Therapie des zirrhotischen Aszites

The development of ascites in the course of liver cirrhosis is very important for its prognosis and associated with a mortality of more than 50% 2 to 5 years after the first episode of ascites occurred. The increase of creatinine concentration in the serum to > 1.5 mg/dl is accompanied by a mortality of up to 80% within 6 to 12 months. Depending on whether the ascites can be washed out by salt restriction and treatment with diuretics alone or not, a distinction is made between uncomplicated and complicated ascites. Ascites treatment is a step-by-step therapy and starts with bedrest, salt and fluid restriction. In addition, aldosterone antagonists and loop diuretics may be applied. In therapy-refractory ascites paracentesis or transjugular intrahepatic portosystemic shunt (TIPS) may be administered. Therapy-refractory ascites occurs in 5-10% of patients. Its prognosis is very severe with a 1-year survival rate of < 50%.