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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
Cirrhosis and Ascites ... Ascites Workup ... Algorithm Ascites ... Peritonitis (SBP) Hepatic ... gastroenterology #hepatology
Deciphering the SAAG - Serum to Ascites Albumin Gradient
Ascites is either made in the liver sinusoid
either made in the liver ... sinusoid (hepatic ... or not by the liver ... liverprof #Diagnosis #Hepatology ... Interpretation #Differential
Diagnosis of ascites according to the serum ascites albumin gradient (SAAG)
SAAG ≥ 1.1:
 - Ascitic protein
Diagnosis of ascites ... SAAG ≥ 1.1: - Ascitic ... syndrome, Massive liver ... albumin #gradient #hepatology ... #differential #
Ascites - Differential Diagnosis
Chronic liver disease (cirrhosis or chronic hepatitis) - 80%
Underlying malignancy - 10%
Congestive heart
Ascites - Differential ... Diagnosis Chronic liver ... Disease, Fulminant Hepatic ... #Differential # ... Diagnosis #hepatology
 End Stage Liver Disease (Cirrhosis) - Complications 
 • Ascites
 • Esophageal Varices
 • Hepatic
End Stage Liver ... Complications • Ascites ... Esophageal Varices • Hepatic ... SBP) #ESLD #Liver ... management #summary #hepatology
Causes of Ascites
Normal Peritoneum
Portal hypertension (SAAG > 1.1 g/dL)
  1. Hepatic congestionl
Hepatic congestionl ... Liver disease ... - Acute fatty liver ... Causes #diagnosis #differential ... #hepatology #SAAG
Causes of Ascites - Differential Diagnosis Algorithm
Portal Hypertension - Prehepatic:
 • Portal vein thrombosis
 • Splenic
- Differential ... Hypertension - Hepatic ... disease • Acute liver ... Hypertension - Post-Hepatic ... #Differential #
Portal Hypertension - Differential Diagnosis
Portal Pressure = the pressure difference between the pressure in the portal
Hypertension - Differential ... of portal HTN: ascites ... portal HTN: • Ascites ... sarcoidosis) • Liver ... metastasis • Fatty liver
Ascites - Differential Diagnosis and Workup Algorithm

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

SAAG ≥ 1.1:
 • Cirrhosis
 • Portal
Ascites Differential ... Diagnosis Table ... #Differential # ... Diagnosis #Table ... Gradient #SAAG #hepatology