Excess fluid in the abdominal cavity can cause significant discomfort and
shortness of breath. The method of treatment depends upon the reason for the
ascites accumulation, how quickly the fluid has accumulated, whether it is a
first occurrence or a repeated event, and how significantly the symptoms affect
Lifestyle Changes and Medication
For patients with cirrhosis, the initial therapy for
ascites begins with dietary salt restriction and medications to assist the body
ridding itself of excess salt and fluid. Spironolactone (Aldactone) is a first line
diuretic medication that helps block the chemical aldosterone which is responsible for salt
retention in the body. Furosemide (Lasix) and
metolazone (Zaroxolyn) may also be
added. This treatment is effective in controlling ascites fluid in the vast
majority of patients.
Body weight is used as a measurement of ascites control. The goal for
diuretic therapy is to lose between one to two pounds of weight per day depending upon
underlying medical conditions. Once most of the ascites fluid is gone,
medication dosing will be individualized to the patient's needs.
Water restriction may be considered if hyponatremia,
(low serum sodium) is
- Paracentesis: If diuretics and diet fail, paracentesis may be the next
step in the treatment offered. Under sterile conditions, a needle is placed into
the peritoneal space and fluid is withdrawn. Paracentesis may be considered as a
first step if the ascites fluid accumulates quickly and the abdominal distension
causes pain or shortness of breath. Because the peritoneal fluid contains
albumin, if large amounts of fluid (more than 5 liters) are withdrawn, an
albumin transfusion may be needed.
Paracentesis may be done more than once, but if it becomes a frequent
necessity for symptom control, other options may be considered.
The complications of paracentesis include infection,
bleeding, electrolyte disturbances, and perforating an organ
such as the
in tense ascites, the benefits outweigh the risks in providing relief to the
- Transjugular intrahepatic portosystemic shunt
(TIPS): TIPS diverts
fluid from the portal vein into the
central blood circulation, thus decreasing pressure in the liver and decreasing
ascites formation. An interventional radiologist is able to thread a
stent underneath the skin from the
internal jugular vein to the
hepatic vein while the patient is sedated.
- Liver transplant: Patients who have cirrhosis and ascites should be considered as candidates
for potential liver transplantation.
- Cancer: In patients with ascites from cancer, diet restrictions and diuretics are not
effective. Paracentesis may be the first-line treatment. If needed, the catheter
maybe left in place to drain, so that fluid can be removed as needed and the
patient does not need to undergo repeated procedures.
- Peritoneovenous shunting: Peritoneovenous shunting is a surgical operation that
may increase short-term survival in cancer patients who are not candidates for,
or who have failed treatment with, paracentesis. Shunting may be also considered
for patients who have refractory ascites and are not candidates for
paracentesis, liver transplant, or a TIPS procedure.
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