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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
Cirrhosis and Ascites ... Ascites Workup ... Algorithm Ascites ... Hyponatremia ... gastroenterology #hepatology
Cirrhosis - Pathophysiology
 - Ascites Formation
 - Dilutional Hyponatremia
 - Hepatorenal Syndrome
 - Spontaneous Infections

#Cirrhosis #Pathophysiology
Pathophysiology - Ascites ... - Dilutional Hyponatremia ... Pathophysiology #hepatology
Diagnosis of ascites according to the serum ascites albumin gradient (SAAG)
SAAG ≥ 1.1:
 - Ascitic protein
Diagnosis of ascites ... SAAG ≥ 1.1: - Ascitic ... metastases - Ascitic ... albumin #gradient #hepatology ... #differential #
Ascites - Differential Diagnosis and Workup Algorithm

•
Perform paracentesis:
 • Cell count and diff 
 • Total
Ascites - Differential ... culture • Check ascites ... SAAG and check ascites ... #Differential # ... gastroenterology #hepatology
Ascites Differential Diagnosis Table - Serum Ascites Albumin Gradient (SAAG)

SAAG ≥ 1.1:
 • Cirrhosis
 • Portal
Ascites Differential ... Table - Serum Ascites ... • Pancreatic ascites ... #Differential # ... Gradient #SAAG #hepatology
Ascites - Diagnostic Approach and Differential Diagnosis
The most common causes: cirrhosis, malignancy and heart failure. Approx
Ascites - Diagnostic ... Approach and Differential ... Cell count and differential ... #workup #Differential ... #Diagnosis #hepatology
Ascites - Differential Diagnosis
Chronic liver disease (cirrhosis or chronic hepatitis) - 80%
Underlying malignancy - 10%
Congestive heart
Ascites - Differential ... Chylous <1% #Ascites ... #Differential # ... Diagnosis #hepatology
Peritonitis - Spontaneous vs Secondary vs Peritoneal Dialysis Associated Peritonitis
Spontaneous Bacterial Peritonitis
 • Cirrhosis (high SAAG)
(high SAAG) + ascites ... PMN > 250 • Treatment ... Positive Culture • Treatment ... Peritoneal #diagnosis #differential ... #ascites
Causes of Ascites - Differential Diagnosis Algorithm
Portal Hypertension - Prehepatic:
 • Portal vein thrombosis
 • Splenic
Causes of Ascites ... - Differential ... amzn.to/2LmUODZ #Ascites ... #Differential # ... Diagnosis #Algorithm #Hepatology
Deciphering the SAAG - Serum to Ascites Albumin Gradient
Ascites is either made in the liver sinusoid
SAAG - Serum to Ascites ... Albumin Gradient Ascites ... liverprof #Diagnosis #Hepatology ... #SAAG #Ascites ... Interpretation #Differential