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World J Hepatol. 2013 May 27;5(5):251-63. doi: 10.4254/wjh.v5.i5.251.

Cirrhotic ascites review: Pathophysiology, diagnosis and management.

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  • 1Christopher M Moore, David H Van Thiel, Section of Hepatology, Department of Medicine, Rush University Medical Center, Chicago, IL 60612, United States.


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.


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

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