Management of Ascites Caused by Cirrhosis

You answered:

D Proceed with a transjugular intrahepatic portosystemic shunt (TIPS) procedure to manage the refractory ascites.

This answer is incorrect. Although TIPS is a reasonable option to manage refractory ascites, there are some contraindications to the procedure. About a third of patients develop encephalopathy with a minority of them developing severe encephalopathy requiring TIPS revision. For patients with who have advanced liver dysfunction and high predicted 30-day mortality (as determined by Child-Pugh-Turcotte Class or MELD score) have an overall poor prognosis placement of TIPS in that setting should be performed only if no options exist, including the option of liver transplanation. Also, in patients with significant hepatic dysfunction, TIPS can precipitate liver failure.

Choose another answer:

A Slowly increase diuretics further with close laboratory monitoring.
B Restrict the patient’s fluid intake to 1 liter a day to correct hyponatremia and continue current diuretic doses for another week to see if ascites improves.
C Stop diuretics, perform large volume paracentesis as needed to control ascites, and refer for evaluation of possible liver transplantation.

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