Cirrhosis and Portal Hypertension: How Do We Deal with Ascites and Its Consequences

Marta Tonon; Salvatore Piano

doi:10.1016/j.mcna.2022.12.004

Cirrhosis and Portal Hypertension: How Do We Deal with Ascites and Its Consequences

Med Clin North Am. 2023 May;107(3):505-516. doi: 10.1016/j.mcna.2022.12.004. Epub 2023 Feb 20.

Authors

Marta Tonon¹, Salvatore Piano²

Affiliations

¹ Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padova, Padova, Italy.
² Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padova, Padova, Italy. Electronic address: salvatorepiano@gmail.com.

PMID: 37001950
DOI: 10.1016/j.mcna.2022.12.004

Abstract

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.

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

Publication types

Review

MeSH terms

Ascites / etiology
Ascites / therapy
Humans
Hypertension, Portal* / complications
Hypertension, Portal* / therapy
Liver Cirrhosis / complications
Liver Cirrhosis / therapy
Liver Transplantation* / adverse effects