Top tips:
- Consider non hepatic causes in the differential diagnosis of a pleural effusion in a patient with cirrhosis
- The mainstay of therapy for a hepatic hydrothorax is sodium restriction and diuretics.
- In symptomatic patients pleural fluid drainage is suggested. Although there are varying protocols for carrying out drainage, a conservative guidance is to drain a maximum of 1.5 L of pleural fluid over 6hours to avoid re-expansion pulmonary edema.
- Do not use surgical chest tube placement
- Consider candidacy for a Transjugular Intrahepatic Portosystemic Shunt (TIPS)
- Consider candidacy for liver transplantation
Order panels for Hepatic Hydrothorax and Thoracentesis:
For adults with cirrhosis admitted with Hepatic Hydrothorax.
Ascites Hepatic Hydrothorax, Edema in Cirrhosis Order
For adult inpatients with cirrhosis requiring thoracentesis.
Inpatient Thoracentesis Order Panel
For adult outpatients with cirrhosis requiring thoracentesis.
Outpatient Thoracentesis Order Panel
General Cirrhosis Admission and Discharge Order Sets
*Add specific panels to general admission orders as appropriate*
For adults with cirrhosis requiring hospital admission
Cirrhosis Adult Admission Orders
For adults with cirrhosis requiring hospital discharge
Cirrhosis Adult Discharge Orders
Check out the bottom of the page for short videos from Dr. Li, Dr. Tandon and Dr. Abraldes!
Introducing Dr. Tandon, Dr. Li and Dr. Abraldes
Coming soon!
Video Links:
See relevant videos:
Video on the ultrasound based drainage of pleural fluid
References:
This section was adapted from content using the following evidence based resources in combination with expert consensus. The presented information is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances to determine a patient’s care.
Authors: Dr. Marilyn Zeman, Dr. Pen Li, Dr. Vijey Selvarajah, Dr. Brian Buchanan, Dr. Puneeta Tandon
References:
- EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatol 2018 Aug;69(2):406-460 PMID 29653741