علاج الفشل الكبدي المزمن في تليف الكبد مع الاستسقاء المقاوم للعلاج

References

• The diagnosis of refractory ascites relies on the assessment of the response of ascites to diuretic therapy and salt restriction.
• Repeated LVP plus albumin (8 g/L of ascites removed) are recommended as first line treatment for refractory ascites (I;1).
• Patients with refractory or recurrent ascites (I;1), or those for whom paracentesis is ineffective (e.g. due to the presence of loculated ascites) should be evaluated for TIPS insertion (III;1).
• TIPS insertion is recommended in patients with recurrent ascites (I;1) as it improves survival (I;1) and in patients with refractory ascites as it improve the control of ascites (I;1).
• The use of small-diameter PTFE-covered stents in patients is recommended to reduce the risk of TIPS dysfunction and hepatic encephalopathy with a high risk of hepatic encephalopathy is recommended (I;1).

DOI: 10.1016/j.jhep.2018.03.024