Management of adult patients with ascites caused by cirrhosis


  • Bruce A. Runyon M.D.

    Corresponding author
    1. Loma Linda Transplantation Institute, Loma Linda, CA
    • Director of Hepatology, Medical Director of Liver Transplantation, Loma Linda Transplantation Institute, 11234 Anderson Street, Room 1405, PO Box 2000, Loma Linda, CA 92354. Fax: (909) 478-4110
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  • Written under the Auspices of The American Association for the Study of Liver Diseases Practice Guidelines Committee


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 ≈90% of patients. The treatment options for the diuretic-resistant patients include serial therapeutic paracenteses, liver transplantation, and peritoneovenous shunting.