Korean J Gastroenterol.  2018 Oct;72(4):179-187. 10.4166/kjg.2018.72.4.179.

2017 Korean Association for the Study of the Liver (KASL) Clinical Practice Guidelines for Ascites and Related Complications: What Has Been Changed from the 2011 KASL Clinical Practice Guidelines?

• Seo YS

• KMID: 2424109
• DOI: http://doi.org/10.4166/kjg.2018.72.4.179

Abstract

Ascites is a common complication in patients with liver cirrhosis and is the most common cause of hospitalization in these patients. The development of ascites is associated with a poor prognosis in patients with liver cirrhosis with a higher mortality rate than in those without ascites. Furthermore, the presence of cirrhotic ascites is related to the development of various serious complications, such as refractory ascites, spontaneous bacterial peritonitis, acute kidney injury, and hepatorenal syndrome. Therefore, early detection and appropriate management for the development of ascites and their complications is very important in these patients. Recently, there have been significant revisions in the diagnostic criteria and treatment of cirrhotic ascites and their complications. This manuscript reviews these revisions.

Keyword

Liver cirrhosis; Ascites; Hypertension, portal; Acute kidney injury; Guideline

MeSH Terms

Acute Kidney Injury
Ascites*
Hepatorenal Syndrome
Hospitalization
Humans
Hypertension, Portal
Liver Cirrhosis
Liver*
Mortality
Peritonitis
Prognosis

Figure

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  Fig. 1 Algorithm for the differential diagnosis of ascites. SAAG, serum-ascites albumin gradient; CHF, congestive heart failure; IVC, inferior vena cava; PMN, polymorphonuclear leukocyte.

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  Fig. 2 Treatment of cirrhotic ascites according to the grades of ascites. Grade 1, minimal ascites, which can be detected only by an imaging study, such as abdominal ultrasound; grade 2, moderate ascites which can be identified easily by a visual inspection and palpation; and grade 3, massive or tense ascites with profound distension of the abdomen.

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