Treatment of patients with cirrhosis and ascites

The treatment of patients with cirrhosis and fluid overload has undergone substantial change in recent years, because of new information regarding old treatments, as well as new treatments. The goals of treatment are to maximize life expectancy and quality of life. Development of ascites is a landmark in the natural history of cirrhosis signaling poor life expectancy, in general. Patients who are appropriate candidates for liver transplantation should undergo evaluation for this procedure after development of ascites. Patients awaiting transplantation as well as non-candidates for this procedure should be managed by restriction of dietary sodium and prescription of diuretics. This approach is effective in controlling fluid overload in > 90% of patients. Only the 10% who fail this simple medical treatment should be considered for second-line therapy.