Explore
In addition, more severe ascites can be treated through paracentesis, which involves aspiration of large amounts of fluid from the abdominal cavity. Due to the potential recurrence, some individuals may require the paracentesis to be repeated multiple times.
What are the treatment options for ascites?
Therapeutic paracentesis may be performed in patients who require rapid symptomatic relief for refractory or tense ascites. When small volumes of ascitic fluid are removed, saline alone is an effective plasma expander. [12] The removal of 5 L of fluid or more is considered large-volume paracentesis.
When is therapeutic paracentesis indicated in the treatment of ascites?
Ascites is the medical term to describe the accumulation of fluid in the abdomen. Ascites is often associated with severe liver disease, but its causes may vary. Ascites usually presents with marked swelling of the patients’ abdomen, increased abdominal girth and sudden weight gain.
What is ascites?
Long-Term Monitoring. The best method of assessing the effectiveness of diuretic therapy is by monitoring body weight and urinary sodium levels. In general, the goal of diuretic treatment of ascites should be to achieve a weight loss of 300-500 g/d in patients without edema and 800-1000 g/d in patients with edema.
What is the long term monitoring of ascites?
What is ascites?
Ascites refers to the buildup of excess fluid in the abdominal cavity. Based on the severity of fluid accumulation, ascites can be categorized as m...
What causes ascites?
The most common cause of ascites is cirrhosis, which is a late stage of liver disease characterized by permanent scarring and fibrosis of the liver...
Is ascites life-threatening?
Ascites can lead to the development of life-threatening complications, such as spontaneous bacterial peritonitis, which is a bacterial infection of...
What does ascites look like?
The presentation of ascites can vary depending on its severity. Those with mild ascites may have an abdomen that appears normal, whereas those with...
What does ascites feel like?
Ascites can put pressure within the abdomen, causing it to feel very large and tight. As the abdomen grows larger, the increased pressure on nearby...
How do you treat ascites?
To treat ascites, the choice of treatment depends on its severity and the underlying cause. In mild cases, salt intake should be reduced to 2000mg...
Can ascites be reversed?
With treatment, ascites can be temporarily reversed. But over time, more invasive treatments will be needed to temporarily reverse ascites. Eventua...
What are the most important facts to know about ascites?
Ascites is an abnormal accumulation of fluid in the abdominal cavity, which can lead to a very large distended abdomen. As the abdomen grows larger...
What is the treatment for ascites?
Treatment for ascites often includes a multifaceted and individualized approach that involves directly treating the excess fluid as well as treating the underlying disease that caused the ascites, such as cirrhosis of the liver, congenital heart disease, or kidney failure.
How to treat ascites in the abdomen?
Treatment for ascites. Treatment of ascites can include: Antibiotics to treat an infection called bacterial peritonitis (infection of the lining that surrounds the abdominal organs) Decreased consumption of high-sodium foods and beverages to reduce fluid retention.
What causes ascites in the liver?
Treatment for the underlying causes of ascites. Ascites is most commonly caused by cirrhosis of the liver. Treatment of cirrhosis includes efforts to stop or slow the progression of damage to the liver and minimize and quickly treat any complications, such as liver failure and hemorrhage.
What is ascites in medical terms?
Ascites is a very serious condition that often indicates cirrhosis of the liver, advanced liver disease, congestive heart failure, cancer, or other life-threatening conditions and complications. Seek immediate medical care (call 911) if you, or someone you are with, have any of these symptoms:
What is a TIPS procedure?
Placement of a TIPS (transjugular intrahepatic portosystemic shunt) to treat ascites caused by portal hypertension. The shunt allows blood to bypass a damaged liver. TIPS placement is a minimally invasive procedure performed through the jugular vein in the neck.
What is ascites in the body?
What is ascites? Ascites is a serious condition in which there is an abnormal accumulation of fluid under the lining (peritoneum) of the abdominal cavity that builds up around the abdominal organs. Ascites is characterized by a swollen abdomen and weight gain. This can be accompanied by abdominal pain or discomfort, difficulty breathing, ...
How to tell if you have ascites?
The main symptom of ascites is a swollen or distended abdomen due to fluid buildup. Other symptoms may include: Abdominal pain or discomfort. Ankle swelling. Jaundice (yellowing of the skin and whites of the eyes) Shortness of breath. Unexplained weight gain.
