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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
of Cirrhosis and ... Workup Algorithm ... Ascites Management ... #diagnosis #management ... gastroenterology #hepatology
Diagnosis of ascites according to the serum ascites albumin gradient (SAAG)
SAAG ≥ 1.1:
 - Ascitic protein
Diagnosis of ascites ... protein ≤ 2.5 g/dL: Cirrhosis ... syndrome, Massive liver ... albumin #gradient #hepatology ... #algorithm
Ascites - Differential Diagnosis
Chronic liver disease (cirrhosis or chronic hepatitis) - 80%
Underlying malignancy - 10%
Congestive heart
Ascites - Differential ... Diagnosis Chronic ... liver disease ( ... hepatitis) - 80% ... #hepatology
 End Stage Liver Disease (Cirrhosis) - Complications 
 • Ascites
 • Esophageal Varices
 • Hepatic
Disease (Cirrhosis ... Complications • Ascites ... #Cirrhosis #Complications ... #diagnosis #management ... #summary #hepatology
Acute-on-Chronic Liver Failure (ACLF) Clinical Guidelines

ACLF = possibly reversible condition in those with CLD (± cirrhosis)
those with CLD (± cirrhosis ... Injury (DILI) ... Viral Hepatitis ... #Hepatology #gastroenterology ... #management #diagnosis
Elevated Liver Function Tests (LFTs) - Differential Diagnosis Framework
Mild (<100-500): 
 • NAFLD
 • Cirrhosis
 •
- Differential Diagnosis ... • NAFLD • Cirrhosis ... Chronic Viral Hepatitis ... injury) • Ischemic ... #hepatology #transaminitis
Patterns of Liver Injury
Transaminase Levels:
  > 50x normal - Ischemic Hepatitis
  > 20x normal
Patterns of Liver ... Injury Transaminase ... CMV), Alcoholic cirrhosis ... #Injury #hepatology ... #differential #diagnosis
Drug Induced Liver Injury (DILI) - Stepwise Diagnosis Algorithm
DILI suspicion
Features toxic aetiology: Skin involvement, Kidney injury,
Stepwise Diagnosis ... Algorithm DILI ... disorder (e.g. ascites ... #Injury #Diagnosis ... #Algorithm #hepatology
Hepatomegaly - Differential Diagnosis Algorithm
Malignant
 • Primary Carcinoma
 • Metastases
 • Lymphoma
 • Leukemia
 • Polycythemia
- Differential Diagnosis ... Algorithm Malignant ... Non-Malignant • Fatty Liver ... Primary Biliary Cirrhosis ... #Hepatology
Approach to the Hospitalized Patient with Cirrhosis
1) Recognize and Manage Decompensation
 • Ascites
 • Variceal Bleeding
Decompensation • Ascites ... Scenarios • Alcoholic Hepatitis ... Portosystemic Shunt • Liver ... #diagnosis #treatment ... #management