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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
Complications of Cirrhosis ... Ascites Workup Algorithm ... #diagnosis #management ... #gastroenterology ... #hepatology
Diagnosis of ascites according to the serum ascites albumin gradient (SAAG)
SAAG ≥ 1.1:
 - Ascitic protein
Diagnosis of ascites ... protein ≤ 2.5 g/dL: Cirrhosis ... albumin #gradient #hepatology ... #differential #diagnosis ... #algorithm
Ascites - Differential Diagnosis and Workup Algorithm

•
Perform paracentesis:
 • Cell count and diff 
 • Total
Diagnosis and Workup ... Algorithm • ... #Differential #Diagnosis ... #Algorithm #gastroenterology ... #hepatology
Patterns of Liver Injury
Transaminase Levels:
  > 50x normal - Ischemic Hepatitis
  > 20x normal
Patterns of Liver Injury ... CMV), Alcoholic cirrhosis ... Patterns #Liver #Injury ... #hepatology #LFTs ... #differential #diagnosis
Causes of Ascites - Differential Diagnosis Algorithm
Portal Hypertension - Prehepatic:
 • Portal vein thrombosis
 • Splenic
Causes of Ascites ... Algorithm Portal ... - Hepatic: • Cirrhosis ... #Algorithm #Hepatology ... #causes
Hepatorenal Syndrome (HRS) - Diagnostic Criteria
HRS-AKI (Acute: previously known as HRS Type 1)
 • ↑ Creatinine
Syndrome (HRS) - Diagnostic ... structural kidney injury ... - No other cause ... - No other cause ... HRSAKI #HRSNAKI #hepatology
Causes of Severe Acute Liver Injury
 - Ichemic hepatitis
 - Acute biliary obstruction
 - Drug-Induced liver
Causes of Severe ... Acute Liver Injury ... - Ichemic hepatitis ... #Differential #Hepatology ... #Diagnosis
Ascites - Diagnostic Approach and Differential Diagnosis
The most common causes: cirrhosis, malignancy and heart failure. Approx
Ascites - Diagnostic ... The most common causes ... more than one cause ... (e.g. cirrhosis ... #hepatology
Portal Hypertension - Differential Diagnosis
Portal Pressure = the pressure difference between the pressure in the portal
- Differential Diagnosis ... of portal HTN: ascites ... portal HTN: • Ascites ... #Differential #Diagnosis ... #causes #hepatology
Elevated Liver Enzymes - Differential Diagnosis Algorithm
Severe ALT > 15x ULN
 • Viral
 • Drugs/Toxins
 •
Algorithm Severe ... Drugs/Toxins • Ischemia ... Infiltrative • Cirrhosis ... Others #LFTs #Hepatology ... #Algorithm #Causes