Ascites : Diagnosis and Management

Ascites, the collection of fluid in the peritoneal cavity, occurs with a variety of disease states. It is one of the earliest and most common complication of chronic liver disease. In cirrhosis, it is associated with circulatory dysfunction characterized by arterial vasodilatation, high cardiac output and stimulation of vasoactive systems. As appropriate treatment depends on accurate diagnosis, paracentesis should be performed in every patient with new onset ascites to determine the cause and to detect potential complications. The treatment of ascites due to causes other than chronic liver disease is based on the underlying disease. In ascites associated with chronic liver disease, a combination of low sodium diet and the administration of diuretics remains the mainstay of therapy. Large volume paracentesis along with infusion of albumin is the preferred treatment for refractory ascites. The recently introduced technique of transjugular intrahepatic portosystemic shunt for the management of refractory ascites needs further evaluation.