Management of ascites

Abstract

Ascites is the most common complication of liver cirrhosis, occurring at the rate of 5-7% of all cirrhotic patients per annum, associated with reduced survival to approximately 60% at 2 years. Abnormal hemodynamics, initiated by portal hypertension, is the basis of the pathophysiology that eventually leads to the development of ascites in cirrhosis. Recent evidence suggests that inflammation, related to bacterial translocation, and ongoing hepatocyte necrosis also contribute to the pathophysiology of ascites formation. The management of ascites consists of dietary sodium restriction and judicious use of diuretics. It is important to recognize when refractory ascites has occurred; then second-line treatments for ascites will need to be initiated. These include large-volume paracentesis with albumin infusions and/or the insertion of a transjugular intrahepatic portal systemic shunt in the appropriate patients. All patients with ascites and liver dysfunction need to be referred for liver transplant assessment. Further treatments that hold promise include regular albumin infusions not accompanying large-volume paracentesis and the use of an alfapump.