Author/Editor		Hafner, Matjaž
Title		Treatment of ascites in patients with cirrhotic liver
Type		članek
Source		Gastroenterolog
Vol. and No.		Letnik 7, št. 1
Publication year		2003
Volume		str. 19-22
Language		eng
Abstract		The natural course of the liver cirrhosis is frequently complicated by ascites - the excessive accumulation of fluid in the peritoneal cavity. According to the arterial vasodilation theory of ascites, portal hypertension is the initial event with resulting splanchnic arteriolar vasodilation causing under filling of the arterial circulation. The arterial receptors sense lower effective arterial blood volume and stimulate the reninangiotensin-aldosteron system, and cause nonosmotic antidiuretic hormone hypersecretion. Renal sodium and water retention are the final consequences of this response. A reduction in salt intake favors a negative sodium balance and facilitates the disappearance of ascites. The main indications for use of diuretics in cirrhosis are the treatment of patients with mild to moderate ascites and the prevention of ascites recurrence after therapeutic paracentesis. Total paracentesis has replaced diuretics as the treatment of choice for cirrhotic patients with severe ascites. Therapeutic options in ascites that cannot be controlled despite dietary sodium restriction and maximal diuretic therapy include repeated total paracentesis and transjugular intrahepatic portosystemic shunt (TIPS) placement. In the long run, liver transplantation is, of course, the only effective treatment modality of the patients with the advanced liver cirrhosis and ascites.
Descriptors		LIVER CIRRHOSIS ASCITES DIURETICS PARACENTESIS PORTASYSTEMIC SHUNT, TRANSJUGULAR INTRAHEPATIC LIVER TRANSPLANTATION