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Ascites in adults with cirrhosis: Initial therapy

Authors
José Such, MD, PhD
Bruce A Runyon, MD
Section Editor
Keith D Lindor, MD
Deputy Editor
Anne C Travis, MD, MSc, FACG, AGAF

INTRODUCTION

Cirrhosis is the most common cause of ascites in the United States, accounting for approximately 85 percent of cases [1]. In addition, ascites is the most common complication of cirrhosis. Within 10 years after the diagnosis of compensated cirrhosis, approximately 58 percent of patients will have developed ascites [2]. (See "Pathogenesis of ascites in patients with cirrhosis".)

Successful treatment of the patient with ascites depends upon an accurate diagnosis regarding the cause of ascites formation [3,4]. A careful history, physical examination, and abdominal paracentesis with appropriate ascitic fluid analysis can usually determine the cause of ascites formation [1,3]. Patients who have a cause for ascites formation other than cirrhosis may not respond to the treatments used in those with cirrhosis. This is particularly true for ascites due to peritoneal carcinomatosis, in which sodium restriction and diuretics cause intravascular volume depletion without mobilization of the ascitic fluid [5]. (See "Evaluation of adults with ascites" and 'Diuretic therapy' below and "Malignancy-related ascites".)

This topic will review the initial therapy of ascites in patients with cirrhosis. The diagnosis and evaluation of patients with ascites, the treatment of refractory ascites, and the management of spontaneous bacterial peritonitis are discussed elsewhere. (See "Evaluation of adults with ascites" and "Ascites in adults with cirrhosis: Diuretic-resistant ascites" and "Spontaneous bacterial peritonitis in adults: Treatment and prophylaxis".)

The management of ascites in adults with cirrhosis is also discussed in a 2013 guideline from the American Association for the Study of Liver Diseases (table 1) [6,7]. The discussion that follows is consistent with that guideline.

GOALS OF THERAPY

The goals of therapy in patients with ascites are to minimize ascitic fluid volume and decrease peripheral edema, without causing intravascular volume depletion. Although there is no evidence that treatment of fluid overload in patients with cirrhosis improves survival, the following benefits have been noted:

                     

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Literature review current through: Nov 2016. | This topic last updated: Fri Apr 17 00:00:00 GMT+00:00 2015.
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