{
  "schemaVersion": 2,
  "eyebrow": "Hepatology",
  "title": "Ascites",
  "summary": "New or worsening ascites requires prompt paracentesis, fluid-pattern interpretation, and early detection of spontaneous bacterial peritonitis, renal dysfunction, and portal-hypertensive decompensation. Management is driven by etiology, ascites severity, response to fluid removal, and candidacy for TIPS or liver transplantation.",
  "seoDescription": "Point-of-care approach to ascites: diagnostic paracentesis, SAAG interpretation, SBP thresholds, albumin replacement, and escalation for refractory cirrhotic ascites.",
  "clinicalQuestion": "How should physicians rapidly classify, investigate, and manage new or worsening ascites while identifying infection and refractory portal-hypertensive disease?",
  "specialty": "Gastroenterology and Hepatology",
  "audience": "U.S. physicians and medical trainees",
  "tags": [
    "ascites",
    "diagnostic paracentesis",
    "SAAG",
    "spontaneous bacterial peritonitis",
    "cirrhosis",
    "large-volume paracentesis",
    "TIPS",
    "refractory ascites"
  ],
  "keyTakeaways": [
    "Perform diagnostic paracentesis in every patient with new-onset ascites and without delay in hospitalized patients with cirrhosis and ascites. [10][19]",
    "Use same-day serum and ascitic albumin to calculate SAAG: ≥1.1 g/dL supports portal-hypertensive ascites; combine it with ascitic total protein to distinguish cirrhosis from cardiac ascites. [10][23]",
    "Treat ascitic neutrophil counts >250/mm3 as spontaneous bacterial peritonitis; obtain fluid cell count with differential and culture as part of the initial tap. [19][23]",
    "After removal of >5 L during paracentesis for cirrhotic ascites, give 20% or 25% albumin 8 g per liter removed. [2][3]",
    "Refractory or recurrent ascites warrants TIPS consideration and liver-transplant assessment, but bilirubin >50 micromol/L, platelets <75 × 10^9/L, current encephalopathy, infection, renal decline, cardiac dysfunction, or pulmonary hypertension identify higher-risk TIPS candidates. [6][9]"
  ],
  "sections": [
    {
      "id": "first-presentation-and-hospital-admission",
      "eyebrow": "Initial action",
      "heading": "When ascites requires immediate diagnostic paracentesis",
      "intro": "Do not attribute fluid accumulation to cirrhosis without fluid analysis.",
      "paragraphs": [
        "Perform diagnostic paracentesis for all new-onset ascites. Obtain abdominal ultrasound before the procedure for fluid confirmation and site selection. In cirrhosis, perform the tap without delay at hospital admission and repeat diagnostic evaluation when ascites worsens or when gastrointestinal bleeding, shock, fever, systemic inflammation, gastrointestinal symptoms, worsening kidney or liver function, or hepatic encephalopathy occurs. [10][19]",
        "Send ascitic fluid for cell count with differential, albumin, and total protein; obtain serum albumin on the same day for SAAG calculation. Send culture when infection is suspected, ideally by bedside inoculation into aerobic and anaerobic blood-culture bottles before antimicrobials. Cytology requires a larger sample than the approximately 50 mL generally sufficient for routine diagnostic studies. [11][12][23]",
        "Ascites in cirrhosis is a decompensating event rather than an isolated symptom: five-year survival declines from approximately 80% in compensated cirrhosis to approximately 30% after ascites develops. Clinically significant ascites and associated complications should prompt consideration of liver-transplant evaluation. [19][24]"
      ],
      "bullets": [
        "Use ultrasound-guided site selection when fluid is limited, loculated, or the bedside examination is uncertain. [10][12]",
        "During a therapeutic tap in a hospitalized patient, also request ascitic cell count because SBP may coexist with symptomatic volume overload. [12]",
        "If the drain is left in place, limit dwell time to 6 hours to reduce infection risk. [12]"
      ],
      "subsections": [],
      "table": {
        "caption": "Initial ascitic-fluid studies and the decision each result changes. [10][11][12][19][23]",
