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Hepatology International
Erschienen in: Hepatology International 1/2018

23.08.2017 | Special Issue - Portal Hypertension

Management of ascites and hepatorenal syndrome

verfasst von: Salvatore Piano, Marta Tonon, Paolo Angeli

Erschienen in: Hepatology International | Sonderheft 1/2018

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Abstract

Ascites represents the most common decompensating event in patients with liver cirrhosis. The appearance of ascites is strongly related to portal hypertension, which leads to splanchnic arterial vasodilation, reduction of the effective circulating volume, activation of endogenous vasoconstrictor systems, and avid sodium and water retention in the kidneys. Bacterial translocation further worsens hemodynamic alterations of patients with cirrhosis and ascites. The first-line treatment of uncomplicated ascites is a moderate sodium-restricted diet combined with diuretic treatment. In patients who develop refractory ascites, paracentesis plus albumin represents the most feasible option. Transjugular intrahepatic portosystemic shunt placement is a good alternative for selected patients. Other treatments such as vasoconstrictors and automated low-flow pumps are two potential options still under investigations. Ascites is associated with a high risk of developing further complications of cirrhosis such as dilutional hyponatremia, spontaneous bacterial peritonitis and/or other bacterial infections and acute kidney injury (AKI). Hepatorenal syndrome (HRS) is the most life-threatening type of AKI in patients with cirrhosis. The most appropriate medical treatment in patients with AKI-HRS is the administration of vasoconstrictors plus albumin. Finally, ascites impairs both the quality of life and survival in patients with cirrhosis. Thus, all patients with ascites should be evaluated for the eligibility for liver transplantation. The aim of this article is to review the management of patients with cirrhosis, ascites and HRS.
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Metadaten
Titel
Management of ascites and hepatorenal syndrome
verfasst von
Salvatore Piano
Marta Tonon
Paolo Angeli
Publikationsdatum
23.08.2017
Verlag
Springer India
Erschienen in
Hepatology International / Ausgabe Sonderheft 1/2018
Print ISSN: 1936-0533
Elektronische ISSN: 1936-0541
DOI
https://doi.org/10.1007/s12072-017-9815-0

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