3. Large-volume paracentesis

Indicated for tense ascites that impairs respiration, for refractory ascites.

Albumin administered after paracentesis (6g/L removed) to avoid post-paracentesis circulatory dysfucntion. Diuretics continued after procedure if possible.


Poor outcome (worsening liver failure) in patients with Child class C cirrhosis.

5. Hepatorenal syndrome

Assure volume expansion with central pressure monitoring Experimental therapy: Vasoconstrictors, TIPS D. Spontaneous bacterial peritonitis

1. Choice of antibiotics

Initial therapy with cefotaxime 3-6 g/d (or equivalent) until culture results. Repeat paracentesis after 48 hours to assure response (0PMN of 50%).

2. Culture-negative neutrophylic ascites Repeat paracentesis critical

3. Prevention of renal failure

Discontinue diuretics until satisfactory microbiological response Experimental therapy: iv albumin.

4. Prophylaxis. Several regimens proposed

Norfloxacin 400 mg/d, Bactrim 5 days/week, Ciprofloxacin 1/week.

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