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 NICE CKS. 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 NICE CKS.
For refractory ascites, a Transjugular Intrahepatic Portosystemic Shunt (TIPS) procedure may be considered NICE NG50. Nurse-led day case paracentesis services for refractory ascites can help reduce emergency hospital admissions, lower costs, and improve patient outcomes and experience NICE CKS.
Regarding spontaneous bacterial peritonitis (SBP), antibiotics are not routinely offered to prevent SBP in people with cirrhosis and ascites NICE NG50. 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) NICE NG50. 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 NICE NG50. If antibiotics are offered for SBP prevention, local microbiological advice should be followed, and treatment should continue until the ascites resolves NICE NG50.