Management of ascites.
The evaluation of ascites includes a directed history, focused physical examination, and diagnostic paracentesis with ascitic fluid analysis. Dietary sodium restriction and oral diuretics are the mainstay of therapy for the majority of patients with cirrhotic ascites. Transjugular intrahepatic portocaval shunt has emerged as the treatment of choice for selected patients with refractory ascites, although serial large-volume paracenteses should be attempted first. Early diagnosis, broad-spectrum antibiotics, and albumin infusion contribute to the successful management of spontaneous bacterial peritonitis (SBP). Referral for liver transplant evaluation should be considered at the first sign of decompensation and should not be delayed until development of ominous clinical features, such as refractory ascites and SBP.
Yu
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Division of Gastroenterology and Hepatology, Stanford University School of Medicine, and Liver Transplant Program, Stanford University Medical Center, Stanford, USA. andysyu@stanford.edu
Hu
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D000418:Albumins / Q000378:metabolism; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001201:Ascites / Q000150:complications / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D001202:Ascitic Fluid / Q000378:metabolism / Q000382:microbiology; D001424:Bacterial Infections / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D004039:Diet, Sodium-Restricted; D004232:Diuretics / Q000627:therapeutic use; D006801:Humans; D006876:Hydrothorax / Q000209:etiology; D008103:Liver Cirrhosis / Q000150:complications*; D019152:Paracentesis; D010536:Peritoneovenous Shunt; D010538:Peritonitis / Q000628:therapy; D019168:Portasystemic Shunt, Transjugular Intrahepatic
D000418:Albumins; D000900:Anti-Bacterial Agents; D004232:Diuretics