Diagnosis, Evaluation, and Management of Ascites and Hepatorenal Syndrome
Patient Guideline Summary
- Cirrhosis refers to scar tissue in an organ, commonly the liver.
- Common causes of liver cirrhosis are long-standing alcohol intake, hepatitis and fatty liver disease.
- Symptoms include ascites (fluid in the abdomen), decreased mental function and stomach bleeding.
- The disease can lead to kidney failure, serious infections and death. Its mechanics are complex.
- This patient summary focuses on management of the complications of liver cirrhosis.
- A complete evaluation of each patient is necessary – medical history, physical exam and laboratory testing.
- Ascites is removed with a needle and tested for infection and chemical analysis.
- If infection is suspected, the fluid is cultured for bacteria.
- A large amount of ascites can be removed through a needle.
- Sodium restriction and diuretics are also used to reduce the amount of ascites.
- Albumin or baclofen may be used as well.
- Fluid intake may be restricted.
- Note: because blood flow through the scarred liver is restricted, back pressure forces ascitic fluid from veins into the abdomen. Consequently, re-routing blood flow around the liver helps relieve ascites. The recommended approach to this problem is a transjugular intrahepatic portosystemic shunt (TIPS), threading an instrument from the jugular vein in the neck into the liver and connecting a vein flowing into the liver with a vein flowing out of the liver.
- The body may develop hyponatremia (too little sodium in the blood), requiring fluid adjustments and medications to restore balance.
- Fluid may leak into the chest as well as the abdomen and need removal.
- Ascites (fluid leak into the abdomen) and hydrothorax (fluid leak into the chest) are prone to infection.
- Changing fluid pressures may cause a hiatus hernia (part of the stomach in the chest) or other hernias (abdominal tissue protruding through the abdominal wall).
- Liver failure may cause hepatorenal syndrome (kidney failure) and require dialysis.
- Patients with recurring ascites should be evaluated for liver transplantation.
- Antibiotics may be used to treat, and sometimes to prevent, infections.
- Diuretics are used to improve fluid balance and reduce ascites.
- In addition to TIPS, hernia surgery may be needed.
- Liver transplant may be needed in qualified patients.
- AASLD: American Association For The Study Of Liver Diseases
- TIPS: Transjugular Intrahepatic Portosystemic Shunt