From the Guidelines
Tense ascites is a condition characterized by a significant accumulation of fluid in the abdominal cavity, causing increased pressure and discomfort.
Key Characteristics
- It is a complication of cirrhosis, where the liver is unable to properly process sodium, leading to fluid retention and accumulation in the abdomen.
- The condition is marked by abdominal distension, discomfort, and shortness of breath due to the increased pressure on the diaphragm and lungs.
Management
- Large-volume paracentesis is a common treatment approach, which involves removing a large amount of fluid (up to 5L) from the abdominal cavity to rapidly relieve symptoms 1.
- The use of intravenous albumin (8g/L of fluid removed) can help prevent complications associated with large-volume paracentesis, such as hypovolemia and renal impairment.
- Diuretic therapy is also essential in managing tense ascites, as it helps to reduce sodium retention and prevent reaccumulation of fluid 1.
- A single large-volume paracentesis followed by diet and diuretic therapy is considered an appropriate treatment approach for patients with tense ascites.
- Reducing sodium intake and increasing urinary sodium excretion with diuretics, such as furosemide, can help prevent reaccumulation of fluid and manage the underlying condition.
From the Research
Definition of Tense Ascites
- Tense ascites is a condition characterized by the accumulation of fluid within the peritoneal cavity, leading to increased abdominal pressure and discomfort 2.
- It is a severe form of ascites, which is a common complication of liver cirrhosis and other liver diseases 3, 4, 5.
Treatment of Tense Ascites
- The treatment of tense ascites typically involves paracentesis, which is the removal of fluid from the peritoneal cavity, followed by albumin infusion and diuretic therapy 2, 5.
- Paracentesis provides immediate relief from the symptoms of tense ascites, while albumin infusion helps to prevent hemodynamic and renal dysfunction 4.
- Diuretic therapy, such as spironolactone and furosemide, is used to reduce fluid accumulation and prevent the recurrence of ascites 4, 2.
Management of Ascites
- The management of ascites, including tense ascites, depends on the underlying cause and severity of the condition 3, 4, 2, 5.
- A combination of sodium restriction, diuretic therapy, and paracentesis is often used to manage ascites, while liver transplantation may be considered in severe cases 3, 4, 5.
- It is essential to distinguish between cirrhotic and non-cirrhotic causes of ascites to guide therapy and improve patient outcomes 2.