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Management of refractory ascites
Author(s) -
DUDLEY FRANCIS
Publication year - 2004
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/j.1440-1746.2004.03675.x
Subject(s) - medicine , paracentesis , ascites , refractory (planetary science) , liver transplantation , transplantation , peritoneovenous shunt , surgery , intensive care medicine , intravascular volume status , hemodynamics , physics , astrobiology
Management of refractory ascites is based on correcting the underlying pathophysiological mechanisms which result in its development. Liver transplantation is the optimal treatment. While awaiting a transplant or if transplantation is contraindicated first line therapy is abdominal paracentesis with intravascular volume support. If tolerated diuretics are helpful in reducing the need for repeated paracentesis. TIPS should be considered when the frequency of paracentesis is greater than 2 or 3 per month or when paracentesis is poorly tolerated or ineffective and post TIPS monitoring is necessary to minimise complications and to identify shunt dysfunction early.