Cirrhotic ascites review: Pathophysiology, diagnosis and management

Abstract

Ascites is a pathologic accumulation of peritoneal fluidcommonly observed in decompensated cirrhotic states.Its causes are multi-factorial, but principally involve significant volume and hormonal dysregulation in the setting of portal hypertension. The diagnosis of ascites is considered in cirrhotic patients given a constellation of clinical and laboratory findings, and ultimately confirmed, with insight into etiology, by imaging and paracentesis procedures. Treatment for ascites is multi-modal including dietary sodium restriction, pharmacologic therapies, diagnostic and therapeutic paracentesis, and in certain cases transjugular intra-hepatic portosystemic shunt. Ascites is associated with numerous complications including spontaneous bacterial peritonitis, hepato-hydrothorax and hepatorenal syndrome. Given the complex nature of ascites and associatedcomplications, it is not surprising that it heralds increased morbidity and mortality in cirrhotic patients and increased cost-utilization upon the health-care system. This review will detail the pathophysiology of cirrhotic ascites, common complications derived from it, and pertinent treatment modalities.

Keywords: Ascites; Cirrhosis; Hepato-hydrothorax; Hepatorenal syndrome; Spontaneous bacterial peritonitis

Core tip: Ascites is an accumulation of fluid most commonly found in cirrhosis with portal hypertension. Ascites can cause or is associated with a number of complications including spontaneous bacterial peritonitis, hepato-hydrothorax and hepatorenal syndrome. Ascites itself, and these associated complications are a significant cause of morbidity and mortality in cirrhotic patients. The management of ascites is complex, utilizing an array of medications and interventional therapies to maintain appropriate total body volume, prevent multi-organ dysfunction, and manage against increased risk for associated infections.