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Spontaneous Bacterial Peritonitis

SAAG

Serum Albumin – Albumin of Ascitic Fluid

High SAAG (>11g/L)

Suggests that the cause of ascites is related to portal hypertension

Causes:
Cirrhosis
Hepatic malignancy or metastasis
Right-Sided Cardiac Failure
Portal Vein Thrombosis
Budd-Chiari Syndrome

Low SAAG (<11g/L)
Suggests that cause of ascites is NOT related to portal hypertension

Causes:
Pancreatitis
Peritoneal metastasis
Nephrotic Syndrome
Tuberculosis

Hepatic Encephalopathy

Can be classified by the West Haven Criteria:

Grade	Criteria
0	Nil obvious changes clinically On formal psychometric or neuropsychological tests, may have some minor dysfunction
1	Trivial lack of awareness Disrupted sleep/wake cycle Shortened attention span Anxiety or euphoria
2	Lethargy and Apathy Moderate confusion Personality changes/Inappropriate Behaviour Asterixis
3	Marked confusion Stuporous Incoherent speech Gross disorientation
4	Comatose

Types of Hepatic Encephalopathy

Type A (Acute) – Hepatic encephalopathy associated with acute liver failure

Type B (Bypass) – Hepatic encephalopathy associated with portosystemic shunting in the ABSENCE of liver disease

Type C (Cirrhosis) – Hepatic encephalopathy associated with cirrhosis with resulting portal hypertension or systemic shunting

Wernicke-Korsakoff Syndrome

Develops as a result of thiamine (Vitamin B1) Deficiency, and refers to two separate stages of the disease:

Wernicke’s Encephalopathy: Acute syndrome that requires treatment to prevent further neurological morbidity. Classified by the triad of:

Korsakoff’s Syndrome: A chronic neurological condition that comes as a result of untreated Wernicke’s Encephalopathy. Characterised by:

References:

Ferenci, P. (2020), Hepatic Encephalopathy in Adults: Clinical Manifestations and Diagnosis. UpToDate. Retrieved November 21, 2020 from https://www.uptodate.com.acs.hcn.com.au/contents/hepatic-encephalopathy-in-adults-clinical-manifestations-and-diagnosis

Runyon, B.A. (2020), Evaluation of Adults with Ascites. UpToDate. Retrieved November 21, 2020 from https://www.uptodate.com.acs.hcn.com.au/contents/evaluation-of-adults-with-ascites

Yuen, T.S. (2020), Wernicke Encephalopathy. UpToDate. Retrieved November 21, 2020 from https://www.uptodate.com.acs.hcn.com.au/contents/wernicke-encephalopathy

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