Ascites is the most common of the major complications of cirrhosis. The development of ascites is an important landmark in the natural history of cirrhosis and has been proposed as an indication for liver transplantation. The initial evaluation of a patient with ascites should include a history, physical evaluation, and abdominal paracentesis with ascitic fluid analysis. Treatment should consist of abstinence from alcohol, sodium restricted diet, and diuretics. This regimen is effective in Ο·90% of patients. The treatment options for the diuretic-resistant patients include serial therapeutic paracenteses, liver transplantation, and peritoneovenous shunting. (HEPATOLOGY 1998;27;264-272.) PREAMBLE Evaluation History.
Most patients (Ο·80%) with ascites in the United States have cirrhosis. 7 There is a nonhepatic cause of fluid retention in about 20% of patients with ascites. Successful treatment depends on an accurate diagnosis of the cause of ascites, e.g., peritoneal carcinomatosis does not respond to diuretic therapy. 8 Patients with ascites should be questioned about risk factors for liver disease, including alcohol, intravenous and recreational drug use, transfusions, homosexuality, acupuncture, tattoos, ear-piercing, country of origin, family history, history of jaundice or hepatitis, etc. Past history of cancer, heart failure, or tuberculosis is also relevant.
Physical Examination. The presence of a full, bulging abdomen should lead to percussion of the flanks. If the amount of Abbreviations: PMN, polymorphonuclear; SBP, spontaneous bacterial peritonitis.