Treatment of Chronic Liver Failure in Liver Cirrhosis with Refractory Ascites
In patients with liver cirrhosis, refractory ascites represents a clinically significant complication where fluid accumulation fails to respond to diuretic therapy and dietary salt restriction — whether classified as diuretic-resistant or diuretic-intractable. This page outlines the clinical scenario and the general nature of the structured management approach.
Clinical Scenario
The diagnosis of refractory ascites in cirrhosis is established through formal assessment of the response of ascites to diuretic therapy and salt restriction. Patients who meet criteria for either diuretic-resistant or diuretic-intractable ascites fall within this protocol's scope, representing a population where standard conservative measures are insufficient.
Treatment Approach
The evidence-based protocol for this scenario involves evaluation for an interventional shunt-based procedure, with specific technical criteria guiding both patient selection and procedural approach.
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
View source ↗