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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
Workup Algorithm ... Ascites Management ... in Cirrhosis, HRS-AKI ... #diagnosis #management ... gastroenterology #hepatology
Patterns of Liver Injury
Transaminase Levels:
  > 50x normal - Ischemic Hepatitis
  > 20x normal
> 50x normal - Ischemic ... 20x normal - Acute ... CMV), Alcoholic cirrhosis ... Liver #Injury #hepatology ... #differential #diagnosis
Hepatorenal Syndrome (HRS) - Diagnostic Criteria
HRS-AKI (Acute: previously known as HRS Type 1)
 • ↑ Creatinine
Syndrome (HRS) - Diagnostic ... (Acute: previously ... (Non-Acute: previously ... Hepatorenal #Syndrome #diagnosis ... HRSAKI #HRSNAKI #hepatology
Elevated Liver Function Tests (LFTs) - Differential Diagnosis Framework
Mild (<100-500): 
 • NAFLD
 • Cirrhosis
 •
• NAFLD • Cirrhosis ... Hepatopathy • Acute ... Viral Hepatitis ... liver injury) • Ischemic ... #hepatology #transaminitis
Serum Ascites Albumin Gradient (SAAG) - Differential Diagnosis
High albumin gradient (>1.1 g/dl):
 - Cirrhosis	
 - Alcoholic
- Differential Diagnosis ... - Alcoholic hepatitis ... Veno-occlusive disease - Acute ... associated with bowel ischemia ... #hepatology
Acute-on-Chronic Liver Failure (ACLF) Clinical Guidelines

ACLF = possibly reversible condition in those with CLD (± cirrhosis)
Acute-on-Chronic ... those with CLD (± cirrhosis ... (DILI) Viral Hepatitis ... #Hepatology #gastroenterology ... #management #diagnosis
Causes of Ascites - Differential Diagnosis Algorithm
Portal Hypertension - Prehepatic:
 • Portal vein thrombosis
 • Splenic
- Differential Diagnosis ... Algorithm Portal ... - Hepatic: • Cirrhosis ... Infiltrative disease • Acute ... #Algorithm #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 ... /acute hepatitis ... #causes #hepatology
Elevated Liver Enzymes - Differential Diagnosis Algorithm
Severe ALT > 15x ULN
 • Viral
 • Drugs/Toxins
 •
Algorithm Severe ... Drugs/Toxins • Ischemia ... • Alcoholic hepatitis ... Infiltrative • Cirrhosis ... Others #LFTs #Hepatology
Drug Induced Liver Injury (DILI) - Stepwise Diagnosis Algorithm
DILI suspicion
Features toxic aetiology: Skin involvement, Kidney injury,
Algorithm DILI ... disease, Hepatic ischaemia ... dechallenge • Acute ... disorder (e.g. ascites ... #Algorithm #hepatology