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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
Ascites Workup ... Peritonitis (SBP) Hepatic ... Complications #diagnosis ... #management #gastroenterology ... #hepatology
Ascites - Differential Diagnosis and Workup Algorithm

•
Perform paracentesis:
 • Cell count and diff 
 • Total
Ascites - Differential ... Diagnosis and Workup ... #Differential # ... #gastroenterology ... #hepatology
Disorders of the Hepatic and Mesenteric Circulation

Platelets in Cirrhosis
Hypercoagulability in Cirrhosis
Bleeding in Cirrhosis
Portal Vein Thrombosis (PVT)
Mesenteric
Disorders of the Hepatic ... in Cirrhosis Bleeding ... Circulation #Disorders #Hepatology ... #Gastroenterology ... #diagnosis #Management
Diagnosis of ascites according to the serum ascites albumin gradient (SAAG)
SAAG ≥ 1.1:
 - Ascitic protein
Diagnosis of ascites ... SAAG ≥ 1.1: - Ascitic ... albumin #gradient #hepatology ... #differential # ... diagnosis #algorithm
Ascites - Differential Diagnosis
Chronic liver disease (cirrhosis or chronic hepatitis) - 80%
Underlying malignancy - 10%
Congestive heart
Ascites - Differential ... Diagnosis Chronic ... Disease, Fulminant Hepatic ... #Differential # ... Diagnosis #hepatology
Cirrhosis Timeline and Mortality Rate
Compensated Cirrhosis
Stage 1 - No varices (Annual Mortality Rate 1%)
Stage 2 -
Cirrhosis Stage 3 - Ascites ... Stage 4 - Gl bleeding ... or Hepatic Encephalopathy ... Mortality #Timeline #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 ... Matherly @liverprof #Diagnosis ... #Hepatology #SAAG ... Interpretation #Differential
Complications of Portal Hypertension
 • Hepatic Encephalopathy
 • Pulmonary: Hepatopulmonary syndrome, Portopulmonary hypertension, Hepatic hydrothorax
 •
Hypertension • Hepatic ... hypertension, Hepatic ... Hepatorenal syndrome • Ascites ... Complications #hepatology ... #diagnosis
Causes of Ascites - Differential Diagnosis Algorithm
Portal Hypertension - Prehepatic:
 • Portal vein thrombosis
 • Splenic
- Differential ... Diagnosis Algorithm ... Hypertension - Hepatic ... #Differential # ... #Hepatology #causes
Transhepatic Intrajugular Portosystemic Shunt (TIPS) 
Indications:
 • Ascites / Hepatic Hydrothorax
 • Variceal Bleeding
Cardiopulmonary, Renal, and
Indications: • Ascites ... / Hepatic Hydrothorax ... • Variceal Bleeding ... Portosystemic #Shunt #Hepatology ... #Gastroenterology