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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
Complications of Cirrhosis ... Ascites Workup Algorithm ... Hydrothorax AKI in Cirrhosis ... TinaPhamHang #Cirrhosis ... gastroenterology #hepatology
Diagnosis of ascites according to the serum ascites albumin gradient (SAAG)
SAAG ≥ 1.1:
 - Ascitic protein
Diagnosis of ascites ... SAAG ≥ 1.1: - Ascitic ... protein ≤ 2.5 g/dL: Cirrhosis ... albumin #gradient #hepatology ... differential #diagnosis #algorithm
Causes of Ascites - Differential Diagnosis Algorithm
Portal Hypertension - Prehepatic:
 • Portal vein thrombosis
 • Splenic
Causes of Ascites ... Differential Diagnosis Algorithm ... - Hepatic: • Cirrhosis ... Differential #Diagnosis #Algorithm ... #Hepatology #causes
Ascites - Differential Diagnosis and Workup Algorithm

•
Perform paracentesis:
 • Cell count and diff 
 • Total
Ascites - Differential ... Diagnosis and Workup ... Algorithm • ... Differential #Diagnosis #Algorithm ... gastroenterology #hepatology
Portal Hypertension - Differential Diagnosis
Portal Pressure = the pressure difference between the pressure in the portal
HTN: ascites (SAAG ... to non-cirrhotic ... Ascites protein ... Post-Hepatic: • Cardiac causes ... #hepatology
Ascites Differential Diagnosis Table - Serum Ascites Albumin Gradient (SAAG)

SAAG ≥ 1.1:
 • Cirrhosis
 • Portal
Ascites Differential ... Table - Serum Ascites ... SAAG ≥ 1.1: • Cirrhosis ... • Portal vein ... Gradient #SAAG #hepatology
Ascites - Diagnostic Approach and Differential Diagnosis
The most common causes: cirrhosis, malignancy and heart failure. Approx
The most common causes ... more than one cause ... (e.g. cirrhosis ... #workup #Differential ... #Diagnosis #hepatology
Causes of Ascites
Normal Peritoneum
Portal hypertension (SAAG > 1.1 g/dL)
  1. Hepatic congestionl
Causes of Ascites ... Normal Peritoneum ... disease - Cirrhosis ... #Causes #diagnosis ... #differential #hepatology
Hepatorenal Syndrome (HRS) - Diagnostic Criteria
HRS-AKI (Acute: previously known as HRS Type 1)
 • ↑ Creatinine
+ ascites • No ... No haematuria, Normal ... - No other cause ... - No other cause ... HRSAKI #HRSNAKI #hepatology
Complications of Portal Hypertension
 • Hepatic Encephalopathy
 • Pulmonary: Hepatopulmonary syndrome, Portopulmonary hypertension, Hepatic hydrothorax
 •
Complications of Portal ... hydrothorax • Cirrhotic ... Hepatorenal syndrome • Ascites ... @drkeithsiau #Portal ... Complications #hepatology