Treatment of ascites

Treatment of ascites

The treatment of ascites is aimed at lowering the abdominal blood volume. This can be achieved in different ways: Decreasing water and salt intake. Increasing water and salt excretion by the kidneys with a diuretic. The aldosterone antagonist spironolactone is drug of choice to decrease the volume of ascites. Consultation the Nephrology & Urology chapter for the mechanism of spironolactone. Furosemide is a diuretic that can be added to spironolactone therapy

for a quicker reduction of the ascites. For its mechanism, see the section on loop diuretics in the Nephrology & Urology chapter. Paracentesis and albumin therapy. Removal of excess fluid and addition of albumin decrease the osmotic pressure and lower the ascitic volume. Bypassing liver obstruction by placing a TIPS (transjugular intrahepatic portosystemic shunt), thereby decreasing portal hypertension. Since patients with liver cirrhosis and ascites are at higher risk for spontaneous bacterial peritonitis (SBP), antimicrobial prophylaxis is indicated for these patients. Oral norfloxacin, a fluoroquinolone antibacterial agent is used for this purpose.