Medical management of ascites

Leung, Wesley

doi:10.1517/14656566.2011.549126

Cited by 9 publications

(1 citation statement)

References 98 publications

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“…The underlying pathophysiology that leads to ascites formation in cirrhosis is renal sodium retention; therefore, the mainstay of treatment of ascites is to induce a negative sodium balance. This can be achieved by reducing the dietary sodium intake, as well as increasing the renal sodium output using a combination of diuretics 4 . It is not uncommon for patients with ascites who are not on diuretics to have renal sodium excretion of < 20 mmol/day.…”

Section: Dietary Sodium Restrictionmentioning

confidence: 99%

Management of ascites in cirrhosis

Wong

2011

J of Gastro and Hepatol

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Ascites is a common complication of liver cirrhosis associated with a poor prognosis. The treatment of ascites requires dietary sodium restriction and the judicious use of distal and loop diuretics, sequential at an earlier stage of ascites, and a combination at a later stage of ascites. The diagnosis of refractory ascites requires the demonstration of diuretic nonresponsiveness, despite dietary sodium restriction, or the presence of diuretic-related complications. Patients with refractory ascites require second-line treatments of repeat largevolume paracentesis (LVP) or the insertion of a transjugular intrahepatic portosystemic shunt (TIPS), and assessment for liver transplantation. Careful patient selection is paramount for TIPS to be successful as a treatment for ascites. Patients not suitable for TIPS insertion should receive LVP. The use of albumin as a volume expander is recommended for LVP of >5-6 L to prevent the development of circulatory dysfunction, although the clinical significance of post-paracentesis circulatory dysfunction is still debated. Significant mortality is still being observed in cirrhotic patients with ascites and relatively preserved liver and renal function, as indicated by a lower Model for End-Stage Liver Disease (MELD) score. It is proposed that patients with lower MELD scores and ascites should receive additional points in calculating their priority for liver transplantation. Potential new treatment options for ascites include the use of various vasoconstrictors, vasopressin V 2 receptor antagonists, or the insertion of a peritoneo-vesical shunt, all of which could possibly improve the management of ascites.

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Section: Dietary Sodium Restrictionmentioning

confidence: 99%

Management of ascites in cirrhosis

Wong

2011

J of Gastro and Hepatol

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Transjugular Intrahepatic Portosystemic Shunt Placement During Pregnancy: A Case Series of Five Patients

Ingraham

Padia

Johnson

et al. 2015

Cardiovasc Intervent Radiol

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Ascites

Gordon

2012

Clinics in Liver Disease

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Ascites is the pathologic accumulation of fluid in the peritoneum. It is the most common complication of cirrhosis, with a prevalence of approximately 10%. Over a 10-year period, 50% of patients with previously compensated cirrhosis are expected to develop ascites. As a marker of hepatic decompensation, ascites is associated with a poor prognosis, with only a 56% survival 3 years after onset. In addition, morbidity is increased because of the risk of additional complications, such as spontaneous bacterial peritonitis and hepatorenal syndrome. Understanding the pathophysiology of ascites is essential for its proper management.

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Medical management of ascites

Cited by 9 publications

References 98 publications

Management of ascites in cirrhosis

Management of ascites in cirrhosis

Transjugular Intrahepatic Portosystemic Shunt Placement During Pregnancy: A Case Series of Five Patients

Ascites

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