Management of the Adult Patient with Cirrhosis Complicated by Ascites

Ascites is the most common and often the first decompensating event that occurs in cirrhosis. It has both a high symptom burden and high mortality rate. Increased abdominal girth, generalized abdominal pain, early satiety, and shortness of breath have a negative impact on quality of life. Treatments used to manage ascites include dietary sodium restriction, diuretics, large volume paracentesis, and transjugular intrahepatic portosystemic shunt. Secondary complications of ascites include refractory ascites, hyponatremia, and hepatorenal syndrome and are associated with reduced survival. Consideration should be given to the appropriateness and timing of referrals for liver transplant and/or palliative care.