Document Detail


The management of ascites in cirrhosis: report on the consensus conference of the International Ascites Club.
MedLine Citation:
PMID:  12830009     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Ascites is a common complication of cirrhosis, and heralds a new phase of hepatic decompensation in the progression of the cirrhotic process. The development of ascites carries a significant worsening of the prognosis. It is important to diagnose noncirrhotic causes of ascites such as malignancy, tuberculosis, and pancreatic ascites since these occur with increased frequency in patients with liver disease. The International Ascites Club, representing the spectrum of clinical practice from North America to Europe, have developed guidelines by consensus in the management of cirrhotic ascites from the early ascitic stage to the stage of refractory ascites. Mild to moderate ascites should be managed by modest salt restriction and diuretic therapy with spironolactone or an equivalent in the first instance. Diuretics should be added in a stepwise fashion while maintaining sodium restriction. Gross ascites should be treated with therapeutic paracentesis followed by colloid volume expansion, and diuretic therapy. Refractory ascites is managed by repeated large volume paracentesis or insertion of a transjugular intrahepatic portosystemic stent shunt (TIPS). Successful placement of TIPS results in improved renal function, sodium excretion, and general well-being of the patient but without proven survival benefits. Clinicians caring for these patients should be aware of the potential complications of each treatment modality and be prepared to discontinue diuretics or not proceed with TIPS placement should complications or contraindications develop. Liver transplantation should be considered for all ascitic patients, and this should preferably be performed prior to the development of renal dysfunction to prevent further compromise of their prognosis.
Authors:
Kevin P Moore; Florence Wong; Pere Gines; Mauro Bernardi; Andreas Ochs; Francesco Salerno; Paolo Angeli; Michael Porayko; Richard Moreau; Guadelupe Garcia-Tsao; Wladimiro Jimenez; Ramon Planas; Vicente Arroyo
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Publication Detail:
Type:  Consensus Development Conference; Journal Article; Review    
Journal Detail:
Title:  Hepatology (Baltimore, Md.)     Volume:  38     ISSN:  0270-9139     ISO Abbreviation:  Hepatology     Publication Date:  2003 Jul 
Date Detail:
Created Date:  2003-06-27     Completed Date:  2003-07-25     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8302946     Medline TA:  Hepatology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  258-66     Citation Subset:  IM    
Affiliation:
Centre for Hepatology, Royal Free and University College Medical School, UCL, London, United Kingdom. kmoore@rfc.ucl.ac.uk
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MeSH Terms
Descriptor/Qualifier:
Ascites / etiology,  therapy*
Evidence-Based Medicine
Humans
Liver Cirrhosis / complications*

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