Management of Patients with Ascites

Karen L. Krok, MD, Assistant Professor of Medicine, Division of Gastroenterology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Andrés Cárdenas, MD, MMSc, Institut de Malalties Digestives i Metaboliques, Hospital Clinic, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.

Ascites is the accumulation of free fluid in the peritoneal cavity. In over 80% of cases, it is a result of cirrhosis. Ascites develops in 60% of patients with cirrhosis within 10 years of the diagnosis of cirrhosis, and its development marks a turning point in the natural history of the disease. The mainstays of treatment are twofold: sodium restriction and diuretics. The development of spontaneous bacterial peritonitis is another ominous sign that requires indefinite antibiotic prophylaxis to prevent future infections. A referral to a transplant centre is essential once ascites or spontaneous bacterial peritonitis develop.
Key words: ascites, portal hypertension, cirrhosis, spontaneous bacterial peritonitis, paracentesis, albumin infusion.