Best treatment of refractory ascites is?
Refractory ascites can be managed by: Trans-jugular intra-hepatic peritoneal shunt (TIPS) Serial large volume paracentesis (LVP) with albumin. TIPS is superior to LVP in reducing the re-accumulation of ascites but is associated with an increased frequency of hepatic encephalopathy Extra Edge: Diagnostic criteria for refractory ascites Lack of response to maximal doses of diuretic for at least 1 week Diuretic-induced complications in the absence of other precipitating factor Early recurrence of ascites within 4 weeks of fluid mobilization. Persistent ascites despite sodium restriction Mean weight loss <0.8 kg over 4 days Urinary sodium excretion less than sodium intake
AV shunt
TIPS
Frusemide with Low volume paracentesis
Distal splenorenal shunt
Cirrhosis