[Experimental methods in hepatology. Guidelines of the German Work Group for Study of the Liver. Therapy of ascites in liver diseases. German Work Group for Study of the Liver].

Patients with "uncomplicated" ascites (no encephalopathy, electrolyte derangements or markedly impaired renal function) respond well to the conventional sequential therapy comprising dietary sodium restriction, aldosterone antagonists and loop diuretics. A close monitoring of the patients is important to avoid side effects. For massive ascites, ascites refractory to diuretic treatment or recidivant ascites daily therapeutic paracentesis is recommended. Four to six liters of ascites should be drained daily followed by infusion of plasma expanders (preferentially albumin, eventually hemacell or dextran-70) until the patient is almost free of ascites. The diuretic treatment should be instituted. The transjugular intrahepatic portosystemic shunt (TIPS) represents a promising novel therapeutic modality the therapeutic impact of which has to be more clearly defined in prospective studies. Several experimental approaches have been proposed for the therapy of the hepatorenal syndrome (Dopamine, Ornipressin, TIPS). Liver transplantation is the only causal treatment of refractory ascites or hepatorenal syndrome and should be discussed when a patient presents with massive ascites.