        "columns": [
          "Test",
          "Actionable result",
          "Interpretation and next action"
        ],
        "rows": [
          [
            "Cell count and differential",
            "Neutrophils >250/mm3",
            "Diagnose SBP and initiate treatment; do not await culture confirmation. [19]"
          ],
          [
            "Ascitic albumin plus same-day serum albumin",
            "SAAG ≥1.1 g/dL",
            "Supports portal-hypertensive ascites; integrate total protein and clinical context. [10][23]"
          ],
          [
            "Ascitic total protein",
            "<2.5 g/dL with SAAG ≥1.1 g/dL",
            "Pattern strongly supports cirrhosis with portal hypertension. [10]"
          ],
          [
            "Ascitic total protein",
            "≥2.5 g/dL with SAAG ≥1.1 g/dL",
            "Pattern usually indicates right-heart failure; direct cardiac evaluation accordingly. [10]"
          ],
          [
            "Culture",
            "Positive culture with PMN <250/mm3",
            "Bacterascites; treat if symptomatic, while asymptomatic patients should undergo repeat paracentesis. [13]"
          ]
        ]
      }
    },
    {
      "id": "etiologic-classification",
      "eyebrow": "Fluid pattern",
      "heading": "Use SAAG and ascitic protein to direct the etiologic workup",
      "intro": "Classify portal-hypertensive versus nonportal ascites before committing to cirrhosis-directed therapy.",
      "paragraphs": [
        "Calculate SAAG as serum albumin minus ascitic albumin. A SAAG ≥1.1 g/dL indicates portal hypertension and correlates with a hepatic vein–portal vein pressure gradient greater than 11 mm Hg; a SAAG <1.1 g/dL redirects the evaluation toward nonportal mechanisms. Although SAAG is highly useful, interpret it with the total clinical picture because exceptions occur. [10][23]",
        "For high-SAAG ascites, ascitic total protein is the key discriminator. A protein concentration <2.5 g/dL supports cirrhosis and portal hypertension, whereas protein ≥2.5 g/dL usually indicates right-heart failure. A high-SAAG result therefore should not automatically be labeled cirrhotic ascites when cardiac congestion is plausible. [10]",
        "For low-SAAG ascites, prioritize peritoneal malignancy, chronic peritoneal infection including tuberculosis, and nephrotic syndrome. Evaluate for nephrotic syndrome or protein-losing enteropathy when the clinical setting supports either diagnosis. Pancreatic ascites may produce an elevated PMN count but generally remains low-SAAG, so neutrophilia alone does not establish SBP in a nonportal fluid pattern. [10]"
      ],
      "bullets": [
        "Order ascitic cytology when a low-SAAG pattern or clinical course suggests peritoneal malignancy; malignant ascites reflects advanced malignant disease and may require repeated symptom-directed fluid management. [8][12]",
        "In milky fluid, measure ascitic triglycerides and investigate malignancy, cirrhosis, postsurgical or traumatic lymphatic injury, and infection according to context. Chylous ascites is typically defined by triglycerides >200 mg/dL. [15][16]",
        "Use imaging to assess liver morphology, portal-hypertensive features, malignancy, pancreatic disease, or cardiac congestion in parallel with fluid classification; ultrasound is recommended before paracentesis. [10]"
      ],
      "subsections": [],
      "table": {
        "caption": "Etiologic branching by SAAG and ascitic total protein. [10][15][16][23]",
        "columns": [
          "Fluid pattern",
          "Most likely mechanism or cause",
          "Next diagnostic direction"
        ],
        "rows": [
          [
            "SAAG ≥1.1 g/dL; protein <2.5 g/dL",
            "Cirrhosis with portal hypertension",
            "Assess decompensation, infection, kidney function, and response to ascites treatment. [10]"
          ],
          [
            "SAAG ≥1.1 g/dL; protein ≥2.5 g/dL",
            "Usually right-heart failure",
            "Evaluate for cardiac congestion rather than assuming cirrhosis. [10]"
          ],
          [
            "SAAG <1.1 g/dL",
