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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
Diagnosis of ascites according to the serum ascites albumin gradient (SAAG)
SAAG ≥ 1.1:
 - Ascitic protein
Diagnosis of ascites ... SAAG ≥ 1.1: - Ascitic ... metastases - Ascitic ... albumin #gradient #hepatology ... #differential #
Ascites - Differential Diagnosis
Chronic liver disease (cirrhosis or chronic hepatitis) - 80%
Underlying malignancy - 10%
Congestive heart
Ascites - Differential ... Disease, Fulminant Hepatic ... Chylous <1% #Ascites ... #Differential # ... Diagnosis #hepatology
Deciphering the SAAG - Serum to Ascites Albumin Gradient
Ascites is either made in the liver sinusoid
liver sinusoid (hepatic ... the liver The hepatic ... is hepatic lymph ... liverprof #Diagnosis #Hepatology ... Interpretation #Differential
Complications of Portal Hypertension
 • Hepatic Encephalopathy
 • Pulmonary: Hepatopulmonary syndrome, Portopulmonary hypertension, Hepatic hydrothorax
 •
Hypertension • Hepatic ... hypertension, Hepatic ... Hepatorenal syndrome • Ascites ... Complications #hepatology
Causes of Ascites - Differential Diagnosis Algorithm
Portal Hypertension - Prehepatic:
 • Portal vein thrombosis
 • Splenic
- Differential ... Hypertension - Hepatic ... Hypertension - Post-Hepatic ... #Differential # ... Diagnosis #Algorithm #Hepatology
Causes of Ascites
Normal Peritoneum
Portal hypertension (SAAG > 1.1 g/dL)
  1. Hepatic congestionl
Hepatic congestionl ... - Fulminant hepatic ... - Massive hepatic ... Causes #diagnosis #differential ... #hepatology #SAAG
 End Stage Liver Disease (Cirrhosis) - Complications 
 • Ascites
 • Esophageal Varices
 • Hepatic
Complications • Ascites ... Esophageal Varices • Hepatic ... management #summary #hepatology
Ascites - Differential Diagnosis and Workup Algorithm

•
Perform paracentesis:
 • Cell count and diff 
 • Total
Ascites - Differential ... culture • Check ascites ... SAAG and check ascites ... #Differential # ... gastroenterology #hepatology
Hepatic Masses on MRI - Differential Diagnosis by MRI Findings

Masses: Hemangioma, Adenoma, FNH, HCC, Fibrolamellar HCC,
Hepatic Masses on ... MRI - Differential ... CBarreraMD #Hepatic ... #Masses #MRI #differential ... diagnosis #liver #hepatology