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Topics:
Hepatology
•
Portal Hypertension
How do you decide between empiric carvedilol versus obtaining HVPG to confirm CSPH when noninvasive markers suggest CSPH but there is limited hemodynamic/renal reserve (borderline MAP and/or CKD)?
Related Questions
How do you use IVC caliber and collapsibility to guide decisions about diuresis?
How do you balance the need for diuretics from a volume perspective (Ex: ascites, edema) in decompensated cirrhotic patients and progressive renal dysfunction?
What are your clinical considerations to pursue an automated-low-flow ascites (ALFA) pump for a patient with refractory ascites?
Would you consider adding a loop diuretic for patients with HRS type 1 who are on a stable dose of vasoconstrictors to enhance diuresis?
What role do you see for albumin infusions in patients with hypoalbuminemia to help assist in volume status, outside of its use in replenishment after a large volume paracentesis or renal dysfunction?
In patients who meet Baveno VII NIT criteria for CSPH and are candidates for NSBB to prevent decompensation, when (if ever) do you still perform screening endoscopy before starting NSBB, and what specific findings would change your management?
Would you consider making a diagnosis of hepatorenal syndrome-associated acute kidney injury with a one-day diagnostic fluid challenge instead of a two-day challenge to expedite vasoconstrictor therapy if needed?
Who would be the right candidate in which TIPS placement would reduce portal hypertension to allow for a previously unattainable procedure?
When would you choose to measure a patient's spleen stiffness?
What is your strategy to manage peri-procedural bleeding risk in patients with cirrhosis?
