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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 ... Peritonitis (SBP) Hepatic ... #diagnosis #management ... gastroenterology #hepatology
 End Stage Liver Disease (Cirrhosis) - Complications 
 • Ascites
 • Esophageal Varices
 • Hepatic
Disease (Cirrhosis ... Complications • Ascites ... Esophageal Varices • Hepatic ... #diagnosis #management ... #summary #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 ... syndrome, Massive liver ... albumin #gradient #hepatology ... #algorithm
Ascites - Differential Diagnosis
Chronic liver disease (cirrhosis or chronic hepatitis) - 80%
Underlying malignancy - 10%
Congestive heart
Ascites - Differential ... Diagnosis Chronic ... liver disease ( ... Disease, Fulminant Hepatic ... #hepatology
Causes of Ascites - Differential Diagnosis Algorithm
Portal Hypertension - Prehepatic:
 • Portal vein thrombosis
 • Splenic
- Differential Diagnosis ... Algorithm Portal ... : • Cirrhosis ... disease • Acute liver ... #Algorithm #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 ... sarcoidosis) • Liver ... #causes #hepatology
Ascites Differential Diagnosis Table - Serum Ascites Albumin Gradient (SAAG)

SAAG ≥ 1.1:
 • Cirrhosis
 • Portal
Diagnosis Table ... SAAG ≥ 1.1: • Cirrhosis ... #Differential #Diagnosis ... #Table #Serum # ... Gradient #SAAG #hepatology
Causes of Ascites
Normal Peritoneum
Portal hypertension (SAAG > 1.1 g/dL)
  1. Hepatic congestionl
Liver disease ... - Cirrhosis ... - Acute fatty liver ... #Causes #diagnosis ... #differential #hepatology
Cirrhosis Timeline and Mortality Rate
Compensated Cirrhosis
Stage 1 - No varices (Annual Mortality Rate 1%)
Stage 2 -
Cirrhosis Timeline ... Stage 3 - Ascites ... Gl bleeding or Hepatic ... Mortality #Timeline #diagnosis ... #hepatology
Complications of Portal Hypertension
 • Hepatic Encephalopathy
 • Pulmonary: Hepatopulmonary syndrome, Portopulmonary hypertension, Hepatic hydrothorax
 •
Hypertension • Hepatic ... hydrothorax • Cirrhotic ... Hepatorenal syndrome • Ascites ... Complications #hepatology ... #diagnosis