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Refractory Ascites Definition — SCE Palliative Medicine MCQ

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ModerateGI SymptomsRefractory Ascites DefinitionSCE Palliative Medicine

A 70-year-old man with advanced hepatocellular carcinoma and portal hypertension presents with tense ascites. His serum albumin is 22 g/L. He is on maximum diuretics (spironolactone 400 mg and furosemide 160 mg daily). His ascites is described as ‘refractory’. He is not a transplant or TIPS candidate. Which of the following best defines ‘refractory ascites’?

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Correct answer: C — Ascites that cannot be mobilised or recurs early despite optimal diuretic therapy and sodium restriction, requiring repeated large-volume paracentesis

Refractory ascites is formally defined in UK (BSG/BASL) guidance as ascites that cannot be mobilised—or recurs early after therapeutic paracentesis—despite appropriate sodium restriction and maximum tolerated diuretics. Option C directly reflects this. Option E is incorrect because duration alone is insufficient. Option B is incorrect: a single paracentesis often suffices when combined with medical therapy. Option A is irrelevant to physiology. Option D confuses ascites with infection (e.g. SBP), which is a distinct issue.

Reference: BSG/BASL guidelines in Gut 2021: ‘Refractory ascites’ defined as ascites that cannot be mobilised or whose early recurrence cannot be prevented by medical treatment. NICE also assumes this definition in its HealthTech guidance. (Gut 2021, NICE HTG648 2022)