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Portal Hypertension - Differential Diagnosis
Portal Pressure = the pressure difference between the pressure in the portal
Clues to non-cirrhotic ... Intrahepatic: • Cirrhosis ... sarcoidosis) • Liver ... metastasis • Fatty liver ... Primary biliary cirrhosis
 End Stage Liver Disease (Cirrhosis) - Complications 
 • Ascites
 • Esophageal Varices
 • Hepatic
End Stage Liver ... Disease (Cirrhosis ... Esophageal Varices • Hepatic ... SBP) #ESLD #Liver ... #Cirrhosis #Complications
Approach to the Hospitalized Patient with Cirrhosis
1) Recognize and Manage Decompensation
 • Ascites
 • Variceal Bleeding
Hospitalized Patient with Cirrhosis ... Variceal Bleeding • Hepatic ... Portosystemic Shunt • Liver ... DeanEhrlich_MD #inpatient #Cirrhosis
Ascites - Differential Diagnosis
Chronic liver disease (cirrhosis or chronic hepatitis) - 80%
Underlying malignancy - 10%
Congestive heart
Diagnosis Chronic liver ... disease (cirrhosis ... failure - 3-5% Cirrhosis ... Disease, Fulminant Hepatic
Causes of Portal Hypertension According to Site of Vascular Obstruction
1) Prehepatic pre-sinusoidal: Portal vein thrombosis due
or secondary to cirrhosis ... Schistosomiasis, Congenital hepatic ... 3) Sinusoidal: Cirrhosis ... , Polycystic liver ... disease 5) Post-hepatic
Portal Hypertension Classification by site of vascular obstruction
1) Post-hepatic Post-sinusoidal: Budd-Chiari syndrome
2) Intrahepatic Post-sinusoidal: Veno-occlusive disease
3)
obstruction 1) Post-hepatic ... 3) Sinusoidal: Cirrhosis ... , Polycystic liver ... Schistosomiasis, Congenital hepatic ... or secondary to cirrhosis
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
Clinical Examination for Liver and Biliary Diseases
1) Hands: Clubbing, Dupuytren's contracture, Leuconychia, Bruising, Flapping tremor (hepatic
Examination for Liver ... Flapping tremor (hepatic ... Palpable gallbladder, Hepatic ... #physicalexam #cirrhosis ... #liver #disease
Causes of Ascites
Normal Peritoneum
Portal hypertension (SAAG > 1.1 g/dL)
  1. Hepatic congestionl
Hepatic congestionl ... Liver disease ... - Cirrhosis ... - Massive hepatic ... - Acute fatty liver
Serum Ascites Albumin Gradient (SAAG) - Differential Diagnosis
High albumin gradient (>1.1 g/dl):
 - Cirrhosis	
 - Alcoholic
>1.1 g/dl): - Cirrhosis ... ascites - Massive liver ... - Fulminant hepatic ... failure - Hepatic ... - Acute fatty liver