hepatic and biliary disorders
Ascites
Treatment of Ascites
Dietary sodium restriction Sometimesspironolactone, possibly plusfurosemide Sometimes therapeutic paracentesis (See also the American Association for the Study of Liver Diseases [AASLD] practice guidelineAASLD 2021 Guideline on diagnosis, evaluation and managementof ascites, spontaneous bacterial peritonitis [SBP], and hepatorenal syndrome.) Dietary sodium restriction (2000 mg/day) is the first and least risky treatment for ascites due to Portal Hypertension . Diuretics should be used if rigid sodium restriction fails to initiate diuresis within a few days. Changes in body weight and urinary sodium determinations reflect response to treatment. Weight loss of about 0.5 kg/day is optimal because the ascitic compartment cannot be mobilized much more rapidly. More aggressive diuresis depletes fluid from the intravascular compartment, especially when peripheral edema is absent; this depletion may cause renal failure or electrolyte imbalance (eg, hypokalemia) that may precipitate Portosystemic Encephalopathy . If peripheral edema is present, more aggressive diuresis up to 1 kg/day is usually well tolerated ( helps reduce the risk of post-paracentesis hypotension (post-paracentesis circulatory dysfunction), which can precipitate Hepatorenal syndrome . Therapeutic paracentesis can reduce ascites more quickly than diuretics; however, patients require ongoing diuretics to prevent reaccumulation of ascites. Techniques for the autologous infusion of ascitic fluid (eg, the LeVeen peritoneovenous shunt) often cause complications and are generally no longer used. Transjugular intrahepatic portosystemic shunting (TIPS) can lower portal pressure and successfully treat ascites resistant to other treatments, but TIPS is invasive and may cause complications, including portosystemic encephalopathy and worsening hepatocellular function. 400 mg daily) or inability to tolerate diuretics due to Acute Kidney Injury (AKI) or hypotension. Refractory ascites is an indication for referral for (See also the AASLD practice guidelineAASLD 2021 Guideline on diagnosis, evaluation and managementof ascites, SBP, and hepatorenal syndrome. 1.European Association for the Study of the Liver: EASL clinical practice guidelines for the management of patients with decompensated cirrhosis.J Hepatol69:406-460, 2018. doi.org/10.1016/j.jhep.2018.03.024 