Accumulation of peritoneal fluid due to portal hypertension and splanchnic vasodilatation; marks decompensated cirrhosis.
Investigations
- • Diagnostic paracentesis in every new or deteriorating ascites
- • Fluid neutrophil count (SBP if ≥250/mm³), albumin (SAAG >11 g/L = portal hypertension), culture in blood-culture bottles
- • U&E, MELD score
Management
- • Salt restriction 5–6 g/day; fluid restriction only if Na <125
- • Spironolactone 100 mg ± furosemide 40 mg, ratio 100:40, titrated
- • Large-volume paracentesis with 8 g albumin per litre removed
- • TIPS or transplant assessment for refractory ascites
Clinical pearls
- • Avoid NSAIDs and ACE inhibitors — precipitate hepatorenal syndrome
- • Any deterioration in a cirrhotic with ascites = tap to exclude SBP
Related in WardRound
Educational — verify locally.
