paracentesis

  • SAAG > 1.1: portal HTN
    • TP > 2.5: cardiac, heart failure, budd chiari
    • TP < 2.5: cirrhotic
    • if TP < 1.5: less complement, less immunity, assume SBP
  • SAAG < 1.1: nephrotic syndrome
  • SBP: signs of renal dysfunction, bad systemic function (bili > 3, Child pugh > 9)
  • portal vein => (1) hepatic vein => heart
    1. sinusoids, protein from heart. Pressure pushes out protein, so higher protein
    • in cirrhosis, fibrosis prevents outflow, so lower total protein