            "Peritoneal malignancy, tuberculosis, nephrotic syndrome, or pancreatic ascites",
            "Use clinical context to pursue cytology, chronic infection evaluation, renal protein-loss assessment, or pancreatic evaluation. [10]"
          ],
          [
            "Milky fluid; triglycerides >200 mg/dL",
            "Chylous ascites",
            "Evaluate for malignancy, cirrhosis-related portal hypertension, postoperative or traumatic lymphatic leak, and infection. [15][16]"
          ]
        ]
      }
    },
    {
      "id": "sbp-and-infected-ascites",
      "eyebrow": "Infection",
      "heading": "Recognize and act on spontaneous bacterial peritonitis",
      "intro": "The ascitic neutrophil count determines immediate management.",
      "paragraphs": [
        "Diagnose SBP when ascitic fluid neutrophils exceed 250/mm3. This threshold applies whether neutrophils are measured microscopically or by flow cytometry-based automated counting; reagent strips do not have clear evidence for routine diagnosis. In a traumatic paracentesis with ascitic red cells >10,000/mm3, correct the PMN count by subtracting 1 PMN for every 250 red cells/mm3. [11][19]",
        "Culture-negative neutrocytic ascites has PMN ≥250/mm3 with a negative culture and remains an infected-ascites phenotype requiring treatment. In contrast, monomicrobial nonneutrocytic bacterascites has a positive culture with PMN <250/mm3: treat symptomatic patients, but in asymptomatic patients repeat paracentesis and start antibiotics if the repeat PMN count reaches ≥250/mm3. [13]",
        "In SBP with increased or rising serum creatinine, administer albumin 1.5 g/kg within 6 hours of diagnosis followed by 1 g/kg on day 3. This regimen targets the high-risk renal phenotype rather than routine albumin use for every infected ascites presentation. [2][3][17]"
      ],
      "bullets": [
        "Collect ascitic culture before antibiotics when feasible; bedside inoculation into aerobic and anaerobic bottles increases culture yield from approximately 50% to approximately 80% when PMN is ≥250/mm3. [11]",
        "For healthcare-associated or nosocomial SBP, choose empiric therapy using local susceptibility data; piperacillin-tazobactam is suggested in settings with low multidrug resistance, while ESBL-prevalent settings may require a carbapenem, with additional gram-positive multidrug-resistant coverage considered where prevalent. [17]",
        "If ascitic cultures are polymicrobial, consider procedural bowel puncture or another secondary intra-abdominal source rather than uncomplicated SBP. [13]"
      ],
      "subsections": [],
      "table": {
        "caption": "Ascitic-fluid infection phenotypes and immediate action. [11][13][19]",
        "columns": [
          "Phenotype",
          "Fluid findings",
          "Management decision"
        ],
        "rows": [
          [
            "SBP",
            "PMN >250/mm3",
            "Treat as SBP; culture result does not delay treatment. [19]"
          ],
          [
            "Culture-negative neutrocytic ascites",
            "PMN ≥250/mm3 with negative culture",
            "Manage as infected ascites requiring treatment. [13]"
          ],
          [
            "Monomicrobial nonneutrocytic bacterascites",
            "Single-organism culture positive; PMN <250/mm3",
            "Treat if symptomatic; if asymptomatic, repeat paracentesis and treat if PMN becomes ≥250/mm3. [13]"
          ],
          [
            "Polymicrobial bacterascites",
            "Multiple organisms; PMN <250/mm3",
            "Assess for needle-related gut puncture or another secondary source. [13]"
          ]
        ]
      }
    },
    {
      "id": "cirrhotic-ascites-management",
      "eyebrow": "Volume management",
      "heading": "Manage large-volume and refractory cirrhotic ascites",
      "intro": "Paracentesis and albumin replacement are central when ascites is tense, symptomatic, or diuretic-refractory.",
      "paragraphs": [
        "Large-volume paracentesis is standard care for large-volume ascites and is used with diuretic therapy when applicable. In diuretic-refractory ascites, remove as much fluid as feasible for symptom control. Bedside paracentesis is generally safe, and repeated therapeutic paracentesis is commonly used when fluid is refractory to fluid restriction and diuretics. [2][5][12]",