How to treat ascites?
Ascites is treated by decreasing dietary sodium and taking diuretic medications. In addition, more severe cases may need a paracentesis, placement of a transjugular intrahepatic portosystemic shunt, and ultimately a liver transplant.
What is an ascites?
Ascites refers to the buildup of excess fluid in the abdominal cavity. Based on the severity of fluid accumulation, ascites can be categorized as mild, moderate, and large. There are two different types of ascites: uncomplicated and refractory ascites.
What are the complications of ascites?
Other complications that ascites can include hepatorenal syndrome, malnutrition, pleural effusion, and gastrointestinal bleeding.
What causes ascites in the liver?
The most common cause of ascites is cirrhosis, which is a late stage of liver disease characterized by permanent scarring and fibrosis of the liver, often as a consequence of chronic alcoholism or hepatitis. Normally, the liver receives blood from the spleen and gastrointestinal organs via the portal vein. When fibrosis becomes extensive, it is ...
Is ascites a kidney failure?
Often, refractory ascites can be associated with kidney failure.
Is ascites life threatening?
Is ascites life-threatening? Ascites can lead to the development of life-threatening complications , such as spontaneous bacterial peritonitis, which is a bacterial infection of the ascitic fluid. If not caught and treated promptly, bacteria can enter the bloodstream and lead to sepsis.
Can ascites be reversed?
With treatment, ascites can be temporarily reversed. But over time, more invasive treatments will be needed to temporarily reverse ascites. Eventually, most people with ascites will need a liver transplant.
Why is ascites a life threatening condition?
Ascites is due to the loss of compensatory mechanism to maintain effective arterial blood volume secondary to splanchnic arterial vasodilatation in the progression of liver disease and portal hypertension.
What are the signs of ascites?
Several signs support the presence of ascites such as the shifting dullness, fluid wave, and puddle signs . The former has 83% sensitivity and 56% specificity in detecting ascites. It is also less cumbersome and performs better than the latter two [ 3, 10 ].
What is SBP in a patient?
SBP is a common infection of ascitic fluid developed in patients in the absence of an intra-abdominal genesis of infection. SBP was described for the first-time long time ago, approximately in the 1970s by Harold Conn [ 74 ], who pointed out the high in-hospital mortality in patients with this complication.
How much weight can I lose with ascites grade 2?
The goal of treatment is to achieve an average weight loss of no more than 500 g/day in patients without peripheral edema and no more than 800–1000 g/day in those with peripheral edema.
Is ascites a heterogeneous disease?
4. Complications, prognosis, and treatment. Despite the fact that patients with ascites constitute a heterogeneous population with different prognosis depending on the degree of liver insufficiency and circulatory dysfunction, the development of ascites is an ominous sign.
What is ascites in liver?
Ascites is one of the major complications of liver cirrhosis and is associated with a poor prognosis. It is important to distinguish noncirrhotic from cirrhotic causes of ascites to guide therapy in patients with noncirrhotic ascites. Mild to moderate ascites is treated by salt restriction and diuretic therapy.
What is the most important measure for cirrhosis?
In patients with alcoholic liver cirrhosis, the most important measure is alcohol abstinence. In the majority of patients with alcoholic liver disease, alcohol abstinence results in an improvement of liver function and ascites[12].
Is hyponatremia a common finding in patients with ascites and liver cirrhosis
Hyponatremia is a common finding in patients with ascites and liver cirrhosis, but a study including 997 patients with liver cirrhosis found severe hyponatremia (≤125 mmol/L) in only 6.9% of patients[19].
Should ascites be treated before liver transplant?
Therefore, patients with ascites should be considered for liver transplantation, preferably before the development of renal dysfunction[1]. This article will give a concise overview of the diagnosis and treatment of patients with ascites in liver cirrhosis and the management of the most common complications of ascites.
Can ascites be treated as an outpatient?
Patients with uncomplicated mild or moderate ascites do not require hospitalization and can be treated as outpatients. Patients with ascites have a positive sodium balance, i.e. sodium excretion is low relative to sodium intake. Hence, the mainstay of ascites therapy is sodium restriction and diuretic therapy.
Can you have conservative management for chylous ascites?
