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3.3.3 - Ascites

from Section 3.3 - Acute Liver Failure

Published online by Cambridge University Press:  27 July 2023

By
Michael Spiro  and
Jeremy Fabes
Edited by
Ned Gilbert-Kawai ,
Debashish Dutta  and
Carl Waldmann
Ned Gilbert-Kawai
Affiliation:
The Royal Liverpool Hospital
Debashish Dutta
Affiliation:
Princess Alexandra Hospital NHS Trust, Harlow
Carl Waldmann
Affiliation:
Royal Berkshire Hospital, Reading
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Summary

Key Learning Points

  1. 1. The most common cause of ascites in the UK is hepatic cirrhosis.

  2. 2. Diagnosis of the underlying aetiology is key for management and dependent on a robust history and examination, with appropriate tests on serum and paracentesis samples.

  3. 3. Whilst certain routine tests should be performed on all paracentesis samples, more specialist tests should be ordered, dependent on clinical findings.

  4. 4. Clinical suspicion of spontaneous bacterial peritonitis requires rapid diagnosis and management to prevent deterioration.

  5. 5. Ascites secondary to portal hypertension that is resistant to medical therapy is an indication for liver transplantation.

Keywords

ascitesparacentesisspontaneous bacterial peritonitiscirrhosisSAAGtransudateexudate
Type
Chapter
Information
Intensive Care Medicine
The Essential Guide
 , pp. 164 - 167
Publisher: Cambridge University Press
Print publication year: 2021

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References

References and Further Reading

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;57:1651.CrossRefGoogle Scholar
Runyon, BA, Montano, AA, Akriviadis, EA, Antillon, MR, Irving, MA, McHutchison, JG. 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.CrossRefGoogle Scholar
Saab, S, Nieto, JM, Lewis, SK, Runyon, BA. TIPS versus paracentesis for cirrhotic patients with refractory ascites. Cochrane Database Syst Rev 2006;4:CD004889.Google Scholar

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