Cirrhosis TIPS for the decompensated cirrhotic & acute on chronic liver failure from expert hepatologist and keto-practitioner Scott Matherly MD, @liverprof and chief hepatologist at @KashlakHospital. We walk through acute management of variceal bleeds, when to suspect SBP in decompensated cirrhosis (all the time, it turns out), how much fluid to remove in paracentesis, and some definitions about what decompensated cirrhosis and acute on chronic liver failure really mean. Take our pretest on cirrhosis! Full show notes available at http://thecurbsiders.com/episode-list. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written and produced by: Nora Taranto MS4, Matthew Watto MD Pretest by: Cyrus Askin MD Hosts: Matthew Watto MD, Paul Williams MD, Images and infographics: Hannah Abrams MS3 Edited by: Matthew Watto MD Guest: Scott Matherly MD Sponsor  Get your ACP membership today and use the code CURB100 to save $100 when you join by March 31, 2019. Time Stamps 00:00 NephMadness teaser 00:50 Sponsor - Become an ACP Member today! 01:25 Intro, guest bio 03:45 Guest one-liner, keto diet 07:40 Picks of the week from Paul, Matt and Scott 11:50 Sponsor - Become an ACP Member today! 13:26 Clinical case of bleeding and altered mental status in cirrhosis 16:10 Interpretation of our patient’s labs and physical exam 18:53 Defining terminology in cirrhosis (decompensated vs compensated vs acute on chronic liver failure) 24:48 Initial workup, resuscitation and stabilization in variceal bleeding 26:10 Why occult blood and ammonia levels are unhelpful in cirrhosis 29:00 Fluid choice for the cirrhotic patient with hypotension; octreotide (or terlipressin); antibiotics prophylaxis 33:10 Proton pump inhibitors and ulcers from variceal banding 34:00 Mechanism of action for octreotide and terlipressin 35:54 Prevention of recurrent bleeding with TIPS, or nonselective beta blockers 40:40 Scores for prognostication in the acute setting 44:00 Coagulopathy of cirrhosis and should DVT prophylaxis be used 48:38 Elevated INR and procedures 56:55 Paracentesis in the acute setting and interpretation of fluid studies:cell count, total protein, SAAG, blood culture vial; pathophysiology of ascites 67:30 Treatment of SBP: antibiotics, IV albumin; plus, Hepatorenal physiology explained 79:04 Hepatic encephalopathy is a shunt phenomen; how to evaluate for causes; treatment of HE 87:58 Rifaximin 89:10 Take home points 91:02 Outro