Review article: management of ascites and associated complications in patients with cirrhosis

Abstract

ConclusionsRecent advances in the diagnosis and treatment of ascites and associated complications have improved the medical management and poor prognosis of patients with these manifestations of advanced liver disease. Early diagnosis, adequate treatment and focus on prevention of complications remain essential as well as timely referral for liver transplantation.

Efficacy and safety of a 14-day administration of tolvaptan in the treatment of patients with ascites in hepatic oedema

“…[1][2][3][4] Sodium dietary restriction and diuretic therapy are the primary treatment modalities for patients with hepatic oedema-manifested ascites. 5 Such diuretics often cause electrolyte imbalance before producing a sufficient amount of diuresis, however, [6][7][8][9] which makes it difficult to make escalating dose adjustments for optimal diuretic effect in patients with hepatic dysfunction. 2,10 Tolvaptan (Samsca TM ; Otsuka Pharmaceutical Co. Ltd, Tokyo, Japan), a novel oral aquaretic agent, is an arginine vasopressin nonpeptide V 2 receptor antagonist, developed for the treatment of clinically significant hypervolaemic or euvolaemic hyponatraemia or less marked hyponatraemia in patients with heart failure, cirrhosis or syndrome of inappropriate antidiuretic hormone.…”

Spontaneous bacterial peritonitis

“…The use of antibiotic prophylaxis is widely established in these patients (3)(4)(5)(6)(7)(8)(9)(10). There is only one controlled study of norfloxacin in patients who recovered from an SBP event where the probability of SBP relapse decreased from 68 to 20% in patients receiving antibiotic prophylaxis with norfloxacin (400 mg/24 hours, PO) (80).…”

“…Up to 13% of cases may be asymptomatic (8,10). Clinical manifestations usually consist of a worsening of symptoms commonly associated with cirrhosis, including increased ascites, diuretic therapy failure, encephalopathy development or worsening, vomiting, etc.…”

“…However, it still is a highly relevant condition in clinical practice given its high prevalence (it affects 10-30% of inpatients with cirrhosis and ascites), high recurrence rate (up to 70% in the first year), and poor longterm prognosis with mortality reaching 50-70% at one year, which leads to consider patients recovering from SBP potential candidates for liver transplantation (4)(5)(6)(7)(8)(9)(10).…”

“…It is a bacterial infection of ascitic fluid in the absence of an adjacent, surgically amenable infection source. Since its description in 1964 (1) numerous studies, guidelines, and both national and international consensus conferences have brought significant advancement to the diagnosis and treatment of this condition, and significantly changed its prognosis (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12).…”