In principle, for therapy of ascites, the underlying disease should be treated.
In ascites due to liver disease, the following procedures can be performed in refractory cases.
- Paracentesis – ascites puncture for therapeutic reasons (method of choice); generally, 6-8 g of albumin (blood protein) should be substituted per liter of puncture to avoid hypovolemia (decrease, in the amount of blood in the circulation), which can cause hepatorenal syndrome (functional, potentially reversible renal dysfunction (severe renal dysfunction due to liver cirrhosis)). Symptom relief lasts between 4-45 days in malignant (“malignant”) ascites.
- Note on intravenous volume substitution after paracentesis for malignant ascites:
- <5 l: not routinely.
- > 5 l: no evidence, if necessary dextrose 5% or albumin.
- Intraperitoneal (“located within the peritoneal cavity”) permanent drainage – if more frequent paracentesis is required.
- Transjugular intrahepatic portosystemic stent shunt (TIPS) – short circuit connection to bypass the hepatic stent area.
- Liver transplantation (LTx)
