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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 ... Algorithm Ascites ... Peritonitis (SBP) Hepatic ... #gastroenterology ... #hepatology
 End Stage Liver Disease (Cirrhosis) - Complications 
 • Ascites
 • Esophageal Varices
 • Hepatic
End Stage Liver ... Complications • Ascites ... Esophageal Varices • Hepatic ... Syndrom (HRS) • Liver ... SBP) #ESLD #Liver
Diagnosis of ascites according to the serum ascites albumin gradient (SAAG)
SAAG ≥ 1.1:
 - Ascitic protein
Diagnosis of ascites ... syndrome, Massive liver ... albumin #gradient #hepatology ... #differential # ... diagnosis #algorithm
Causes of Ascites
Normal Peritoneum
Portal hypertension (SAAG > 1.1 g/dL)
  1. Hepatic congestionl
Hepatic congestionl ... Liver disease ... - Acute fatty liver ... Causes #diagnosis #differential ... #hepatology #SAAG
Deciphering the SAAG - Serum to Ascites Albumin Gradient
Ascites is either made in the liver sinusoid
either made in the liver ... sinusoid (hepatic ... or not by the liver ... liverprof #Diagnosis #Hepatology ... Interpretation #Differential
Causes of Ascites - Differential Diagnosis Algorithm
Portal Hypertension - Prehepatic:
 • Portal vein thrombosis
 • Splenic
- Differential ... Diagnosis Algorithm ... Hypertension - Hepatic ... disease • Acute liver ... #Hepatology #causes
Ascites - Differential Diagnosis
Chronic liver disease (cirrhosis or chronic hepatitis) - 80%
Underlying malignancy - 10%
Congestive heart
Ascites - Differential ... Diagnosis Chronic liver ... Disease, Fulminant Hepatic ... #Differential # ... Diagnosis #hepatology
Ascites - Differential Diagnosis and Workup Algorithm

•
Perform paracentesis:
 • Cell count and diff 
 • Total
Ascites - Differential ... #Differential # ... Diagnosis #Algorithm ... #gastroenterology ... #hepatology
Upper GI Bleed - Management Algorithm

Upper GI bleed Suspected: Melena, hematemesis, coffee-ground emesis, BRBPR
Initial Stabilization
Concern for
Stabilization Concern for Liver ... GI Bleed: • Peptic ... GAVE (idiopathic, liver ... UGIB #GIBleed #Differential ... #gastroenterology
Liver Enzymes (LFTs) - Causes of Hepatocellular and Cholestatic Liver Injury
Hepatocellular Liver Injury
 • AST/ALT elevation
Liver Enzymes (LFTs ... and Cholestatic Liver ... more specific for hepatic ... pathology (low level ... Transaminitis #diagnosis #differential