J J Kuiper1, R A de Man, H R van Buuren. 1. Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands. j.j.kuiper@erasmusmc.nl
Abstract
BACKGROUND: Ascites is the most common complication of cirrhosis, associated with an expected survival below 50% after 5 years. Prognosis is particularly poor for patients with refractory ascites and for those developing complications, including spontaneous bacterial peritonitis (SBP) and hepatorenal syndrome (HRS). AIM: To provide an evidence-based overview of the pathophysiology, diagnosis and clinical management of ascites secondary to liver cirrhosis. METHODS: Review based on relevant medical literature. RESULTS: Portal hypertension, splanchnic vasodilatation and renal sodium retention are fundamental in the pathophysiology of ascites formation. The SAAG (serum-ascites albumin gradient) allows reliable assessment of the cause of ascites. The majority of cirrhotic patients with ascites can be managed with dietary sodium restriction in combination with diuretic agents. Large volume paracentesis with albumin suppletion and TIPS are therapeutic options in patients with refractory ascites. Prophylactic antibiotics for SBP should be given in certain patient populations. CONCLUSIONS: Recent advances in the diagnosis and treatment of ascites and associated complications have improved the medical management and poor prognosis of patients with these manifestations of advanced liver disease. Early diagnosis, adequate treatment and focus on prevention of complications remain essential as well as timely referral for liver transplantation.
BACKGROUND:Ascites is the most common complication of cirrhosis, associated with an expected survival below 50% after 5 years. Prognosis is particularly poor for patients with refractory ascites and for those developing complications, including spontaneous bacterial peritonitis (SBP) and hepatorenal syndrome (HRS). AIM: To provide an evidence-based overview of the pathophysiology, diagnosis and clinical management of ascites secondary to liver cirrhosis. METHODS: Review based on relevant medical literature. RESULTS: Portal hypertension, splanchnic vasodilatation and renal sodium retention are fundamental in the pathophysiology of ascites formation. The SAAG (serum-ascites albumin gradient) allows reliable assessment of the cause of ascites. The majority of cirrhotic patients with ascites can be managed with dietary sodium restriction in combination with diuretic agents. Large volume paracentesis with albumin suppletion and TIPS are therapeutic options in patients with refractory ascites. Prophylactic antibiotics for SBP should be given in certain patient populations. CONCLUSIONS: Recent advances in the diagnosis and treatment of ascites and associated complications have improved the medical management and poor prognosis of patients with these manifestations of advanced liver disease. Early diagnosis, adequate treatment and focus on prevention of complications remain essential as well as timely referral for liver transplantation.
Authors: Ki Tae Suk; Soon Koo Baik; Jung Hwan Yoon; Jae Youn Cheong; Yong Han Paik; Chang Hyeong Lee; Young Seok Kim; Jin Woo Lee; Dong Joon Kim; Sung Won Cho; Seong Gyu Hwang; Joo Hyun Sohn; Moon Young Kim; Young Bae Kim; Jae Geun Kim; Yong Kyun Cho; Moon Seok Choi; Hyung Joon Kim; Hyun Woong Lee; Seung Up Kim; Ja Kyung Kim; Jin Young Choi; Dae Won Jun; Won Young Tak; Byung Seok Lee; Byoung Kuk Jang; Woo Jin Chung; Hong Soo Kim; Jae Young Jang; Soung Won Jeong; Sang Gyune Kim; Oh Sang Kwon; Young Kul Jung; Won Hyeok Choe; June Sung Lee; In Hee Kim; Jae Jun Shim; Gab Jin Cheon; Si Hyun Bae; Yeon Seok Seo; Dae Hee Choi; Se Jin Jang Journal: Korean J Hepatol Date: 2012-03-22