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Ascites - Workup and Management

#Ascites #Workup #Diagnosis #Management #SAAG #Evaluation #SBP #Hepatology
Ascites - Workup ... Management #Ascites ... #Workup #Diagnosis ... #Management #SAAG ... Evaluation #SBP #Hepatology
Diagnosis of ascites according to the serum ascites albumin gradient (SAAG)
SAAG ≥ 1.1:
 - Ascitic protein
Diagnosis of ascites ... albumin gradient (SAAG ... ) SAAG ≥ 1.1: ... #gradient #hepatology ... #differential #diagnosis
Ascites Differential Diagnosis Table - Serum Ascites Albumin Gradient (SAAG)

SAAG ≥ 1.1:
 • Cirrhosis
 • Portal
Diagnosis Table ... Cirrhosis • Portal ... • Nephrotic syndrome ... #Differential #Diagnosis ... #hepatology
Ascites - Differential Diagnosis and Workup Algorithm

•
Perform paracentesis:
 • Cell count and diff 
 • Total
Diagnosis and Workup ... • Calculate SAAG ... total protein ... #Differential #Diagnosis ... gastroenterology #hepatology
Causes of Ascites
Normal Peritoneum
Portal hypertension (SAAG > 1.1 g/dL)
  1. Hepatic congestionl
Portal hypertension ... - Budd-Chiari syndrome ... - Nephrotic syndrome ... #Causes #diagnosis ... #differential #hepatology
Deciphering the SAAG - Serum to Ascites Albumin Gradient
Ascites is either made in the liver sinusoid
Deciphering the SAAG ... fibrosis) High SAAG ... sinusoid with (ie Portal ... Matherly @liverprof #Diagnosis ... #Hepatology #SAAG
Complications of Portal Hypertension
 • Hepatic Encephalopathy
 • Pulmonary: Hepatopulmonary syndrome, Portopulmonary hypertension, Hepatic hydrothorax
 •
Hepatopulmonary syndrome ... Renal: Hepatorenal syndrome ... • Ascites: Spontaneous ... Complications #hepatology ... #diagnosis
Causes of Ascites - Differential Diagnosis Algorithm
Portal Hypertension - Prehepatic:
 • Portal vein thrombosis
 • Splenic
Causes of Ascites ... - Differential Diagnosis ... • Budd-Chiari syndrome ... #Differential #Diagnosis ... #Algorithm #Hepatology
Portal Hypertension - Differential Diagnosis
Portal Pressure = the pressure difference between the pressure in the portal
- Differential Diagnosis ... HTN: ascites (SAAG ... and hepatorenal syndrome ... HTN: • Ascites ... #causes #hepatology
Serum Ascites Albumin Gradient (SAAG) - Differential Diagnosis
High albumin gradient (>1.1 g/dl):
 - Cirrhosis	
 - Alcoholic
Gradient (SAAG) ... - Differential Diagnosis ... ) - Portal vein ... #Differential #Diagnosis ... #hepatology