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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 ... of Cirrhosis and ... Spontaneous Bacterial ... #diagnosis #management ... gastroenterology #hepatology
Diagnosis of ascites according to the serum ascites albumin gradient (SAAG)
SAAG ≥ 1.1:
 - Ascitic protein
Diagnosis of ascites ... albumin gradient ... protein ≤ 2.5 g/dL: Cirrhosis ... #albumin #gradient ... #hepatology #differential
Indications for Albumin for Management of Cirrhosis
 • Large volume paracentesis (>5 liter) - 8g per
for Management ... of Cirrhosis • ... 8g per liter of ascites ... • Spontaneous Bacteria ... #hepatology
Ascites Differential Diagnosis Table - Serum Ascites Albumin Gradient (SAAG)

SAAG ≥ 1.1:
 • Cirrhosis
 • Portal
Diagnosis Table ... Albumin Gradient ... SAAG ≥ 1.1: • Cirrhosis ... #Table #Serum #Albumin ... Gradient #SAAG #hepatology
 End Stage Liver Disease (Cirrhosis) - Complications 
 • Ascites
 • Esophageal Varices
 • Hepatic
Complications • Ascites ... • Spontaneous Bacterial ... Complications #diagnosis ... #management #summary ... #hepatology
Ascites - Differential Diagnosis and Workup Algorithm

•
Perform paracentesis:
 • Cell count and diff 
 • Total
Diagnosis and Workup ... protein • Fluid albumin ... and serum albumin ... #Differential #Diagnosis ... gastroenterology #hepatology
Peritonitis - Spontaneous vs Secondary vs Peritoneal Dialysis Associated Peritonitis
Spontaneous Bacterial Peritonitis
 • Cirrhosis (high SAAG)
Peritonitis Spontaneous Bacterial ... Peritonitis • Cirrhosis ... cephalosporin + albumin ... Secondary Bacterial ... Secondary #Peritoneal #diagnosis
Spontaneous Bacterial Peritonitis 
Clinical 
 • Fever 
 • Chills 
 • Abdominal pain 
Diagnosis
Spontaneous Bacterial ... Abdominal pain Diagnosis ... stain/culture Management ... cephalosporin • Albumin ... #Hepatology
Deciphering the SAAG - Serum to Ascites Albumin Gradient
Ascites is either made in the liver sinusoid
SAAG - Serum to Ascites ... Albumin Gradient ... Ascites is either ... Matherly @liverprof #Diagnosis ... #Hepatology #SAAG
Complications of Portal Hypertension
 • Hepatic Encephalopathy
 • Pulmonary: Hepatopulmonary syndrome, Portopulmonary hypertension, Hepatic hydrothorax
 •
hydrothorax • Cirrhotic ... Hepatorenal syndrome • Ascites ... : Spontaneous bacterial ... Complications #hepatology ... #diagnosis