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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
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
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
Ascites - Differential Diagnosis
Chronic liver disease (cirrhosis or chronic hepatitis) - 80%
Underlying malignancy - 10%
Congestive heart
Ascites - Differential ... Diagnosis Chronic ... Disease, Fulminant Hepatic ... Chylous <1% #Ascites ... #hepatology
Transhepatic Intrajugular Portosystemic Shunt (TIPS) 
Indications:
 • Ascites / Hepatic Hydrothorax
 • Variceal Bleeding
Cardiopulmonary, Renal, and
Indications: • Ascites ... / Hepatic Hydrothorax ... • Variceal Bleeding ... Portosystemic #Shunt #Hepatology ... #Gastroenterology
Causes of Ascites
Normal Peritoneum
Portal hypertension (SAAG > 1.1 g/dL)
  1. Hepatic congestionl
Hepatic congestionl ... - Massive hepatic ... peritonitis - HIV-associated ... #Causes #diagnosis ... #differential #hepatology
Causes of Diffuse Lymphadenopathy - Differential Diagnosis Algorithm
Reactive:
 - Systemic Inflammatory
     •
- Differential Diagnosis ... • CMV • HIV ... Leukemia - History of Bleeding ... Algorithm #Causes #Hematology ... #Oncology
Spontaneous Bacterial Peritonitis (SBP) - Diagnosis and Management
Ascites PMN > 250/mm3
? Nosocomial or hospital acquired. Recent
Peritonitis (SBP) - Diagnosis ... and Management Ascites ... Presentation in septic ... acceptable Upper Gl bleeding ... #Management #hepatology
Disseminated Intravascular Coagulation (DIC) Overview

Increased Clotting and Consumption of Clotting Factors

Findings:
 • Bleeding
 • Recent history
or venipuncture sites ... deficiency) • HIT ... 100mg/dL) - Heparin ... #Coagulation #diagnosis ... treatment #management #hematology
Heparin Induced Thrombocytopenia (HIT) - Diagnosis and Management - GrepMed Handbook

Presentation: 
 • Plts ↓50% (nadir
) - Diagnosis and ... (at injection sites ... thrombocytopenia Diagnosis ... #HIT #Heparin ... Management #Treatment #Hematology