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Portal Hypertension - Differential Diagnosis
Portal Pressure = the pressure difference between the pressure in the portal
HTN: ascites (SAAG ... Ascites protein ... : • Cardiac causes ... sarcoidosis) • Liver ... metastasis • Fatty liver
Causes of Ascites
Normal Peritoneum
Portal hypertension (SAAG > 1.1 g/dL)
  1. Hepatic congestionl
Causes of Ascites ... Portal hypertension ... Liver disease ... - Cirrhosis ... #Causes #diagnosis
Causes of Ascites - Differential Diagnosis Algorithm
Portal Hypertension - Prehepatic:
 • Portal vein thrombosis
 • Splenic
Causes of Ascites ... Hypertension - Hepatic ... : • Cirrhosis ... disease • Acute liver ... Hypertension - Post-Hepatic
Approach to the Hospitalized Patient with Cirrhosis
1) Recognize and Manage Decompensation
 • Ascites
 • Variceal Bleeding
Hospitalized Patient with Cirrhosis ... Decompensation • Ascites ... • Variceal Bleeding ... • Hepatic Encephalopathy ... Portosystemic Shunt • Liver
 End Stage Liver Disease (Cirrhosis) - Complications 
 • Ascites
 • Esophageal Varices
 • Hepatic
End Stage Liver ... Disease (Cirrhosis ... Complications • Ascites ... Esophageal Varices • Hepatic ... #Cirrhosis #Complications
Causes of Portal Hypertension According to Site of Vascular Obstruction
1) Prehepatic pre-sinusoidal: Portal vein thrombosis due
Causes of Portal ... or secondary to cirrhosis ... 3) Sinusoidal: Cirrhosis ... , Polycystic liver ... disease 5) Post-hepatic
Ascites - Differential Diagnosis
Chronic liver disease (cirrhosis or chronic hepatitis) - 80%
Underlying malignancy - 10%
Congestive heart
Ascites - Differential ... Diagnosis Chronic liver ... disease (cirrhosis ... failure - 3-5% Cirrhosis ... Disease, Fulminant Hepatic
Complications of Portal Hypertension
 • Hepatic Encephalopathy
 • Pulmonary: Hepatopulmonary syndrome, Portopulmonary hypertension, Hepatic hydrothorax
 •
Complications of Portal ... Hypertension • Hepatic ... hypertension, Hepatic ... hydrothorax • Cirrhotic ... Hepatorenal syndrome • Ascites
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 ... The hepatic sinusoid ... sinusoid with (ie Portal
Clinical Examination for Liver and Biliary Diseases
1) Hands: Clubbing, Dupuytren's contracture, Leuconychia, Bruising, Flapping tremor (hepatic
Examination for Liver ... Flapping tremor (hepatic ... Aspiration of ascitic ... #physicalexam #cirrhosis ... #liver #disease