Current concepts in the management of refractory cirrhotic ascites.
BACKGROUND
Ascites is the pathologic accumulation of fluid within the peritoneal cavity. This condition when refractory to treatment heralds more severe complications and a poor prognosis. The aim of this paper is to review literature on the pathogenesis and current management of refractory cirrhotic ascites.


METHODS
An English language literature search using Medline and PubMed (1976-2006 March) was done to assess all research/review articles on the pathogenesis and management of refractory cirrhotic ascites.


RESULTS
The onset of ascites in cirrhotic patients signifies poor prognosis. Only a small percentage of patients with cirrhotic ascites develop true resistance to diuretics. Serial therapeutic paracentesis remains the available option for the majority of patients. Liver transplantation is the only definitive therapy, but the use of this method is limited by the availability of the organ and the cost of such procedure. Transjugular intrahepatic portosystemic stent shunt is a useful procedure but limited by the complication of disseminated intravascular coagulopathy. The role of other alternatives is less clearly defined.


CONCLUSIONS
Therapeutic options in patient with cirrhotic ascites remains serial therapeutic paracentesis with or without plasma expansion. Transjugular intrahepatic portosystemic stent-shunt is a useful alternative. The unavailability of liver donors serves as a barrier to liver transplantation.
Oguntona
S A
SA
Department of Medicine, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria. oguntonasa@yahoo.com
Alebiosu
C O
CO
D001201:Ascites / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D004108:Dilatation, Pathologic; D004232:Diuretics / Q000627:therapeutic use; D005355:Fibrosis / Q000150:complications; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications; D008103:Liver Cirrhosis / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D016031:Liver Transplantation; D019152:Paracentesis / Q000379:methods; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011379:Prognosis
D004232:Diuretics