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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
Management and Complications ... of Cirrhosis and ... Management Refractory ... #diagnosis #management ... gastroenterology #hepatology
Diagnosis of ascites according to the serum ascites albumin gradient (SAAG)
SAAG ≥ 1.1:
 - Ascitic protein
Diagnosis of ascites ... SAAG ≥ 1.1: - Ascitic ... protein ≤ 2.5 g/dL: Cirrhosis ... albumin #gradient #hepatology ... #differential #diagnosis
 End Stage Liver Disease (Cirrhosis) - Complications 
 • Ascites
 • Esophageal Varices
 • Hepatic
Liver Disease (Cirrhosis ... Complications • Ascites ... Complications #diagnosis ... #management #summary ... #hepatology
Ascites - Workup and Management

#Ascites #Workup #Diagnosis #Management #SAAG #Evaluation #SBP #Hepatology
Ascites - Workup ... and Management ... #Ascites #Workup ... #Diagnosis #Management ... Evaluation #SBP #Hepatology
Complications of Portal Hypertension
 • Hepatic Encephalopathy
 • Pulmonary: Hepatopulmonary syndrome, Portopulmonary hypertension, Hepatic hydrothorax
 •
Encephalopathy • Pulmonary ... hydrothorax • Cirrhotic ... Hepatorenal syndrome • Ascites ... Complications #hepatology ... #diagnosis
Ascites Differential Diagnosis Table - Serum Ascites Albumin Gradient (SAAG)

SAAG ≥ 1.1:
 • Cirrhosis
 • Portal
Diagnosis Table ... - Serum Ascites ... SAAG ≥ 1.1: • Cirrhosis ... #Differential #Diagnosis ... Gradient #SAAG #hepatology
Ascites - Differential Diagnosis
Chronic liver disease (cirrhosis or chronic hepatitis) - 80%
Underlying malignancy - 10%
Congestive heart
Ascites - Differential ... Diagnosis Chronic ... liver disease (cirrhosis ... failure - 3-5% Cirrhosis ... #hepatology
Cirrhosis Timeline and Mortality Rate
Compensated Cirrhosis
Stage 1 - No varices (Annual Mortality Rate 1%)
Stage 2 -
Cirrhosis Timeline ... Rate Compensated Cirrhosis ... Stage 3 - Ascites ... Mortality #Timeline #diagnosis ... #hepatology
Indications for Albumin for Management of Cirrhosis
 • Large volume paracentesis (>5 liter) - 8g per
for Albumin for Management ... of Cirrhosis ... 8g per liter of ascites ... #Cirrhosis #treatment ... #hepatology
Ascites Management Principles
Low Salt Diet - 2000 Mg Sodium
Fluid Restriction - Never
Work-horse Diuretic - Aldosterone Antagonist
Combination
Ascites Management ... @ebtapper #Ascites ... #Management #cirrhosis ... #hepatology