        "After paracentesis removing >5 L, infuse 20% or 25% albumin at 8 g per liter of ascites removed. For removal of <5 L, consider the same 8 g/L replacement in acute-on-chronic liver failure or when post-paracentesis acute kidney injury risk is high. Albumin remains the preferred plasma expander in this setting. [2][3]",
        "Consider TIPS in selected patients with refractory or recurrent ascites, and assess transplant candidacy at the same decision point. TIPS may improve ascites control and, in more recent randomized studies using contemporary selection and stent approaches, improved survival compared with large-volume paracentesis; selection is crucial because the earlier trials commonly excluded more severe liver disease. [3][6][9]"
      ],
      "bullets": [
        "Discuss TIPS with the transplant center before the procedure in transplant-eligible patients. [6]",
        "Treat bilirubin >50 micromol/L, platelets <75 × 10^9/L, current encephalopathy, active infection, progressive renal failure, severe systolic or diastolic dysfunction, and pulmonary hypertension as high-risk features that may predict limited TIPS benefit. [6]",
        "Monitor renal function, serum sodium, arterial pressure, and urine sodium because hyponatremia, low arterial pressure, increased creatinine, and low urine sodium predict poor prognosis in cirrhotic ascites. [17]"
      ],
      "subsections": [
        {
          "heading": "Long-term albumin: selective and unsettled",
          "paragraphs": [
            "Long-term albumin is not equivalent to post-paracentesis replacement. In the ANSWER trial of 442 patients with persistent ascites, 40 g human albumin weekly for up to 18 months was associated with a 38% lower mortality hazard and fewer refractory-ascites, renal, encephalopathy, and infection events. Its role across decompensated cirrhosis remains debated, so use should be individualized rather than substituted for evaluation of refractory ascites, TIPS suitability, or transplantation. [4]"
          ],
          "bullets": []
        }
      ],
      "table": {
        "caption": "Procedure-centered escalation for cirrhotic ascites. [2][3][6][9][12]",
        "columns": [
          "Clinical situation",
          "Primary action",
          "Key guardrail"
        ],
        "rows": [
          [
            "Large, symptomatic ascites",
            "Therapeutic large-volume paracentesis. [2][12]",
            "Give 20% or 25% albumin 8 g/L removed when >5 L is removed. [2][3]"
          ],
          [
            "<5 L removed with ACLF or high post-paracentesis AKI risk",
            "Consider albumin 8 g/L removed. [2][3]",
            "Recommendation is weaker than for >5 L removal. [2][3]"
          ],
          [
            "Refractory or recurrent ascites",
            "Consider TIPS and liver-transplant evaluation. [3][6][9]",
            "Screen for encephalopathy, infection, renal decline, cardiac dysfunction, pulmonary hypertension, bilirubin >50 micromol/L, and platelets <75 × 10^9/L. [6]"
          ],
          [
            "Transplant-eligible patient considered for TIPS",
            "Discuss TIPS with the transplant center. [6]",
            "Do not treat TIPS as a substitute for transplant planning. [6][9]"
          ]
        ]
      }
    },
    {
      "id": "cause-directed-escalation",
      "eyebrow": "Beyond cirrhosis",
      "heading": "Redirect management when ascites is nonportal or atypical",
      "intro": "Fluid removal may relieve symptoms, but definitive control requires treating the driver.",
      "paragraphs": [
        "A low-SAAG profile should prevent reflex escalation of portal-hypertension therapy. Peritoneal malignancy, chronic peritoneal infection, nephrotic syndrome, and pancreatic ascites each require a cause-specific diagnostic pathway; obtain cytology when malignancy is suspected, evaluate protein-loss disorders when indicated, and interpret pancreatic inflammation or leak in the setting of low-SAAG fluid. [10]",
