[Recent aspects in the diagnosis and therapy of ascites]

In the diagnosis of malignant ascites the cytological examination of ascitic fluid lacks sensitivity. Therefore, other parameters for the differentiation of malignant and hepatic ascites are needed. Determination of ascitic fluid cholesterol or fibronectin is superior to the traditional protein measurement in the differential diagnosis of ascites. In the therapy of cirrhotic ascites, physical maneuvers as well as dietary sodium and water restriction have long been known. Diuretic therapy, fraught with considerable side effects, has been applied to cirrhotics with ascites for more than 30 years. However, efficacy of only few regimens has been proven by randomized studies. Recently developed diuretics as well as the novel hormone Atrial Natriuretic Factor might bring about therapeutic advances. Paracentesis combined with intravenous albumin infusion might be reconsidered in severe ascites. Refractory ascites may be treated by implantation of peritoneo-venous shunts.