Skip to main content

Ascites

  • Chapter
  • First Online:
Liver Disorders
  • 1648 Accesses

Abstract

The development of ascites in patients with cirrhosis is common and represents altered function of the regulatory mechanisms governing extracellular fluid. Ascites is a major burden for patients suffering from chronic liver disease and imposes a significant degree of morbidity and mortality. This chapter will focus on the pathophysiology leading to the development of ascites, the diagnosis and evaluation of ascites, common complications encountered by the clinician, and treatment strategies to guide medical decision making to aid in the long-term management of patients with ascites. Lastly, areas of active research and future diagnostic and therapeutic techniques will be discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 199.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Moore KP et al. The management of ascites in cirrhosis: report on the consensus conference of the International Ascites Club. Hepatology. 2003;38(1):258–66.

    Article  PubMed  Google Scholar 

  2. Runyon BA, Montano AA, Akriviadis EA, et al. The serum-ascites albumin gradient is superior to the exudate-transudate concept in the differential diagnosis of ascites. Ann Intern Med. 1992;117:215–20.

    Article  CAS  PubMed  Google Scholar 

  3. Cattau E, Benjamin S, Knuff T, et al. The accuracy of the physical exam in the diagnosis of suspected ascites. JAMA. 1982;247:1164–6.

    Article  PubMed  Google Scholar 

  4. Runyon BA. Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012. Hepatology. 2013;57(4):1651–3.

    Article  PubMed  Google Scholar 

  5. Runyon BA. Paracentesis of ascitic fluid: a safe procedure. Arch Intern Med. 1986;146:2259–61.

    Article  CAS  PubMed  Google Scholar 

  6. Runyon BA, Hoefs JC, Morgan TR. Ascitic fluid analysis in malignancy-related ascites. Hepatology. 1988;8:1104–9.

    Article  CAS  PubMed  Google Scholar 

  7. Runyon BA, Antillon MR, Akriviadis EA, et al. Bedside inoculation of blood culture bottles with ascitic fluid is superior to delayed inoculation in the detection of spontaneous bacterial peritonitis. J Clin Microbiol. 1990;8:2811–2.

    Google Scholar 

  8. Runyon BA. Cardiac ascites: a characterization. J Clin Gastroenterol. 1988;10:410–2.

    Article  CAS  PubMed  Google Scholar 

  9. Akriviadis EA, Runyon BA. The value of an algorithm in differentiating spontaneous from secondary bacterial peritonitis. Gastroenterology. 1990;98:127–33.

    Article  CAS  PubMed  Google Scholar 

  10. Runyon BA, Canawati HN, Akriviadis EA. Optimization of ascitic fluid culture technique. Gastroenterology. 1988;95:1351–5.

    Article  CAS  PubMed  Google Scholar 

  11. Hillebrand DJ, Runyon BA, Yasmineh WG, et al. Ascitic fluid adenosine deaminase insensitivity in detecting tuberculous peritonitis in the United States. Hepatology. 1996;24:1408–12.

    Article  CAS  PubMed  Google Scholar 

  12. Pereira G, Guevara M, Fagundes C, Solá E, Rodríguez E, Fernández J, et al. Renal failure and hyponatremia in patients with cirrhosis and skin and soft tissue infection. A retrospective study. J Hepatol. 2012;56:1040–6.

    Article  PubMed  Google Scholar 

  13. Belghiti J, Rueff B, Fekete F. Umbilical hernia in cirrhotic-patients with ascites-prevalence, course, and management. Gastroenterology. 1983;84:1363A.

    Google Scholar 

  14. Runyon BA, Antillon MR, Montano AA. Effect of diuresis versus therapeutic paracentesis on ascitic fluid opsonic activity and serum complement. Gastroenterology. 1989;97(1):158–62.

    Article  CAS  PubMed  Google Scholar 

  15. Chalasani N et al. Effects of albumin/furosemide mixtures on responses to furosemide in hypoalbuminemic patients. J Am Soc Nephrol. 2001;12(5):1010–6.

    CAS  PubMed  Google Scholar 

  16. Stanley MM et al. Peritoneovenous shunting as compared with medical treatment in patients with alcoholic cirrhosis and massive ascites. N Engl J Med. 1989;321(24):1632–8.

    Article  CAS  PubMed  Google Scholar 

  17. Singh V et al. Midodrine in patients with cirrhosis and refractory or recurrent ascites: a randomized pilot study. J Hepatol. 2012;56(2):348–54.

    Article  CAS  PubMed  Google Scholar 

  18. Smith GS, Barnard GF. Massive volume paracentesis (up to 41 liters) for the outpatient management of ascites. J Clin Gastroenterol. 1997;25(1):402–3.

    Article  CAS  PubMed  Google Scholar 

  19. Ginès P et al. Randomized comparative study of therapeutic paracentesis with and without intravenous albumin in cirrhosis. Gastroenterology. 1988;94:1493–502.

    Article  PubMed  Google Scholar 

  20. Bernardi M et al. Albumin infusion in patients undergoing large‐volume paracentesis: a meta‐analysis of randomized trials. Hepatology. 2012;55(4):1172–81.

    Article  CAS  PubMed  Google Scholar 

  21. Peltekian KM et al. Cardiovascular, renal, and neurohumoral responses to single large-volume paracentesis in patients with cirrhosis and diuretic-resistant ascites. Am J Gastroenterol. 1997;92(3):394–9.

    CAS  PubMed  Google Scholar 

  22. Saab S, et al. TIPS versus paracentesis for cirrhotic patients with refractory ascites. Cochrane Database Syst Rev 2006;(4):CD004889.

    Google Scholar 

  23. D’Amico G et al. Uncovered transjugular intrahepatic portosystemic shunt for refractory ascites: a meta-analysis. Gastroenterology. 2005;129(4):1282–93.

    Article  PubMed  Google Scholar 

  24. Angermayr B et al. Survival in patients undergoing transjugular intrahepatic portosystemic shunt: ePTFE‐covered stentgrafts versus bare stents. Hepatology. 2003;38(4):1043–50.

    Article  PubMed  Google Scholar 

  25. Bureau C et al. Improved clinical outcome using polytetrafluoroethylene-coated stents for TIPS: results of a randomized study. Gastroenterology. 2004;126(2):469–75.

    Article  PubMed  Google Scholar 

  26. Montgomery A et al. MELD score as a predictor of early death in patients undergoing elective transjugular intrahepatic portosystemic shunt (TIPS) procedures. Cardiovasc Intervent Radiol. 2005;28(3):307–12.

    Article  PubMed  Google Scholar 

  27. Romanelli RG et al. Long-term albumin infusion improves survival in patients with cirrhosis and ascites: an unblinded randomized trial. World J Gastroenterol. 2006;12(9):1403–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Krag A et al. Terlipressin improves renal function in patients with cirrhosis and ascites without hepatorenal syndrome. Hepatology. 2007;46(6):1863–71.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Adam J. Schiro M.D. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Schiro, A.J. (2017). Ascites. In: Saeian, K., Shaker, R. (eds) Liver Disorders. Springer, Cham. https://doi.org/10.1007/978-3-319-30103-7_30

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-30103-7_30

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-30101-3

  • Online ISBN: 978-3-319-30103-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics