A #Livertwitter #tweetorial
Hepatology is awesome, exciting, but also humbling.
Nowhere is that clearer than HRS, a true unmet need for patients with ascites
Aims
1. What
2. Why
3. How to prevent/treat
4. ❤️ #cirrhosis physiology
![](https://pbs.twimg.com/media/Do5jTHJXUAILpTV.jpg)
1. HRS is not rare in pts w/ascites (Fig1)
2. HRS is deadly (Fig2)
3. For a definition of terms, check out the Ascites Club (that's a thing!)
ref: gut.bmj.com/content/gutjnl…
or see my review: amjmed.com/article/S0002-… (Fig3)
![](https://pbs.twimg.com/media/Do5sEs-X4AEevuq.jpg)
![](https://pbs.twimg.com/media/Do5sEs_XkAIA6iR.jpg)
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1. #Cirrhosis is a traffic jam 4 portal inflow (Fig 1)
2. Splanchnic (gut) vascular bed vasodilates 🔼 pooling of blood (Fig2)
3. This means🔽return to the ❤️
4. Carotid baroreceptors, ADH, and RAAS to the "rescue" (Fig3)
![](https://pbs.twimg.com/media/Do5sFgtW0AMumgE.jpg)
![](https://pbs.twimg.com/media/Do5sFgwXgAI6nD0.jpg)
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1. Like most things in #hepatology, Sheila Sherlock did it first. (obit: aasldpubs.onlinelibrary.wiley.com/doi/abs/10.105…)
2. In 1956, she was first to note arterial vasodilation and first to use Norepi to treat HRS (Fig2)
3. Today: Albumin + Terli>/=Norepi>Midodrine/Octreo
![](https://pbs.twimg.com/media/Do3oeXWXgAA2lG1.jpg)
![](https://pbs.twimg.com/media/Do5fmbEXsAE-R99.jpg)
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The #cirrhosis #QI takeaways
1. Dont miss SBP (early dx para when admitted)
2. 🚫NSAIDs if ascites
3. Albumin w/therapeutic paras
Please @ me if u have anything to add!
If U want more #cirrhosis physiology, the refs are embedded in the figs