Ascites: diagnosis and management.

Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, MCV Box 980341, Richmond, VA 23298-0341, USA.
The Medical clinics of North America (Impact Factor: 2.8). 08/2009; 93(4):801-17, vii. DOI: 10.1016/j.mcna.2009.03.007
Source: PubMed

ABSTRACT Ascites is the pathologic accumulation of fluid in the peritoneal cavity and is a common manifestation of liver failure, being one of the cardinal signs of portal hypertension. The diagnostic evaluation of ascites involves an assessment of its cause by determining the serum-ascites albumin gradient and the exclusion of complications eg, spontaneous bacterial peritonitis. Although sodium restriction and diuretics remain the cornerstone of ascites management, many patients require additional therapy when they become refractory to such medical treatment. These include repeated large volume paracentesis and transjugular intrahepatic portosystemic shunts. This review article summarizes diagnostic tools and provides an evidence-based approach to the management of ascites.

  • [Show abstract] [Hide abstract]
    ABSTRACT: AIM: To evaluate the efficacy and safety of tolvaptan to treat refractory ascites in decompensated liver cirrhosis patients with or without further complications, such as hepatorenal syndrome and/or hepatocellular carcinoma. METHODS: Thirty-nine patients (mean age 55 years, males: 32) with decompensated liver cirrhosis and refractory ascites were enrolled. All patients received a combination of tolvaptan (15 mg/d for 5-14 d) and diuretics (40-80 mg/d of furosemide and 80-160 mg/d of spironolactone). The etiology of cirrhosis included hepatitis B (69.2%), hepatitis C (7.7%) and alcohol-induced (23.1%). Changes in the urine excretion volume, abdominal circumference and edema were assessed. The serum sodium levels were also measured, and adverse events were recorded. A follow-up assessment was conducted 1 mo after treatment with tolvaptan. RESULTS: Tolvaptan increased the mean urine excretion volume (1969.2 +/- 355.55 mL vs 3410.3 +/- 974.1 mL, P < 0.001), and 89.7% of patients showed improvements in their ascites, 46.2% of whom showed significant improvements. The overall efficacy of tolvaptan in all patients was 89.7%; the efficacies in patients with hepatocellular carcinoma and hepatorenal syndrome were 84.2% and 77.8%, respectively. The incidence of hyponatremia was 53.8%. In patients with hyponatremia, the serum sodium levels increased after tolvaptan treatment (from 128.1 +/- 4.22 mEq/L vs 133.1 +/- 3.8 mEq/L, P < 0.001). Only mild drug-related adverse events, including thirst and dry mouth, were observed. CONCLUSION: Tolvaptan is a promising aquaretic for the treatment of refractory ascites in patients with decompensated liver cirrhosis.
    World Journal of Gastroenterology 08/2014; 20(32):11400-5. DOI:10.3748/wjg.v20.i32.11400 · 2.43 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Refractory ascites accounts for 5-10 % of all ascites and portends a very poor prognosis. Refractory ascites can be diuretic-resistant (unresponsive to maximal dose of diuretics) or diuretic-intractable (inability to use an effective dose of diuretics due to development of complications). Management is challenging as therapeutic options are limited. Available options include serial large volume paracentesis or placement of transjugular intrahepatic portosystemic shunt. A novel device involving an automated low flow ascites pump and a peritoneo-vesical shunt has been recently developed but long term safety and efficacy data are awaited. Liver transplantation is the only modality proven to improve long-term survival.
    Current Hepatitis Reports 03/2014; 13(1):50-59. DOI:10.1007/s11901-014-0216-8
  • [Show abstract] [Hide abstract]
    ABSTRACT: Large-volume paracentesis (LVP) can be time and labor intensive depending on the amount of ascites removed and the method of drainage. Wall suction has been adopted as the preferred method of drainage at many centers, though the safety and benefits of this technique have not been formally evaluated. The primary objective of this study was to define the cost and time savings of wall suction over the traditional glass vacuum bottle method for ascites drainage. The secondary objective was to compare the safety profile and patient satisfaction using these two techniques.
    Therapeutic Advances in Gastroenterology 09/2014; 7(5):184-92. DOI:10.1177/1756283X14532704


Available from