Gut, Liver & Pancreas · ICU Decoded chapter 61 · Free in full
Cited to AASLD / EASL.
Key points
Variceal bleed: octreotide + ceftriaxone + band ligation within 12 h; consider rescue/early TIPS for uncontrolled or recurrent bleeding.
Hepatic encephalopathy: titrate lactulose to 2–3 stools, add rifaximin for recurrent or persistent overt encephalopathy, and correct precipitants.
SBP: ascitic PMN ≥250 → start cefotaxime/ceftriaxone with albumin 1.5 g/kg day 1 and 1 g/kg day 3.
HRS-AKI: albumin plus terlipressin 1 mg IV q6h (FDA-approved) or midodrine+octreotide; MELD-Na drives listing.
Pathways
Assessing Cirrhotic Ascites
Cirrhosis with ascites
New-onset ascites or a change in clinical status?
Paracentesis
Ascitic fluid results?
>250 PMNs/mL and/or (+) culture → give antibiotics, IV albumin
Multiple organisms or high cell counts → any two of: total protein >1 g/dL · glucose <50 mg/dL · LDH > upper limit of serum reference range → work up peritonitis from perforation or nonperforation abdominal abscess
ICU Decoded — original critical-care and internal-medicine pathways by
Dr Javed Akhtar, each cited to a current guideline. For education and quick
reference; verify every dose against local protocols before prescribing.