5Management of ascites and hepatic hydrothorax
Section snippets
ASCITES
Ascites is defined as the accumulation of free fluid in the peritoneal cavity. This entity was first described by the ancient Egyptians and Greeks. In 300 BC, Erasitratus of Cappadoccia described cirrhosis as a risk factor for the formation of ascites. Ludwig van Beethoven is one of the most celebrated figures who suffered with ascites and cirrhosis. He was treated with serial, large-volume paracentesis.1
The most common cause of ascites is portal hypertension secondary to cirrhosis, which
DILUTIONAL HYPONATRAEMIA
Dilutional hyponatraemia in cirrhotic patients is defined as serum sodium <130 mEq/L.49 This type of hyponatraemia is usually caused by an inability of the kidneys to excrete solute free water and occurs in the setting of increased total-body water and dilution of extracellular fluid volume. It is associated with sodium retention and increased total-body sodium and should be distinguished from true hyponatraemia caused by sodium depletion, which although less common can develop in cirrhotic
HEPATIC HYDROTHORAX
Hepatic hydrothorax is a relatively uncommon complication of end-stage liver with an estimated prevalence among cirrhotic patients of 5–10%.56, 57 Despite numerous case reports describing clinical features and treatments for hepatic hydrothorax, current knowledge of this complication of cirrhosis is limited.
References (81)
- et al.
Mechanisms of water and sodium retention in cirrhosis and the pathogenesis of ascites
Best Pract Res Clin Endocrinol Metab
(2003) - et al.
The management of ascites in cirrhosis: report on the consensus conference of the International Ascites Club
Hepatology
(2003) - et al.
Prognostic value of arterial pressure, endogenous vasoactive systems, and renal function in cirrhotic patients admitted to the hospital for the treatment of ascites
Gastroenterology
(1988) - et al.
Incidence, predictive factors, and prognosis of the hepatorenal syndrome in cirrhosis with ascites
Gastroenterology
(1993) - et al.
A prognostic model for predicting survival in cirrhosis with ascites
J Hepatol
(2001) - et al.
Mechanisms of ascites formation
Clin Liver Dis
(2000) - et al.
Diagnosis, treatment and prophylaxis of spontaneous bacterial peritonitis: a consensus document. International Ascites Club
J Hepatol
(2000) Bacterial infections in cirrhosis: treatment and prophylaxis
J Hepatol
(2005)- et al.
Rapid diagnosis of spontaneous bacterial peritonitis by use of reagent strips
Hepatology
(2003) - et al.
Management of complications of cirrhosis prior to liver transplantation
J Hepatol
(2005)
Spironolactone alone or in combination with furosemide in the treatment of moderate ascites in nonazotemic cirrhosis. A randomized comparative study of efficacy and safety
J Hepatol
Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis
Hepatology
Treatment of mastalgia with tamoxifen in male patients with liver cirrhosis: a randomized crossover study
Am J Gastroenterol
A randomized controlled trial of quinidine in the treatment of cirrhotic patients with muscle cramps
J Hepatol
Cirrhosis and muscle cramps: evidence of a causal relationship
Hepatology
Comparison of paracentesis and diuretics in the treatment of cirrhotics with tense ascites. Results of a randomized study
Gastroenterology
Paracentesis-induced circulatory dysfunction: mechanism and effect on hepatic hemodynamics in cirrhosis
Gastroenterology
Randomized comparative study of therapeutic paracentesis with and without intravenous albumin in cirrhosis
Gastroenterology
Peritoneovenous shunt as a bridge to liver transplantation
Am J Transplant
Diuretic requirements after therapeutic paracentesis in non-azotemic patients with cirrhosis. A randomized double-blind trial of spironolactone versus placebo
J Hepatol
Transjugular intrahepatic portosystemic shunting versus paracentesis plus albumin for refractory ascites in cirrhosis
Gastroenterology
Improved clinical outcome using polytetrafluoroethylene-coated stents for TIPS: results of a randomized study
Gastroenterology
Transjugular intrahepatic portosystemic shunts: comparison with paracentesis in patients with cirrhosis and refractory ascites: a randomized trial
J Hepatol
The North American Study for Treatment of Refractory Ascites
Gastroenterology
A meta-analysis of transjugular intrahepatic portosystemic shunt versus paracentesis for refractory ascites
J Hepatol
Uncovered transjugular intrahepatic portosystemic shunt for refractory ascites: a meta-analysis
Gastroenterology
Management of refractory ascites
Clin Gastroenterol Hepatol
Therapy of hyponatremia in cirrhosis with a vasopressin receptor antagonist: a randomized double-blind multicenter trial
Gastroenterology
A vasopressin receptor antagonist (VPA-985) improves serum sodium concentration in patients with hyponatremia: a multicenter, randomized, placebo-controlled trial
Hepatology
for the HypoCat study investigators. Effects of satavaptan (SR121463B), a selective vasopressin V2 receptor antagonist, on serum sodium concentration and Ascites in patients with cirrhosis and hyponatremia
J Hepatol
Detection of diaphragmatic defect as the cause of severe hepatic hydrothorax with magnetic resonance imaging
Am J Gastroenterol
The morphology of diaphragmatic defects in hepatic hydrothorax: thoracoscopic finding
J Thorac Cardiovasc Surg
Hepatic hydrothorax in the absence of clinical ascites: diagnosis and management
Gastroenterology
Spontaneous bacterial empyema in cirrhotic patients: a prospective study
Hepatology
Reexpansion pulmonary edema: a case report and review of the current literature
J Emerg Med
Thoracocentesis. Clinical value, complications, technical problems, and patient experience
Chest
Safety and efficacy of transjugular intrahepatic portosystemic shunt creation for the treatment of hepatic hydrothorax
J Vasc Interv Radiol
Tetracycline-induced pleural symphysis for recurrent hydrothorax complicating cirrhosis. A new approach to treatment
Gastroenterology
Video-assisted thoracoscopic surgery with talc pleurodesis in the management of symptomatic hepatic hydrothorax
Am J Gastroenterol
Out came copious water
Hepatology
Cited by (37)
Hepatic and non-hepatic hydrothorax in pediatric ascites
2022, Clinics and Research in Hepatology and GastroenterologyCitation Excerpt :Currently, first-line diuretic treatment for hydrothorax consists of spironolactone and furosemide(10). For uncomplicated ascites, spironolactone is typically the best initial treatment due to its mild risks; however, the addition of furosemide is recommended when hydrothorax complicates ascites [3]. This may explain why furosemide is associated with hydrothorax, but not spironolactone.
Ascites
2020, Medicine (Spain)Hepatic hydrothorax
2018, Annals of HepatologyCitation Excerpt :A distal acting agent (typically spironolactone 100 mg/day) and a loop diuretic (e.g. furosemide 40 mg/day) should be co-administered as the best initial regimen to produce a renal excretion of sodium at least 120 mEq per day.11,74 The doses may be increased in a stepwise fashion every 3-5 days by doubling the doses with furosemide up to 160 mg/day and spironolactone up to 400 mg/day.37,38 Urinary sodium should be checked before and during therapy to adjust diuretic dosage as per clinical response.2,13
Differentiation of exudate from transudate ascites based on the dipstick values of protein, glucose, and pH
2013, American Journal of Emergency MedicineCitation Excerpt :Ascites is defined as the pathologic accumulation of free fluid in the peritoneal cavity [1].
Management of refractory ascites attenuates muscle mass reduction and improves survival in patients with decompensated cirrhosis
2020, Journal of Gastroenterology