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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
Diagnosis of ascites according to the serum ascites albumin gradient (SAAG)
SAAG ≥ 1.1:
 - Ascitic protein
Diagnosis of ascites ... albumin gradient ... #albumin #gradient ... #hepatology #differential ... #diagnosis #algorithm
Ascites - Differential Diagnosis
Chronic liver disease (cirrhosis or chronic hepatitis) - 80%
Underlying malignancy - 10%
Congestive heart
Ascites - Differential ... liver disease ( ... cirrhosis or chronic hepatitis ... , Fulminant Hepatic ... Diagnosis #hepatology
Serum Ascites Albumin Gradient (SAAG) - Differential Diagnosis
High albumin gradient (>1.1 g/dl):
 - Cirrhosis	
 - Alcoholic
- Differential ... Diagnosis High albumin ... - Alcoholic hepatitis ... failure - Hepatic ... Diagnosis #hepatology
Deciphering the SAAG - Serum to Ascites Albumin Gradient
Ascites is either made in the liver sinusoid
Albumin Gradient ... the blood The diseased ... Matherly @liverprof #Diagnosis ... #Hepatology #SAAG ... Interpretation #Differential
Portal Hypertension - Differential Diagnosis
Portal Pressure = the pressure difference between the pressure in the portal
Hypertension - Differential ... Diagnosis Portal ... ) estimated by gradient ... Cirrhosis/acute hepatitis ... #hepatology
Ascites - Differential Diagnosis and Workup Algorithm

•
Perform paracentesis:
 • Cell count and diff 
 • Total
Ascites - Differential ... Algorithm • ... Diagnosis #Algorithm ... #gastroenterology ... #hepatology
Causes of Ascites
Normal Peritoneum
Portal hypertension (SAAG > 1.1 g/dL)
  1. Hepatic congestionl
Liver disease ... - Alcoholic hepatitis ... #Causes #diagnosis ... #differential # ... hepatology #SAAG
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