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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 ... Peritonitis (SBP) Hepatic ... #gastroenterology ... #hepatology
 End Stage Liver Disease (Cirrhosis) - Complications 
 • Ascites
 • Esophageal Varices
 • Hepatic
End Stage Liver ... Complications • Ascites ... Syndrom (HRS) • Liver ... SBP) #ESLD #Liver ... #summary #hepatology
Diagnosis of ascites according to the serum ascites albumin gradient (SAAG)
SAAG ≥ 1.1:
 - Ascitic protein
protein ≤ 2.5 g/dL: Cirrhosis ... syndrome, Massive liver ... albumin #gradient #hepatology ... #differential # ... diagnosis #algorithm
Ascites - Differential Diagnosis
Chronic liver disease (cirrhosis or chronic hepatitis) - 80%
Underlying malignancy - 10%
Congestive heart
Ascites - Differential ... Diagnosis Chronic liver ... disease (cirrhosis ... Disease, Fulminant Hepatic ... Diagnosis #hepatology
Portal Hypertension - Differential Diagnosis
Portal Pressure = the pressure difference between the pressure in the portal
Hypertension - Differential ... of portal HTN: ascites ... sarcoidosis) • Liver ... metastasis • Fatty liver ... Diagnosis #causes #hepatology
Causes of Ascites
Normal Peritoneum
Portal hypertension (SAAG > 1.1 g/dL)
  1. Hepatic congestionl
Liver disease ... - Cirrhosis ... - Acute fatty liver ... Causes #diagnosis #differential ... #hepatology #SAAG
Causes of Ascites - Differential Diagnosis Algorithm
Portal Hypertension - Prehepatic:
 • Portal vein thrombosis
 • Splenic
- Differential ... Diagnosis Algorithm ... : • Cirrhosis ... disease • Acute liver ... #Hepatology #causes
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
Elevated Liver Function Tests (LFTs) - Differential Diagnosis Framework
Mild (<100-500): 
 • NAFLD
 • Cirrhosis
 •
Elevated Liver Function ... • NAFLD • Cirrhosis ... (Drug-induced liver ... ) • Non-hepatic ... LouLectures #Liver
Serum Ascites Albumin Gradient (SAAG) - Differential Diagnosis
High albumin gradient (>1.1 g/dl):
 - Cirrhosis	
 - Alcoholic
>1.1 g/dl): - Cirrhosis ... - Massive liver ... failure - Hepatic ... - Acute fatty liver ... #Diagnosis #hepatology