Bad Belly

57 year old male with a long history of heavy alcohol consumption presents with complaints of severe abdominal pain and nausea. On exam he's mildly agitated and disoriented to time. Mildly febrile, tachycardic, tachypnic, blood pressure 90s/50s, normal O2 saturation. Jaundiced, numerous spider angiomata including telangiectasias on his face, arms, and chest. Abdomen is grossly distended, obvious fluid wave, and diffusely tender, no guarding but tenderness is elicited on abdominal percussion and rebound.

What acute illness to you most suspect? How will you confirm the diagnosis? How will you perform the diagnostic test? What results do you suspect? If results confirm your suspicion, how will you manage the patient?

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Cirrhosis Treatment Nuggets

Nuggets taken from AFP review paper on treatment in cirrhosis/chronic liver failure

Link to paper:  Liver Failure Treatment

1) In a patient with ascites, list the Grade A treatment recs.  (hint: 3 types)

2) What percentage of patients with ascites have cirrhosis as its etiology?

3) List causes of ascites that have SAAG <1.1 (hint: 1 malignant, 1 infectious, 1 endocrine/exocrine)

4) If propranolol is contraindicated for variceal bleeding prophylaxis, what's the next drug you can use?

Child-Pugh criteria mnemonic

HAPI BAbi

-hepatic encephalopathy
-ascites
-PT/INR

-Bili
-Albumin