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Ascites in a person with abdominal cancer as seen on ultrasound Liver cirrhosis with ascites. Routine complete blood count (CBC), basic metabolic profile, liver enzymes, and coagulation should be performed. Most experts recommend diagnostic paracentesis if the ascites is new or if the person with ascites is being admitted to the hospital.
As the condition is caused by leaking ascitic fluid, treatment centers around managing ascites and decompensated liver disease. Some individuals respond to medical management. In up to 26% of cases, the condition does not respond to medical management, in which case it is known as a refractory hepatic hydrothorax.
Thus, in people with advanced liver disease the shunting of portal blood away from hepatocytes is usually well tolerated. However, in some cases suddenly shunting portal blood flow away from the liver may result in acute liver failure secondary to hepatic ischemia. [6] Acute hepatic dysfunction after TIPS may require emergent closure of the shunt.
HRS can sometimes be triggered by treatments for complications of liver disease: iatrogenic precipitants of HRS include the aggressive use of diuretic medications or the removal of large volumes of ascitic fluid by paracentesis from the abdominal cavity without compensating for fluid losses by intravenous replacement. [9]
Hepatic veno-occlusive disease (VOD) or veno-occlusive disease with immunodeficiency is a potentially life-threatening condition in which some of the small veins in the liver are obstructed. It is a complication of high-dose chemotherapy given before a bone marrow transplant or excessive exposure to hepatotoxic pyrrolizidine alkaloids .
Ascites is most commonly a complication of cirrhosis of the liver. [1] It can also occur in patients with nephrotic syndrome. [3] [4] SBP has a high mortality rate. [5] The diagnosis of SBP requires paracentesis, a sampling of the peritoneal fluid taken from the peritoneal cavity. [6]