Serum-ascites fluid albumin concentration gradient, ascites fluid polymorphonuclear cell count and ascites fluid cytology afford immediate diagnosis of the etiology of ascites. When cirrhotic patients with marked ascites do not respond to diuretics, abdominal paracentesis is the next step, if the ascites is severe enough to justify the risk. When all else fails over a period of several months, a peritoneovenous shunt may be appropriate. We have many options in the management of ascites now, but, in the future, the optimal therapy will include potent and nontoxic diuretic drugs and high-volume paracentesis.