Cirrhosis is irreversible damage to the cells in the liver from scarring. Cirrhosis can be caused by hepatitis C infection, alcoholism or metabolic disorders. Ascites, fluid accumulation in the abdomen and lower extremities, is one of the serious complications of cirrhosis, not because it's life-threatening, but because it indicates disease progression. Fifty percent of patients who develop ascites die within 2 years, the Cleveland Clinic states. There are several ways to treat ascites, depending on the severity; some are simple dietary restrictions and others, invasive surgeries with potential complications.
Sodium Restriction
Restricting sodium is the first step toward controlling ascites. Recommendations in mild ascites range from 1,500 to 2,000g per day. Sodium restriction helps control ascites in all but the most severe cases because fluid follows sodium out of the tissues. Fluid restriction itself is no longer recommended for treatment of ascites.
Diuretics
Diuretics are the first line medical therapy for ascites. The two most commonly used medications are fusosemide (Lasix) and spironolactone (Aldactone). The drugs are often used in conjuction with one another because they work in different ways. Patients on diuretics with ascites need their weight and blood levels of potassium, sodium and creatinine checked frequently as dehydration can cause kidney problems. Rising creatinine levels can necessitate decreasing diuretics to avoid kidney failure.
Paracentesis
Paracentesis is the removal of fluid from the abdomen with a large needle. Paracentesis temporarily corrects the problem but fluid will re-accumulate if measures to control ascites aren't working. One risk to paracentesis is the possibility of infection called spontaneous bacterial peritonitis, which can follow paracentesis or can occur, as the name indicates, spontaneously.
Paracentesis may be done every few weeks to keep ascites under control in the case of refractory ascites. Albumin, a protein that normally prevents ascites from accumulating, is given after paracentesis, in many cases; albumin helps protect the kidney from hepatorenal syndrome, a complication of cirrhosis that may occur after large volume paracentesis (removal of 5 liters or more) in 15 percent of cases, the University of Washington states.
TIPS
TIPS stands for intrahepatic portosystemic shunt. TIPS is a surgical procedure done through the jugular vein in the neck. A stent is placed between the hepatic and portal veins to shunt blood around the liver, the University of Maryland Medical Center states. The TIPS procedure can worsen brain damage called encephalopathy, and is used mostly for patients waiting for liver transplant
Albumin Infusion
Weekly albumin infusions are being used experimentally as treatment for ascites. Since low albumin levels are partially responsible for ascites, albumin infusion may help decrease fluid accumulation and decrease the need for paracentesis.
