Cirrhosis and Portal Hypertension : How Do We Deal with Ascites and Its Consequences - 30/03/23

Doi : 10.1016/j.mcna.2022.12.004

Marta Tonon, MD, PhD, Salvatore Piano, MD, PhD ^⁎
Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padova, Padova, Italy

^∗Corresponding author. Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, ItalyDepartment of MedicineDepartment of MedicineUniversity of PadovaVia Giustiniani 2Padova35128Italy

Résumé

Ascites is the most common complication of cirrhosis, with 5-year mortality reaching 30%. Complications of ascites (ie, spontaneous bacterial peritonitis, hepatorenal syndrome, recurrent/refractory ascites, and hepatic hydrothorax) further worsen survival. The development of ascites is driven by portal hypertension, systemic inflammation, and splanchnic arterial vasodilation. Etiologic treatment and nonselective beta-blockers can prevent ascites in compensated cirrhosis. The treatment of ascites is currently based on the management of fluid overload (eg, diuretics, sodium restriction, and/or paracenteses). In selected patients, long-term albumin use, norfloxacin prophylaxis, and transjugular intrahepatic portosystemic shunt reduce the risk of further decompensation and improve survival.

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Keywords : Ascites, Complications of cirrhosis, Portal hypertension, Large-volume paracentesis, Human albumin, Refractory ascites, TIPS