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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 ... albumin #gradient #hepatology ... #differential #diagnosis ... #algorithm
 End Stage Liver Disease (Cirrhosis) - Complications 
 • Ascites
 • Esophageal Varices
 • Hepatic
End Stage Liver Disease ... • Ascites ... Complications #diagnosis ... #management #summary ... #hepatology
Ascites - Differential Diagnosis
Chronic liver disease (cirrhosis or chronic hepatitis) - 80%
Underlying malignancy - 10%
Congestive heart
Ascites - Differential ... Diagnosis Chronic ... liver disease ( ... cirrhosis or chronic ... #hepatology
Ascites - Diagnostic Approach and Differential Diagnosis
The most common causes: cirrhosis, malignancy and heart failure. Approx
Ascites - Diagnostic ... of underlying disease ... bilirubin 2) Routine tests ... 3) Optional tests ... #hepatology
Causes of Ascites - Differential Diagnosis Algorithm
Portal Hypertension - Prehepatic:
 • Portal vein thrombosis
 • Splenic
- Differential Diagnosis ... Algorithm Portal ... - Hepatic: • Cirrhosis ... • Infiltrative disease ... #Algorithm #Hepatology
Hepatorenal Syndrome (HRS) - Diagnostic Criteria
HRS-AKI (Acute: previously known as HRS Type 1)
 • ↑ Creatinine
Syndrome (HRS) - Diagnostic ... cause of kidney disease ... cause of kidney disease ... Hepatorenal #Syndrome #diagnosis ... HRSAKI #HRSNAKI #hepatology
Spontaneous Bacterial Peritonitis (SBP) - Diagnosis and Management
Ascites PMN > 250/mm3
? Nosocomial or hospital acquired. Recent
Peritonitis (SBP) - Diagnosis ... Ascites PMN > 250 ... cefotaxime) SBP: Medical ... prophylaxis - Best ... #Management #hepatology
Causes of Ascites
Normal Peritoneum
Portal hypertension (SAAG > 1.1 g/dL)
  1. Hepatic congestionl
Veno-occlusive disease ... Liver disease ... - Cirrhosis ... #Causes #diagnosis ... #differential #hepatology
Portal Hypertension - Differential Diagnosis
Portal Pressure = the pressure difference between the pressure in the portal
- Differential Diagnosis ... of portal HTN: ascites ... portal HTN: • Ascites ... Veno-occlusive disease ... #causes #hepatology