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The serum-ascites albumin gradient (SAAG) is probably a better discriminant than older measures (transudate versus exudate) for the causes of ascites. [12] A high gradient (> 1.1 g/dL) indicates the ascites is due to portal hypertension. A low gradient (< 1.1 g/dL) indicates ascites of non-portal hypertensive as a cause. [13]
As the condition is caused by leaking ascitic fluid, treatment centers around managing ascites and decompensated liver disease. Some individuals respond to medical management. In up to 26% of cases, the condition does not respond to medical management, in which case it is known as a refractory hepatic hydrothorax.
Chronic liver failure usually occurs in the context of cirrhosis, itself potentially the result of many possible causes, such as excessive alcohol intake, hepatitis B or C, autoimmune, hereditary and metabolic causes (such as iron or copper overload, steatohepatitis or non-alcoholic fatty liver disease). [citation needed]
Ascites is most commonly a complication of cirrhosis of the liver. [1] It can also occur in patients with nephrotic syndrome. [3] [4] SBP has a high mortality rate. [5] The diagnosis of SBP requires paracentesis, a sampling of the peritoneal fluid taken from the peritoneal cavity. [6]
There can be many causes of kidney failure in individuals with cirrhosis or fulminant liver failure. Consequently, it is a challenge to distinguish hepatorenal syndrome from other entities that cause kidney failure in the setting of advanced liver disease.
The underlying condition needs to be corrected; however, often the source of the hydrothorax is end stage liver disease and correctable only by transplant. Chest tube placement should not occur. Other measures such as a TIPS procedure are more effective as they treat the cause of the hydrothorax, but have complications such as worsened hepatic ...
Cirrhosis caused by Wilson's disease is treated by removing the copper which builds up in organs. [2] This is carried out using chelation therapy such as penicillamine. When the cause is an iron overload, iron is removed using a chelation agent such as deferoxamine or by bloodletting. [citation needed]
Other symptoms can develop based on the cause. For example, if portal vein thrombosis develops due to liver cirrhosis , bleeding or other signs of liver disease may be present. If portal vein thrombosis develops due to pylephlebitis , signs of infection such as fever, chills, or night sweats may be present.