[ 3] Patients can actually be maintained free of ascites if sodium intake is limited to 10 mmol/d. However, this is not practical outside a metabolic ward.
Is midodrine a paracentesis?
However, when midodrine was used as an alternative to albumin in large-volume paracentesis, the mortality was higher for those receiving midod rine than for those receiving albumin;midodrine and albumin had a similar association with the development paracentesis-induced circulatory dysfunction.
What is the procedure to evaluate for clinically apparent ascites?
The evaluation for the etiology of clinically apparent ascites should begin with an abdominal paracentesis with appropriate ascitic fluid analysis. In addition, at time of any hospital admission, a diagnostic paracentesis should be done to assess for infection. Fasting is not required for this procedure.
How long do ascites last?
Natural History and Survival of Persons with Ascites. This figure shows the 1- and 5-year survival of persons with ascites. Patients who do not develop complications have markedly better survival than those who develop dilutional hyponatremia, refractory ascites, or hepatorenal syndrome.
What is refractory ascites?
Among persons with cirrhosis and ascites, fewer than 10% will develop refractory ascites, which is defined as ascites that is unresponsive to dietary sodium restriction and maximal diuretic dosing (typically, spironolactone 400 mg daily and furosemide 160 mg daily), or that recurs rapidly after therapeutic paracentesis. [ 29] There are two different subtypes: diuretic-resistant ascites (lack of response to dietary sodium restriction and intensive diuretic treatment) and diuretic-intractable ascites (diuretic-induced complications such as hepatic encephalopathy, renal insufficiency, hyponatremia, or hyperkalemia that prevent optimization of diuretic dosing). Once refractory ascites develops, one-year mortality is approximately 50%. Options for treatment include optimization of medical management, serial large volume paracenteses, transjugular intrahepatic portosystemic shunt (TIPS), peritoneovenous shunt, and liver transplantation.
What is ascites in cirrhosis?
Ascites is defined as an abnormal accumulation of fluid in the abdominal cavity. It is the most common complication of cirrhosis, with approximately 50% of persons with compensated cirrhosis developing ascites over the course of 10 years. After developing ascites that necessitates hospitalization, the risk of mortality increases to 15% ...
How many people with cirrhosis develop renal dysfunction?
Approximately 20% of hospitalized individuals with cirrhosis and ascites will develop some type of renal dysfunction. In one study, over a mean follow-up of 41 months, 7.6% of hospitalized persons with ascites and cirrhosis developed hepatorenal syndrome. [ 54]
Why should angiotensin-converting-enzyme inhibitors be avoided in persons with cirrhos
The use of angiotensin-converting-enzyme inhibitors and angiotensin-receptor blockers should be avoided in persons with cirrhosis, due to concerns of renal failure and increased mortality for those who develop hypotension. Hypotension (mean arterial pressure less than or equal to 82 mmHg) independently predicts increased one-year mortality in persons with cirrhosis. Among individuals with refractory ascites, propranolol is associated with decreased survival perhaps due to the increased risk of paracentesis-induced circulatory dysfunction, so, the risks and benefits of its use should be considered individually for each person. [ 21] Nonsteroidal anti-inflammatory drugs (NSAIDS), including aspirin, should also be avoided due to the risk of reduced urinary sodium excretion and renal failure. Although vaptans can improve hyponatremia, there are significant risks associated with use of these types of agents in persons with cirrhosis. For example, tolvaptan, a selective oral vasopressin V2-receptor antagonist used to treat hypervolemic and euvolemic hyponatremia, has been shown to be effective in persons with refractory ascites, but is contraindicated for use in persons with underlying liver disease, including those with cirrhosis, due to risk of causing severe hepatotoxicity. [ 22, 23] Moreover, hyponatremia recurs upon discontinuation of the medication. [ 24] Satavaptan was evaluated for the management of ascites in persons with cirrhosis and was potentially associated with a higher risk of mortality. [ 25]
How much fluid should be inoculated for cytology?
Fluid should be directly inoculated into blood culture bottles at the bedside, typically 10 mL into each bottle. If needed, an additional 50 mL of fluid can be sent in a sterile syringe or cup for cytology or other tests. Vacuum bottles are used to assist the speed of fluid removal in a therapeutic paracentesis.