Conduite à tenir devant une ascite

Abstract

Ascites is the most common complication of cirrhosis. Approximately 50% of patients with compensated cirrhosis will develop ascites over a 10-year period. Ascites is associated with increased risks of infections, renal failure and poor long-term outcome. Abstinence from alcohol, salt restriction and diuretics are the mainstays of the therapy, and these measures are effective in approximately 90% of the patients. Treatment options for diuretic-resistant patients include serial therapeutic paracentesis and transjugular intrahepatic portosystemic stent-shunts. Patients eligible for liver transplantation should undergo evaluation for this procedure after development of ascites. A diagnostic paracentesis should be performed on hospital admission in any cirrhotic patient with ascites to investigate the presence of spontaneous bacterial peritonitis. In patients with an ascetic fluid PMN cell count > 250/mm³, antibiotic therapy (cefotaxime or amoxicillin-clavulanic acid) and albumin infusion need to be started before obtaining the results of ascites or blood cultures. Prophylactic antibiotic administration is recommended in cirrhotic patients hospitalized with upper gastrointestinal haemorrhage or low ascites protein (i.e. < 10 g/l) and in patients recovering from an episode of spontaneous bacterial peritonitis.