title: Management of uninfected and infected ascites in cirrhosis.
abstract: Ascites is the most frequent complication of patients with cirrhosis. Ascites is related to increased renal sodium retention as a result of increased activity of the renin-angiotensin-aldosterone system in response to marked vasodilation of the splanchnic circulation. Management of uncomplicated ascites is based on a low-sodium diet and diuretics. However, approximately 10% of patients develop refractory ascites during follow-up, which is associated with a poor prognosis. The treatment of choice in patients with refractory ascites is large-volume paracentesis associated with intravenous albumin. Moreover, patients who develop refractory ascites should be considered as candidates for liver transplantation. Patients with ascites are all at risk of developing spontaneous bacterial peritonitis (SBP). SBP is a common infection in patients with cirrhosis with a risk of mortality of 20%. Empirical antibiotics are the treatment of choice in patients with SBP but differ depending on the acquisition site of infection, because nosocomial infections have a higher risk of being caused by multiresistant bacteria. In addition to antibiotic treatment, all patients with SBP should also receive intravenous albumin. This review summarizes the management of uninfected ascites and SBP in cirrhosis.
authors.affiliation: Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain.|Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto Reina Sofía de Investigación Nefrológica (IRSIN).
authors.forename: Elsa
authors.initials: E
authors.lastname: Solà
authors.affiliation: Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain.|Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto Reina Sofía de Investigación Nefrológica (IRSIN).
authors.forename: Cristina
authors.initials: C
authors.lastname: Solé
authors.affiliation: Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain.|Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto Reina Sofía de Investigación Nefrológica (IRSIN).
authors.forename: Pere
authors.initials: P
authors.lastname: Ginès
mesh_terms: D000418:Albumins / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001201:Ascites / Q000209:etiology / Q000628:therapy*; D001424:Bacterial Infections / Q000188:drug therapy*; D003428:Cross Infection / Q000188:drug therapy; D019468:Disease Management; D004232:Diuretics / Q000627:therapeutic use; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D016031:Liver Transplantation / Q000009:adverse effects; D019152:Paracentesis / Q000009:adverse effects*; D010538:Peritonitis / Q000382:microbiology*; D016032:Randomized Controlled Trials as Topic; D012084:Renin-Angiotensin System / Q000187:drug effects; D012307:Risk Factors
chemical_list: D000418:Albumins; D000900:Anti-Bacterial Agents; D004232:Diuretics
keywords: ascites; diuretics; paracentesis; spontaneous bacterial peritonitis