        "Malignant ascites is associated with advanced cancer and significant morbidity. Use paracentesis for symptom relief and coordinate disease-directed oncologic assessment rather than treating the fluid pattern as cirrhotic ascites. Diuretics are described as a treatment mainstay, but the expected response depends on the underlying physiology and should not delay diagnostic clarification. [8][12]",
        "For chylous ascites, distinguish lymphatic obstruction or leak from portal-hypertensive lymphatic overload. In adults in Western settings, tumors, cirrhosis, and postoperative leakage are common causes; lymphangiography may be a therapeutic option for refractory lymphatic leakage in selected cases. [15][16]"
      ],
      "bullets": [
        "Rapid fluid reaccumulation, low SAAG, atypical imaging, or milky fluid should trigger reassessment for malignancy or lymphatic pathology rather than repeated empiric cirrhosis-directed management. [10][15][16]",
        "In suspected chylous ascites, triglycerides >200 mg/dL support the diagnosis but do not establish cause; actively exclude malignancy when nonportal etiologies are plausible. [16]"
      ],
      "subsections": [],
      "table": {
        "caption": "Escalation triggers that should redirect the working diagnosis. [8][10][15][16]",
        "columns": [
          "Trigger",
          "Concern",
          "Next action"
        ],
        "rows": [
          [
            "SAAG <1.1 g/dL",
            "Nonportal ascites",
            "Prioritize malignancy, tuberculosis or other chronic peritoneal infection, nephrotic syndrome, and pancreatic causes. [10]"
          ],
          [
            "Milky fluid with triglycerides >200 mg/dL",
            "Chylous ascites",
            "Investigate malignancy, cirrhosis, postsurgical or traumatic lymphatic injury, and infection. [15][16]"
          ],
          [
            "High SAAG with protein ≥2.5 g/dL",
            "Cardiac ascites",
            "Evaluate for right-heart failure or congestive physiology. [10]"
          ],
          [
            "Clinical concern for cancer or low-SAAG pattern",
            "Peritoneal malignancy",
            "Obtain cytology and pursue malignancy-directed assessment. [8][10][12]"
          ]
        ]
      }
    }
  ],
  "faq": [],
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  "citations": [
    {
      "number": 1,
      "title": "Cirrhosis - Guidelines | BMJ Best Practice",
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      "url": "https://bestpractice.bmj.com/topics/en-gb/278/guidelines",
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      "title": "Guidelines on the management of ascites in cirrhosis - Gut",
      "detail": "gut.bmj.com",
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      "snippet": "solution) should be infused after paracentesis of >5 L is completed at a dose of 8 g albu-min/L of ascites removed. (Quality of evidence: high; Recom-mendation: strong) 6.2. Albumin (as 20% or 25% solution) can be considered after paracentesis of <5 L at a dose of 8 g albumin/L of as-cites removed i",
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      "detail": "gut.bmj.com",
      "url": "https://gut.bmj.com/content/70/1/9",
      "authors": "gut.bmj.com",
      "host": "gut.bmj.com",
      "snippet": "6.2. Albumin (as 20% or 25% solution) can be considered after paracentesis of <5 L at a dose of 8 g albumin/L of ascites removed in patients with ACLF or high risk of post-paracentesis acute kidney injury. (Quality of evidence: low; Recommendation: weak)\n\n6.3. In patients with SBP and an increased s",
      "score": 0.76826453
    },
    {
      "number": 4,
      "title": "chronic liver failure (ACLF) and the role of biomarkers - Gut",
      "detail": "gut.bmj.com",
      "url": "https://gut.bmj.com/content/gutjnl/early/2024/03/25/gutjnl-2023-330584.full.pdf",
      "authors": "gut.bmj.com",
      "host": "gut.bmj.com",
      "snippet": "It is well established and used in the prevention and treatment of circulatory dysfunction and renal failure associated with large-­ volume paracentesis and SBP and it has been incorporated in international guidelines. However, its benefit in the treatment of decompensated cirrhosis remains a matter",
