1. Complications of Cirrhosis

2. Table 302 -1 Causes of Cirrhosis Alcoholism Cardiac cirrhosis Chronic viral hepatitis Inherited metabolic liver disease Hepatitis B Hemochromatosis Hepatitis C Wilson's disease Autoimmune hepatitis 1 Antitrypsin deficiency Nonalcoholic steatohepatitis Cystic fibrosis Biliary cirrhosis Cryptogenic cirrhosis Primary biliary cirrhosis Primary sclerosing cholangitis Autoimmune cholangiopathy

3. Table 302-2 Complications of Cirrhosis Portal hypertension Coagulopathy Gastroesophageal varices Factor deficiency Portal hypertensive gastropathy Fibrinolysis Splenomegaly, hypersplenism Thrombocytopenia Ascites Bone disease Spontaneous bacterial peritonitis Osteopenia Hepatorenal syndrome Osteoporosis Type 1 Osteomalacia Type 2 Hematologic abnormalities Hepatic encephalopathy Anemia Hepatopulmonary syndrome Hemolysis Portopulmonary hypertension Thrombocytopenia Malnutrition Neutropenia

5. Table 302 -3 Classification of Portal Hypertension Pre-hepatic Portal vein thrombosis Splenic vein thrombosis Massive splenomegaly (Banti's syndrome) Hepatic Presinusoidal Schistosomiasis Congenital hepatic fibrosis Sinusoidal Cirrhosis—many causes Alcoholic hepatitis Postsinusoidal Hepatic sinusoidal obstruction (venoocclusive syndrome) Posthepatic Budd-Chiari syndrome Inferior vena caval webs Cardiac causes Restrictive cardiomyopathy Constrictive pericarditis Severe congestive heart failure

11. Table 302-2 Complications of Cirrhosis Portal hypertension Coagulopathy Gastroesophageal varices Factor deficiency Portal hypertensive gastropathy Fibrinolysis Splenomegaly, hypersplenism Thrombocytopenia Ascites Bone disease Spontaneous bacterial peritonitis Osteopenia Hepatorenal syndrome Osteoporosis Type 1 Osteomalacia Type 2 Hematologic abnormalities Hepatic encephalopathy Anemia Hepatopulmonary syndrome Hemolysis Portopulmonary hypertension Thrombocytopenia Malnutrition Neutropenia

12. Ascites

18. Table 44-1 Characteristics of Ascitic Fluid in Various Disease States Condition Gross Appearance Protein, g/L Serum-Ascites Albumin Gradient, g/dL Cell Count Other Tests Red Blood Cells, >10,000/ L White Blood Cells, per L Cirrhosis Straw-colored or bile-stained <25 (95%) >1.1 1% <250 (90%) a ; predominantly mesothelial Neoplasm Straw-colored, hemorrhagic, mucinous, or chylous >25 (75%) <1.1 20% >1000 (50%); variable cell types Cytology, cell block, peritoneal biopsy Tuberculous peritonitis Clear, turbid, hemorrhagic, chylous >25 (50%) <1.1 7% >1000 (70%); usually >70% lymphocytes Peritoneal biopsy, stain and culture for acid-fast bacilli Pyogenic peritonitis Turbid or purulent If purulent, >25 <1.1 Unusual Predominantly polymorphonuclear leukocytes Positive Gram's stain, culture Congestive heart failure Straw-colored Variable, 15–53 >1.1 10% <1000 (90%); usually mesothelial, mononuclear Nephrosis Straw-colored or chylous <25 (100%) <1.1 Unusual <250; mesothelial, mononuclear If chylous, ether extraction, Sudan staining Pancreatic ascites (pancreatitis, pseudocyst) Turbid, hemorrhagic, or chylous Variable, often >25 <1.1 Variable, may be blood-stained Variable Increased amylase in ascitic fluid and serum

21. Table 44-1 Characteristics of Ascitic Fluid in Various Disease States Condition Gross Appearance Protein, g/L Serum-Ascites Albumin Gradient, g/dL Cell Count Other Tests Red Blood Cells, >10,000/ L White Blood Cells, per L Cirrhosis Straw-colored or bile-stained <25 (95%) >1.1 1% <250 (90%) a ; predominantly mesothelial Neoplasm Straw-colored, hemorrhagic, mucinous, or chylous >25 (75%) <1.1 20% >1000 (50%); variable cell types Cytology, cell block, peritoneal biopsy Tuberculous peritonitis Clear, turbid, hemorrhagic, chylous >25 (50%) <1.1 7% >1000 (70%); usually >70% lymphocytes Peritoneal biopsy, stain and culture for acid-fast bacilli Pyogenic peritonitis Turbid or purulent If purulent, >25 <1.1 Unusual Predominantly polymorphonuclear leukocytes Positive Gram's stain, culture Congestive heart failure Straw-colored Variable, 15–53 >1.1 10% <1000 (90%); usually mesothelial, mononuclear Nephrosis Straw-colored or chylous <25 (100%) <1.1 Unusual <250; mesothelial, mononuclear If chylous, ether extraction, Sudan staining Pancreatic ascites (pancreatitis, pseudocyst) Turbid, hemorrhagic, or chylous Variable, often >25 <1.1 Variable, may be blood-stained Variable Increased amylase in ascitic fluid and serum