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hepatology diagnosis ascites differential gradient management algorithm clinical gastroenterology sbp serum treatment ultrasound abdominal abscess acutephasereactants analysis bacterial calling causes
Deciphering the SAAG - Serum to Ascites Albumin Gradient Ascites is either made in the liver sinusoid
Deciphering the SAAG ... either made in the liver ... or not by the liver ... fibrosis) High SAAG ... oncotic pressure Low SAAG
Ascites - Differential Diagnosis and Workup Algorithm • Perform paracentesis: • Cell count and diff • Total
• Perform paracentesis ... protein • Fluid albumin ... and serum albumin ... • Calculate SAAG
Diagnosis of ascites according to the serum ascites albumin gradient (SAAG) SAAG ≥ 1.1: - Ascitic protein
serum ascites albumin ... gradient (SAAG) ... SAAG ≥ 1.1: ... syndrome, Massive liver ... #ascites #albumin
Indications for Albumin for Management of Cirrhosis • Large volume paracentesis (>5 liter) - 8g per
Indications for Albumin ... • Large volume paracentesis ... (>5 liter) - 8g ... per liter of ascites ... terlipressin #Albumin
Ascites - Diagnosis and Management Summary Paracentesis studies: cell count + differential, albumin, protein, culture • Serum-ascites-albumin-gradient
Management Summary Paracentesis ... (SAAG): > 1.1 g ... ) Large-volume paracentesis ... Summary #Hepatology #SAAG ... #paracentesis
The Liver Consult Primer - Guide to calling a consult HPI: - Start with reason for consult
The Liver Consult ... different) PMHx: - Focus ... on prior Liver/ ... surgeries, TIPS, paracentesis ... US - Prior liver
Spontaneous Bacterial Peritonitis DIAGNOSTICS Paracentesis: • Calculate absolute PMN count (total WBC x PMN %) • Correct
DIAGNOSTICS Paracentesis ... as 10 days 2) Albumin ... 1.5 g/kg of 25% albumin ... : lg/kg of 25% albumin ... dL and advanced liver
Serum Ascites Albumin Gradient (SAAG) - Differential Diagnosis High albumin gradient (>1.1 g/dl): - Cirrhosis - Alcoholic
Serum Ascites Albumin ... Gradient (SAAG) ... ascites - Massive liver ... - Acute fatty liver ... ischemia/infarction #SAAG
Portal Hypertension - Differential Diagnosis Portal Pressure = the pressure difference between the pressure in the portal
HTN: ascites (SAAG ... INR, bilirubin, albumin ... sarcoidosis) • Liver ... metastasis • Fatty liver
Paracentesis Supplies Checklist • Sterile gloves • cap • face shield • chlorhex • sterile towels
Paracentesis Supplies ... perforation risk) or paracentesis ... bottles • 25% albumin ... dosed 6-8g per liter ... removed if >5L #Paracentesis
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