Medical Health Encyclopedia

Patients who require this 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.

Peritoneovenous Shunting. Peritoneovenous (LeVeen, Denver) shunting is an older, more invasive procedure, involving insertion of a tube, or shunt, under the skin that routes the fluid from the abdomen into the jugular vein. The procedure can have serious complications, including infection, blood clots, encephalopathy, and rupture of blood vessels in the esophagus. It is now generally reserved for patients who are not candidates for repeat paracentesis or liver transplantation.

Treatment of Hepatorenal Syndrome

Text Continues Below

---

Hepatorenal syndrome can occur in patients ascites. This is a life-threatening condition in which kidneys fail in trying to compensate for altered blood flow in the liver. Studies are suggesting that terlipressin may be an effective treatment in combination with albumin for hepatorenal syndrome.

Investigative Agents

Researchers are testing certain drugs that may redress the imbalances in circulation that lead to portal hypertension and ascites. Of particular interest are agents called nonpeptide vasopressin antagonists, also referred to as aquaretics. They may reverse the dilation in blood vessels that lead to salt and fluid retention.

Liver Transplantation

The prognosis for patients with ascites is poor, even with intensive procedures. Liver transplantation should be considered for patients when ascites does not respond to treatments and when poor liver function or other complications, such as peritonitis or kidney failure, are present.

Click the icon to see an illustrated series detailing a liver transplant.