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Ascites - Workup and Management

#Ascites #Workup #Diagnosis #Management #SAAG #Evaluation #SBP #Hepatology
Ascites - Workup ... and Management ... #Ascites #Workup ... #Diagnosis #Management ... Evaluation #SBP #Hepatology
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 ... Ascites Workup ... Management Refractory ... Complications #diagnosis #management ... gastroenterology #hepatology
Ascites - Diagnostic Approach and Differential Diagnosis
The most common causes: cirrhosis, malignancy and heart failure. Approx
causes: cirrhosis, malignancy ... disease: Cirrhosis, Malignancy ... concentration (malignancy ... #workup #Differential ... #Diagnosis #hepatology
Ascites - Differential Diagnosis and Workup Algorithm

•
Perform paracentesis:
 • Cell count and diff 
 • Total
Ascites - Differential ... Diagnosis and Workup ... culture • Check ascites ... SAAG and check ascites ... gastroenterology #hepatology
Ascites Differential Diagnosis Table - Serum Ascites Albumin Gradient (SAAG)

SAAG ≥ 1.1:
 • Cirrhosis
 • Portal
Ascites Differential ... Table - Serum Ascites ... Nephrotic syndrome • Malignancy ... • Pancreatic ascites ... Gradient #SAAG #hepatology
Ascites - Differential Diagnosis
Chronic liver disease (cirrhosis or chronic hepatitis) - 80%
Underlying malignancy - 10%
Congestive heart
Ascites - Differential ... 80% Underlying malignancy ... Chylous <1% #Ascites ... Differential #Diagnosis #hepatology
Deciphering the SAAG - Serum to Ascites Albumin Gradient
Ascites is either made in the liver sinusoid
SAAG - Serum to Ascites ... Albumin Gradient Ascites ... Extrahepatic source: Malignancy ... liverprof #Diagnosis #Hepatology ... #SAAG #Ascites
Causes of Ascites - Differential Diagnosis Algorithm
Portal Hypertension - Prehepatic:
 • Portal vein thrombosis
 • Splenic
Causes of Ascites ... Protein-rich: • Malignancy ... Hemoperitoneum • Chylous ascites ... amzn.to/2LmUODZ #Ascites ... Diagnosis #Algorithm #Hepatology
Approach to the Hypercoagulable State
Arterial thromboembolism
→ Cardiac rhythm monitoring, Echocardiogram, Vascular imaging
→ Test for APS, particularly
trauma, active malignancy ... an established malignancy ... - No other workup ... Hypercoagulable #Workup ... #hematology #diagnosis
Ascites Management Principles
Low Salt Diet - 2000 Mg Sodium
Fluid Restriction - Never
Work-horse Diuretic - Aldosterone Antagonist
Combination
Ascites Management ... Restriction - Never Work-horse ... @ebtapper #Ascites ... #Management #cirrhosis ... #hepatology