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Cirrhotic Ascites

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  1. See Also
    1. Ascites
    2. Ascites Causes
    3. Cirrhosis
  2. Complications
    1. Spontaneous Bacterial Peritonitis
    2. Umbilical Hernia with risk of rupture
  3. Prognosis
    1. Poor prognostic sign for Cirrhosis course
  4. Evaluation
    1. Diagnostic Paracentesis Indications
      1. Unexplained Ascites
      2. New onset Ascites
      3. Hospitalized patients
      4. Clinical deterioration
    2. Ascites characteristics
      1. Portal Hypertension (Cirrhosis)
        1. Serum Albumin - Ascites Albumin exceeds 1.1 mg/dl
      2. Ascites not due to Portal Hypertension
        1. Albumin gradient (see above) <1.1 mg/dl
        2. Consider other Ascites Causes
          1. Peritoneal carcinomatosis
          2. Abdominal Tuberculosis
  5. Management
    1. See Spontaneous Bacterial Peritonitis
    2. Therapeutic Paracentesis Indications
      1. Significant patient discomfort
      2. Respiratory compromise
      3. Large Umbilical Hernia
      4. Recurrent bacterial peritonitis
    3. Sodium restriction
      1. Maximum salt intake: 2 grams per day
      2. Salt restriction controls Ascites in 10-20% patients
    4. Diuretics
      1. Spironolactone (Aldactone) 25-50 mg tid-qid
        1. Effective in 40-75% of cases
      2. Lasix 40 mg po qd to bid may be added
      3. Goal
        1. Urine Sodium exceeds Urine Potassium
        2. Do not allow Serum Creatinine to rise over 3.0
    5. Fluid Restriction
      1. Indicated for Serum Sodium <125 meq/L
    6. Liver Transplantation
      1. See Cirrhosis
      2. Consider for all cirrhotic patients with Ascites
  6. References
    1. Garcia (2001) Postgrad Med 109(2):91
    2. Zervos (2001) Am J Surg 181(3):256

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