Internal Medicine

P1: SBT

0521779407-04 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:8

Ascites 165

➣Contraindications: absolute: clinically evident disseminated

intravascular coagulopathy or fibrinolysis

■TIPS:

➣Side effects: hepatic encephalopathy (23%), liver failure, post-

procedural bleed, stent occlusion, heart failure, hemolysis

➣Contraindications: absolute: advanced liver disease, heart fail-

ure, pulmonary hypertension, advanced renal dysfunction

■Peritoneovenous shunt:

➣Side effects: shunt thrombosis, consumptive coagulopathy, heart

failure, bowel obstruction

➣Contraindications: absolute: active or prior spontaneous bacte-

rial peritonitis, heart failure, renal failure

follow-up

During Treatment

■Regularly monitor serum electrolytes & creatinine

■Daily body weight:

➣No limit to weight loss in presence of pedal edema

➣Diuresis limited to 750 mL/d once edema resolved

Routine

■Clinical follow-up & renal chemistry q 1–3 mo

■Medical compliance reinforced

complications and prognosis

Complications

■Spontaneous ascitic fluid infection:

➣27% of pts w/ cirrhotic ascites on admission

➣Long-term outpt prophylactic antibiotic after 1 episode of infec-

tion

■Hepatic hydrothorax:

➣5% of all pts w/ cirrhotic ascites

➣Principles of management same as those for cirrhotic ascites;

TIPS & liver transplant if conservative measures fail

■Abdominal wall hernia:

➣20% among all pts w/ ascites

➣Surgical repair considered electively, postponed until transplant

surgery for transplant candidates, but performed emergently for

incarceration or rupture of hernia

Prognosis

■50% 2-y survival once ascites occurs