      "score": 0.62906903
    },
    {
      "number": 5,
      "title": "Treatment of Patients with Cirrhosis",
      "detail": "www.nejm.org",
      "url": "https://www.nejm.org/doi/full/10.1056/NEJMra1504367",
      "authors": "www.nejm.org",
      "host": "www.nejm.org",
      "snippet": "With diuretic-refractory ascites, the goal is to remove as much fluid as possible. it is recommended that 6 to 8 g of albumin should be given per liter of",
      "score": 0.5176446
    },
    {
      "number": 6,
      "title": "Transjugular intrahepatic portosystemic stent-shunt in the ... - Gut",
      "detail": "gut.bmj.com",
      "url": "https://gut.bmj.com/content/69/7/1173",
      "authors": "gut.bmj.com",
      "host": "gut.bmj.com",
      "snippet": "#### TIPSS for ascites\n\nThe initial randomised studies of TIPSS vs large-volume paracentesis (LVP) for patients with refractory and/or recurrent ascites published between 1996–2004 came to varying conclusions with regard to survival.54–58 However, these studies used relatively outmoded approaches in",
      "score": 0.5063723
    },
    {
      "number": 7,
      "title": "Does This Patient Have Ascites? How to Divine Fluid in the Abdomen",
      "detail": "jamanetwork.com",
      "url": "https://jamanetwork.com/journals/jama/fullarticle/397285",
      "authors": "jamanetwork.com",
      "host": "jamanetwork.com",
      "snippet": "When clinically detectable, ascites may indicate underlying heart failure, liver disease, nephrotic syndrome, or malignancy.",
      "score": 0.5157425
    },
    {
      "number": 8,
      "title": "Malignant Ascites: New Concepts in Pathophysiology, Diagnosis ...",
      "detail": "jamanetwork.com",
      "url": "https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/752267",
      "authors": "jamanetwork.com",
      "host": "jamanetwork.com",
      "snippet": "Malignant ascites is a manifestation of advanced malignant disease that is associated with significant morbidity. Mainstays of treatment include diuretics.",
      "score": 0.44767818
    },
    {
      "number": 9,
      "title": "Liver diseases: epidemiology, causes, trends and predictions - Nature",
      "detail": "www.nature.com",
      "url": "https://www.nature.com/articles/s41392-024-02072-z",
      "authors": "www.nature.com",
      "host": "www.nature.com",
      "snippet": "Article \nCAS \nPubMed \nGoogle Scholar\n\nBiggins, S. W. et al. Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology 74, 1014–1048 (2021).\n\nArticle \nPub",
      "score": 0.34707275
    },
    {
      "number": 10,
      "title": "Unexplained ascites - Hernaez - 2016 - Clinical Liver Disease - Wiley Online Library",
      "detail": "onlinelibrary.wiley.com",
      "url": "https://onlinelibrary.wiley.com/doi/full/10.1002/cld.537",
      "authors": "onlinelibrary.wiley.com",
      "host": "onlinelibrary.wiley.com",
      "snippet": "The majority of patients will have ascites related to cirrhosis and portal hypertension; however, other causes of ascites are not uncommon. The underlying mechanism of development of ascites can include elevated hydrostatic pressure (e.g., cirrhosis and congestive heart failure), decreased oncotic p",
      "score": 0.750937
    },
    {
      "number": 11,
      "title": "Serum-Ascites Albumin Gradient - an overview",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/topics/medicine-and-dentistry/serum-ascites-albumin-gradient",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
      "snippet": "### 29 How is cirrhotic ascites diagnosed?\n\nNew-onset ascites should be assessed with diagnostic paracentesis to confirm cirrhosis as the cause and rule out spontaneous bacterial peritonitis (SBP). The serum-ascites albumin gradient (SAAG) is the most important diagnostic parameter in determining th",
      "score": 0.5809471
    },
    {
      "number": 12,
      "title": "Performing Abdominal Paracentesis - ScienceDirect",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/science/article/pii/S1555415522005104",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
