Cirrhosis - Ascites

Ascites

Nearly all patients with ascites (fluid accumulation in the abdomen) can benefit from the following measures:

• Abstaining from alcohol. (Sometimes abstaining from alcohol is enough to reverse this complication.)
• Restricting salt.
• Taking diuretics, usually spironolactone (Aldactone) and furosemide (Lasix). Previously, spironolactone was usually given alone, but experts now use it by itself only in patients with minimal fluid buildup. Patients should be monitored carefully for excessive and too rapid fluid loss, which can set off complications, including hypokalemia (dangerously low potassium levels), kidney failure, or encephalopathy. Weight loss from diuretics usually should not exceed 1 - 2 pounds per day, but there is no limit for patients with massive swelling.

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Doctors often recommend bed rest for patients with ascites, but many experts believe this is not necessary and studies do not support its benefits. Restricting fluid is not usually necessary unless sodium levels in the blood are very low.

Treatment for Recurring or Refractory Ascites

Patients with recurring ascites or ascites that does not respond to standard diuretics after a month may require procedures to reduce fluid.

Large-Volume Paracentesis. Large-volume paracentesis is the current standard procedure and involves the following:

• Large volumes of fluid are removed through a tube in the abdomen. Research indicates that 4 - 6 liters are usually effective and safe.
• Albumin (protein) may be administered intravenously. This helps prevent a sudden drop in blood flow in the arteries. One study suggested that terlipressin, a drug that constricts blood vessels, may be as effective.
• If the ascites does not respond to treatments, paracentesis may need to be repeated every 2 weeks or more frequently, and up to 10 liters may need to be removed.

Patients who need this procedure are probably not complying with dietary requirements.

Transjugular Intrahepatic Portosystemic Shunt (TIPS). Studies have been mixed on whether transjugular intrahepatic portosystemic shunt (TIPS) improves survival without transplantation compared to large-volume paracentesis. An important 2003 study reported that although TIPS reduced the number of paracenteses, there was no improvement in survival rates. In addition, patients who were given TIPS had a higher risk for encephalopathy than those given large-volume paracentesis. In general, TIPS should be a second-line option for ascites that does not respond to diuretics.