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Management of refractory ascites.
1Division of Gastroenterology and Hepatology, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada.
Clinical and Molecular Hepatology
|June 9, 2022
Summary
Refractory ascites in cirrhosis indicates advanced disease, often linked to hemodynamic changes and inflammation. Management includes paracentesis, albumin, TIPS, and ultimately liver transplant referral for improved outcomes.
Area of Science:
- Hepatology
- Gastroenterology
- Nephrology
Background:
- Refractory ascites affects 10% of decompensated cirrhosis patients, signaling disease progression.
- Pathogenesis involves hemodynamic shifts, portal hypertension, renal hypoperfusion, and sodium retention.
- Inflammation may exacerbate portal hypertension via microthrombi.
Purpose of the Study:
- To outline the pathogenesis and complications of refractory ascites.
- To review current and potential management strategies.
- To emphasize the importance of timely referral for advanced therapies.
Main Methods:
- Review of pathogenesis, including hemodynamic and inflammatory factors.
- Discussion of management options: sodium restriction, paracentesis with albumin, transjugular intrahepatic porto-systemic shunt (TIPS).
- Consideration of future devices and referral pathways for liver transplantation.
Main Results:
- Renal dysfunction is the most common complication.
- Large volume paracentesis with albumin is a cornerstone of management.
- Transjugular intrahepatic porto-systemic shunt (TIPS) can improve quality of life and survival.
- Liver transplantation is indicated for eligible patients.
Conclusions:
- Refractory ascites signifies advanced cirrhosis with significant morbidity.
- Multifaceted management strategies are crucial, including medical, procedural, and surgical options.
- Early referral for liver transplant evaluation is essential for improving patient prognosis.
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