Primary Biliary Cirrhosis (PBC) - Summary

PBC Epidemiology:
 • Female:Male 9:1
 • Common European descent
 • Age:
Primary Biliary ... Cirrhosis (PBC) ... /Liver failure ... #Cirrhosis #PBC ... diagnosis #workup #hepatology