What are the recommended management strategies for a patient with ascites due to cirrhosis?

For a patient with ascites caused by cirrhosis, several management strategies are recommended.

If a person shows signs of decompensated liver disease, such as ascites, emergency hospital admission or immediate referral to a hepatologist or gastroenterologist with an interest in hepatology should be arranged, depending on clinical judgment ¹. Referral to an urgent specialist nurse-led liver clinic may also be appropriate to avoid admission, as these clinics can facilitate diuretic drug titration for refractory ascites ¹.

For refractory ascites, a Transjugular Intrahepatic Portosystemic Shunt (TIPS) procedure may be considered ². Nurse-led day case paracentesis services for refractory ascites can help reduce emergency hospital admissions, lower costs, and improve patient outcomes and experience ¹.

Regarding spontaneous bacterial peritonitis (SBP), antibiotics are not routinely offered to prevent SBP in people with cirrhosis and ascites ². However, antibiotics may be considered for SBP prevention if the person is at high risk, such as having severe liver disease (e.g., ascitic protein of 15 g/L or less, Child–Pugh score >9, or MELD score >16) ². Prophylactic antibiotics may also be considered if the consequences of an infection could severely impact the person's care, for example, affecting their wait for a transplant or TIPS ². If antibiotics are offered for SBP prevention, local microbiological advice should be followed, and treatment should continue until the ascites resolves ².