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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 ... general measures • Spontaneous ... #hepatology
Cirrhosis - Pathophysiology
 - Ascites Formation
 - Dilutional Hyponatremia
 - Hepatorenal Syndrome
 - Spontaneous Infections

#Cirrhosis #Pathophysiology
Cirrhosis - Pathophysiology ... - Ascites Formation ... Hepatorenal Syndrome - Spontaneous ... Infections #Cirrhosis ... Pathophysiology #hepatology
 End Stage Liver Disease (Cirrhosis) - Complications 
 • Ascites
 • Esophageal Varices
 • Hepatic
Complications • Ascites ... Evaluation • Spontaneous ... Complications #diagnosis ... #management #summary ... #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
Peritonitis - Spontaneous vs Secondary vs Peritoneal Dialysis Associated Peritonitis
Spontaneous Bacterial Peritonitis
 • Cirrhosis (high SAAG)
Peritonitis - Spontaneous ... Peritonitis • Cirrhosis ... (high SAAG) + ascites ... cephalosporin + albumin ... Secondary #Peritoneal #diagnosis
Spontaneous Bacterial Peritonitis 
Clinical 
 • Fever 
 • Chills 
 • Abdominal pain 
Diagnosis
Spontaneous Bacterial ... stain/culture Management ... cephalosporin • Albumin ... #Spontaneous # ... #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
Complications of Portal Hypertension
 • Hepatic Encephalopathy
 • Pulmonary: Hepatopulmonary syndrome, Portopulmonary hypertension, Hepatic hydrothorax
 •
hydrothorax • Cirrhotic ... Hepatorenal syndrome • Ascites ... : Spontaneous bacterial ... Complications #hepatology ... #diagnosis