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Refractory Ascites — RACP Adult Medicine MCQ

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HardGastroenterologyRefractory AscitesRACP Adult Medicine

A 60-year-old man with refractory ascites despite maximal diuretics (spironolactone 400 mg + furosemide 160 mg) and sodium restriction requires paracentesis every 2 weeks. He has no hepatic encephalopathy and MELD score is 15. What is the most appropriate management?

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Correct answer: A — TIPS placement

Refractory ascites (persistent despite maximal diuretics or diuretic-intolerant) is an indication for TIPS in patients without contraindications (hepatic encephalopathy, severe liver failure, cardiac disease). TIPS reduces portal pressure and is superior to serial large-volume paracentesis for ascites control and survival. Liver transplant assessment should also be initiated.

Reference: GESA – 2024 – Refractory Ascites; EASL 2024