[How I treat ... ascites].
Ascites is the most common of the major complications of cirrhosis. The initial evaluation of a patient with ascites should include a history, physical evaluation and some investigations. Treatment should consist of treating the underlying liver disease, sodium restricted diet (2 g of Na+/day) and diuretics. This regimen is effective in 90% of patients. The treatment options for the diuretic resistant patients include serial therapeutic paracentesis, peritoneovenous shunting, TIPS and liver transplantation. The treatment and prophylaxis of spontaneous bacterial peritonitis which is a frequent and severe complication in cirrhotic patients with ascites is also important. The differential diagnosis with secondary bacterial peritonitis is essential because the latter usually does not resolve unless patients are surgically treated.
Gielen
S
S
Service de Gastro-entérologie, CHU Sart Tilman.
Delwaide
J
J
Detry
O
O
Belaiche
J
J
D001201:Ascites / Q000209:etiology / Q000382:microbiology / Q000628:therapy*; D001424:Bacterial Infections / Q000209:etiology / Q000517:prevention & control; D003937:Diagnosis, Differential; D004032:Diet; D004232:Diuretics / Q000627:therapeutic use; D004351:Drug Resistance; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000628:therapy; D016031:Liver Transplantation; D019152:Paracentesis; D010538:Peritonitis / Q000209:etiology / Q000517:prevention & control; D010808:Physical Examination; D011379:Prognosis
D004232:Diuretics