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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
Management and Complications ... Management Refractory ... Complications #diagnosis #management ... #gastroenterology ... #hepatology
Acute-on-Chronic Liver Failure (ACLF) Clinical Guidelines

ACLF = possibly reversible condition in those with CLD (± cirrhosis)
(DILI) Viral Hepatitis ... Procedures Management ... Failure #Cirrhosis #Hepatology ... #gastroenterology ... #management #diagnosis
Ascites - Differential Diagnosis
Chronic liver disease (cirrhosis or chronic hepatitis) - 80%
Underlying malignancy - 10%
Congestive heart
Ascites - Differential ... Diagnosis Chronic liver ... cirrhosis or chronic hepatitis ... Chylous <1% #Ascites ... Differential #Diagnosis #hepatology
 End Stage Liver Disease (Cirrhosis) - Complications 
 • Ascites
 • Esophageal Varices
 • Hepatic
End Stage Liver ... Complications • Ascites ... SBP) #ESLD #Liver ... Complications #diagnosis #management ... #summary #hepatology
Approach to the Hospitalized Patient with Cirrhosis
1) Recognize and Manage Decompensation
 • Ascites
 • Variceal Bleeding
Decompensation • Ascites ... • Variceal Bleeding ... Scenarios • Alcoholic Hepatitis ... Portosystemic Shunt • Liver ... diagnosis #treatment #management
Causes of Ascites
Normal Peritoneum
Portal hypertension (SAAG > 1.1 g/dL)
  1. Hepatic congestionl
Causes of Ascites ... Liver disease ... - Alcoholic hepatitis ... - Acute fatty liver ... #differential #hepatology
Acute Fatty Liver of Pregnancy (AFLP)
Pathophysiology:
 • Defect in fetal free fatty acid metabolism products →
develops (DIC, ascites ... Diagnosis: Viral Hepatitis ... Intrahepatic Cholestasis Management ... #Pregnancy #hepatology ... obgyn #diagnosis #management
Spontaneous Bacterial Peritonitis (SBP) - Diagnosis and Management
Ascites PMN > 250/mm3
? Nosocomial or hospital acquired. Recent
Ascites PMN > ... acceptable Upper Gl bleeding ... protein (< 1.5g/L) ascites ... dysfunction or liver ... #hepatology
Disorders of the Hepatic and Mesenteric Circulation

Platelets in Cirrhosis
Hypercoagulability in Cirrhosis
Bleeding in Cirrhosis
Portal Vein Thrombosis (PVT)
Mesenteric
in Cirrhosis Bleeding ... Circulation #Disorders #Hepatology ... #Gastroenterology ... #diagnosis #Management
Drug Induced Liver Injury (DILI) - Stepwise Diagnosis Algorithm
DILI suspicion
Features toxic aetiology: Skin involvement, Kidney injury,
Drug Induced Liver ... disorder (e.g. ascites ... ), Chronic hepatitis ... • Autoimmune hepatitis ... Diagnosis #Algorithm #hepatology