The patient was a 67-year-old female with liver cirrhosis due to hepatitis C. She was administered furosemide at 20 mg/day and spironolactone at 25 mg/day, but the ascites did not improve. Despite the additional administration of tolvaptan at 3.75 mg/day, the response to ascites was still poor. While the dose of tolvaptan was thereafter increased to 7.5 mg/day on the 7th hospital day, the ascit...

Abstract Purpose of Review Our understanding beta blockers in liver cirrhosis has transformed over the last 40 years. However, questions remain their safety acute decompensation and on chronic failure. Since these conditions are associated with significant morbidity mortality, a critical appraisal recent literature is imperative to help guide clinicians. Recent Findings The latest BAVENO guidel...

Medical treatment of cirrhotic ascites is essentially supportive, dictated by the patient's discomfort, impaired cardiovascular or respiratory function and potential for infection. Treatment of 'simple' ascites (moderate fluid accumulation, serum albumin > 3.5 g/dl, serum creatinine < 1.5 mg/dl, no electrolyte disturbance) is implemented sequentially. Only 10% of patients respond to dietary sod...

PURPOSE We describe the clinical characteristics and assess the outcomes and stability of inguinal hernia repair under local anesthesia for patients with liver cirrhosis accompanied by ascites. METHODS We retrospectively reviewed the medical records of 22 patients with cirrhosis and ascites who underwent mesh plug hernia repair performed by a single surgeon from January 2002 to August 2009, a...

Cirrhosis with refractory ascites was considered a contraindication to laparoscopic surgery,1 until recently. However, current literature has shown the efficacy and safety of various laparoscopic procedures in the diagnosis and management of surgical conditions in cirrhotic patients. The incidence of ventral hernias in cirrhotic patients with tense ascites is high. It is well known that open he...

OBJECTIVE Ascites usually complicates chronic liver disease, and some patients with ascites are refractory to medical treatment. Recently, saphenoperitoneal shunt (SPS) was described to treat this condition. This procedure avoids the insertion of a foreign expensive shunt into the circulation. We present our experience with this procedure with some modification in the technique. METHODS We pe...

Espírito Santo R, et al. BMJ Case Rep 2017. doi:10.1136/bcr-2017-219882 Description A 30-year-old primigravida was referred to our institution due to an isolated fetal ascites (IFA). The gestation was uneventful until the 32nd week when the mother was hospitalised due to refractory hypertension. An ultrasound revealed a fetal abdominal circumference above percentile 99. Fetal parameters and amn...

Therapeutic paracentesis is considered to be a relatively safe procedure and is performed commonly for the control of massive ascites in patients with liver cirrhosis. The commonest puncture site, approximately 4 or 5 cm medial of left anterior superior iliac spine, can be located across the route of the inferior epigastric artery, which is one of the sites of potential massive bleeding. In a 4...