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Refractory ascites — ESEGH MCQ

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HardHepatologyRefractory ascitesESEGH

A 66-year-old man with refractory ascites from cirrhosis needs large-volume paracentesis every 10 days despite sodium restriction and tolerated diuretics. He has bilirubin 32 micromol/L, creatinine 92 micromol/L, no encephalopathy and echocardiography is satisfactory. Ascitic cultures are repeatedly negative. What is the most appropriate management?

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Reveal the answer and explanation

Correct answer: E — Consider transjugular intrahepatic portosystemic shunt at a specialist MDT

Refractory ascites with preserved renal function and no encephalopathy can be considered for TIPS after careful specialist assessment. Escalating diuretics despite hyponatraemia increases harm. Albumin is indicated after large-volume paracentesis to reduce circulatory dysfunction. The pearl is that TIPS selection is driven by encephalopathy risk, cardiac status and liver reserve.

Reference: BSG/BASL Ascites in Cirrhosis Guideline