Korean J Gastroenterol.  2018 Aug;72(2):49-55. 10.4166/kjg.2018.72.2.49.

Ascites

• Jeong SW

• KMID: 2418763
• DOI: http://doi.org/10.4166/kjg.2018.72.2.49

Abstract

Ascites is the most common cause of decompensation in cirrhosis, and 5% to 10% of patients with compensated cirrhosis develop ascites each year. The main factor of ascites formation is renal sodium retention due to activation of the renin-angiotensin-aldosterone system and sympathetic nervous system by the reduced effective volume secondary to splanchnic arterial vasodilation. Diagnostic paracentesis is indicated in all patients with a new onset of grade 2 or 3 ascites and in those admitted to hospital for any complication of cirrhosis. A serum-ascites albumin gradient of ≥1.1 g/dL indicates portal hypertension with an accuracy of approximately 97%. Sodium restriction, diuretics, and large volume paracentesis are the mainstay of treatment in grade 1 to 3 ascites. The refractoriness of ascites is associated with a poor prognosis with a median survival of approximately six months. Repeated large volume paracentesis plus albumin is the first line treatment, and liver transplantation is recommended in patients with refractory ascites. A careful selection of patients is also important to obtain the beneficial effects of transjugular intrahepatic portosystemic shunts in refractory ascites. This review details the recent diagnosis and treatment of cirrhotic ascites.

Keyword

Ascites; Liver cirrhosis; Hypertension portal

MeSH Terms

Ascites*
Diagnosis
Diuretics
Fibrosis
Humans
Hypertension, Portal
Liver Cirrhosis
Liver Transplantation
Paracentesis
Portasystemic Shunt, Surgical
Prognosis
Renin-Angiotensin System
Sodium
Sympathetic Nervous System
Vasodilation
Diuretics
Sodium