      "snippet": "Title: Performing Abdominal Paracentesis - ScienceDirect\n# Featured Article Performing Abdominal Paracentesis. Paracentesis relieves symptoms and improves outcomes in patients with ascites. Paracentesis can be performed at the bedside. Complication rates are low, but albumin must be used in cirrhoti",
      "score": 0.55998856
    },
    {
      "number": 13,
      "title": "Ascites - an overview | ScienceDirect Topics",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/ascites",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
      "snippet": "1.\n_Spontaneous bacterial peritonitis_ (SBP) is defined as an ascitic fluid infection with PMN count of 250 cells/mm 3 or greater and positive culture (usually for a single organism).\n\n2.\n_Culture-negative neutrocytic ascites_ (CNNA) is defined as an ascitic fluid PMN count of 250 cells/mm 3 or grea",
      "score": 0.50476116
    },
    {
      "number": 14,
      "title": "The Epidemiology of Ascites in a Multi‐Ethnic Asian Population - Sinnanaidu - 2025 - JGH Open - Wiley Online Library",
      "detail": "onlinelibrary.wiley.com",
      "url": "https://onlinelibrary.wiley.com/doi/full/10.1002/jgh3.70111",
      "authors": "onlinelibrary.wiley.com",
      "host": "onlinelibrary.wiley.com",
      "snippet": "The etiology of ascites varied with ethnicity as follows: the most common cause of ascites was malignancy (37.6%) among ethnic Chinese, heart failure (20.5%) in ethnic Malays and chronic liver disease (43.7%) in ethnic Indians. Malignancy and liver cirrhosis are the leading cause of ascites in a mul",
      "score": 0.8080827
    },
    {
      "number": 15,
      "title": "Intranodal lymphangiography in the treatment of chylous ascites - ScienceDirect",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/science/article/abs/pii/S2173510718300843",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
      "snippet": "# Brief report Intranodal lymphangiography in the treatment of chylous ascitesLinfografía intranodal en el tratamiento de la ascitis quilosa☆. Chylous ascites is the presence of lymph from the thorax or bowel in the abdominal cavity. In Western countries, the most common causes of chylous ascites in",
      "score": 0.6439794
    },
    {
      "number": 16,
      "title": "Chylous Ascites From Cirrhosis-Related Portal... : ACG Case Reports Journal",
      "detail": "journals.lww.com",
      "url": "https://journals.lww.com/acgcr/fulltext/2026/01000/chylous_ascites_from_cirrhosis_related_portal.22.aspx",
      "authors": "journals.lww.com",
      "host": "journals.lww.com",
      "snippet": "Chylous ascites, the accumulation of lymphatic fluid within the peritoneal cavity, is a rare and challenging clinical entity. It accounts for less than 1% of all ascitic presentations and is often secondary to traumatic, malignant, or infectious etiologies.1 However, its association with portal hype",
      "score": 0.52670854
    },
    {
      "number": 17,
      "title": "Optimal Management of Cirrhotic Ascites: A Review for Internal Medicine Physicians - PMC",
      "detail": "pmc.ncbi.nlm.nih.gov",
      "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC7805288",
      "authors": "pmc.ncbi.nlm.nih.gov",
      "host": "pmc.ncbi.nlm.nih.gov",
      "snippet": "For healthcare-associated and nosocomial SBP, EASL guidelines suggest the use of piperacillin/tazobactam in areas with low prevalence of multidrug resistance. Carbapenem should instead be used in areas with high prevalence of extended-spectrum beta-lactamases (ESBLs) producing Enterobacteriaceae, ev",
      "score": 0.7715858
    },
    {
      "number": 18,
      "title": "The AASLD Clinical Practice Guidelines: A Critical Review of Scientific Evidence and Evolving Recommendations - PMC",
      "detail": "pmc.ncbi.nlm.nih.gov",
      "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC4613804",
      "authors": "pmc.ncbi.nlm.nih.gov",
      "host": "pmc.ncbi.nlm.nih.gov",
      "snippet": "Although most guidelines have evolved with increased numbers of recommendations, the PBC and Management of Adult Patients with Ascites in Cirrhosis guidelines had a decrease in grade I recommendations. In the PBC guideline, the overall decrease of recommendations can be attributed to a >70% decrease",
