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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
Algorithm Ascites ... Peritonitis (SBP) Hepatic ... Complications #diagnosis ... #management #gastroenterology ... #hepatology
Ascites - Differential Diagnosis and Workup Algorithm

•
Perform paracentesis:
 • Cell count and diff 
 • Total
Ascites - Differential ... Algorithm • ... Diagnosis #Algorithm ... #gastroenterology ... #hepatology
Ascites - Differential Diagnosis
Chronic liver disease (cirrhosis or chronic hepatitis) - 80%
Underlying malignancy - 10%
Congestive heart
Ascites - Differential ... Diagnosis Chronic ... liver disease ( ... , Fulminant Hepatic ... Diagnosis #hepatology
Causes of Ascites - Differential Diagnosis Algorithm
Portal Hypertension - Prehepatic:
 • Portal vein thrombosis
 • Splenic
- Differential ... Diagnosis Algorithm ... • Infiltrative disease ... Diagnosis #Algorithm ... #Hepatology #causes
 End Stage Liver Disease (Cirrhosis) - Complications 
 • Ascites
 • Esophageal Varices
 • Hepatic
End Stage Liver Disease ... Complications • Ascites ... Esophageal Varices • Hepatic ... #management #summary ... #hepatology
Diagnosis of ascites according to the serum ascites albumin gradient (SAAG)
SAAG ≥ 1.1:
 - Ascitic protein
Diagnosis of ascites ... SAAG ≥ 1.1: - Ascitic ... albumin #gradient #hepatology ... #differential # ... diagnosis #algorithm
Causes of Ascites
Normal Peritoneum
Portal hypertension (SAAG > 1.1 g/dL)
  1. Hepatic congestionl
Veno-occlusive disease ... Liver disease ... #Causes #diagnosis ... #differential # ... hepatology #SAAG
Deciphering the SAAG - Serum to Ascites Albumin Gradient
Ascites is either made in the liver sinusoid
the blood The diseased ... hepatic sinusoid ... Matherly @liverprof #Diagnosis ... #Hepatology #SAAG ... Interpretation #Differential
Diagnostic Schema for Hyperferritinemia

Pearl: Diseases associated with extreme elevations: 
1. HLH 
2. Still's disease 
3. Systemic
Diagnostic Schema ... Still's disease ... Hyperferritinemia #Algorithm ... #Differential # ... Diagnosis #Hematology
Portal Hypertension - Differential Diagnosis
Portal Pressure = the pressure difference between the pressure in the portal
Hypertension - Differential ... Diagnosis Portal ... of portal HTN: ascites ... #Diagnosis #causes ... #hepatology