Ascites: tips on diagnosis and management

ABSTRACT

Clinical evaluation and diagnostic paracentesis with estimation of the serum-ascitic albumin gradient [SAAG] is the most important step in identifying the etiology of ascites. At a level of 1.1 g/dl, SAAG, accurately [96.7%] differentiate portal hypertension from nonportal I hypertension-associated ascites. The majority of patients with ascites [>80%] have portal hypertension associated etiology mainly, liver cirrhosis. Approximately 90% of patients with ascites complicating cirrhosis respond to salt restriction and diuretics. The remainder [10%] have refractory ascites which commonly respond well to large volume paracentesis [LVP]. Asymptomatic complications occurring in patients treated with LVP may not necessitate treatment. Other alternative methods for treatment of refractory ascites include ascitic fluid recirculation [AR], peritoneovenous shunting [PVS],transjugular intrahepatic portosystemic stent-shunting [TIPS] and orthotopic liver transplantation [OLT]