      "score": 0.7395922
    },
    {
      "number": 19,
      "title": "[PDF] EASL Clinical Practice Guidelines for the management of patients ...",
      "detail": "easl.eu",
      "url": "https://easl.eu/wp-content/uploads/2018/10/decompensated-cirrhosis-English-report.pdf",
      "authors": "easl.eu",
      "host": "easl.eu",
      "snippet": "The occurrence of ascites impairs patient working and social life, often leads to hospitalisation, requires chronic treatment and is a direct cause of further complications, such as SBP, restrictive ventilatory dysfunction, or abdominal hernias. The appearance of ascites heralds a poor prognosis, as",
      "score": 0.7311551
    },
    {
      "number": 20,
      "title": "EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. - Abstract",
      "detail": "pubmed.ncbi.nlm.nih.gov",
      "url": "https://pubmed.ncbi.nlm.nih.gov/20633946",
      "authors": "pubmed.ncbi.nlm.nih.gov",
      "host": "pubmed.ncbi.nlm.nih.gov",
      "snippet": "Guevara\n\n2005    \n\n  \n\n   ### Management of adult patients with ascites due to cirrhosis.\n\nRunyon BA; Practice Guidelines Committee, American Association for the Study of Liver Diseases (AASLD)\n\nHepatology, (3):841-856  2004\n\nMED: 14999706    \n\n  \n\n   ### The serum-ascites albumin gradient is superi",
      "score": 0.7295395
    },
    {
      "number": 21,
      "title": "[PDF] Hepatorenal-Cirrhosis-English-report.pdf - EASL",
      "detail": "easl.eu",
      "url": "https://easl.eu/wp-content/uploads/2018/10/Hepatorenal-Cirrhosis-English-report.pdf",
      "authors": "easl.eu",
      "host": "easl.eu",
      "snippet": "Runyon BAPractice Guidelines Committee, American Association for the Study of Liver Diseases (AASLD). Management of adult patients with ascites due to cirrhosis. Hepatology 2004;39:841–855.\n Runyon BA, Montano AA, Akriviadis EA, et al. The serum–ascites albumin gradient is superior to the exudate–tr",
      "score": 0.72325134
    },
    {
      "number": 22,
      "title": "Cirrhosis & Complications Archives - EASL-The Home of Hepatology.",
      "detail": "easl.eu",
      "url": "https://easl.eu/publication_topic/cirrhosis-complications",
      "authors": "easl.eu",
      "host": "easl.eu",
      "snippet": "EASL   /  10th October 2010\n\nEASL has published clinical practice guidelines for the management of ascites, the most common complication of cirrhosis. The peer-reviewed guidelines\n\nScroll to Top\n\n## Search EASL [...] EASL   /  2nd October 2018\n\nEASL Guideline on Management of Decompensated Cirrhosis",
      "score": 0.7132923
    },
    {
      "number": 23,
      "title": "Evidence-based clinical practice guidelines for Liver Cirrhosis 2020",
      "detail": "pmc.ncbi.nlm.nih.gov",
      "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC8280040",
      "authors": "pmc.ncbi.nlm.nih.gov",
      "host": "pmc.ncbi.nlm.nih.gov",
      "snippet": "global guidelines, such as the European Association for the Study of the Liver (EASL) and American Association for the Study of Liver Diseases (AASLD), we are introducing data based on the evidence for clinical practice in Japan. The flowchart for nutrition therapy was reviewed to be useful for dail",
      "score": 0.70214266
    },
    {
      "number": 24,
      "title": "Diagnosis, Evaluation and Management of Ascites, Spontaneous ...",
      "detail": "www.aasld.org",
      "url": "https://www.aasld.org/practice-guidelines/diagnosis-evaluation-and-management-ascites-spontaneous-bacterial-peritonitis",
      "authors": "www.aasld.org",
      "host": "www.aasld.org",
      "snippet": "Skip to content\n\n Home\n Practice Guidelines\n\n# Diagnosis, Evaluation and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome\n\nAASLD develops evidence-based practice guidelines and practice guidances which are updated regularly by a  multi-disciplinary panel of experts, ",
      "score": 0.6739866
    }
  ],
  "publishedAt": "2026-09-16T00:41:11.267757+00:00",
  "updatedAt": "2026-09-16T00:41:11.267757+00:00",
  "readingMinutes": 6,
  "slug": "ascites"
}