Refractory ascites is a condition where fluid accumulates in the abdomen and does not respond to medical treatment. It is often a complication of liver failure and can be managed with dietary changes, diuretics, and shunts. Patients with liver problems should monitor their health and seek treatment if they notice changes.
Refractory ascites are accumulations of fluid in the abdomen that are unresponsive to reasonable attempts at medical treatment. An estimated 10% of ascites cases are considered refractory or intractable, with the goal of patient care directed towards keeping the patient comfortable rather than trying to resolve the problem. Most commonly, this condition is a complication of liver failure, although some other conditions can also cause a similar fluid buildup, especially in the final stages.
In patients with ascites, the abdomen swells and fluid can be seen on medical imaging studies. Aspiration of the fluid with a needle can show a mixture of components, including a potential accumulation of white blood cells if the patient develops an abdominal infection. Ascites is generally considered an ominous clinical sign, showing that a patient’s body is struggling to process fluids and cannot eliminate them efficiently. Refractory ascites is indicative of a serious arrest in the patient’s body.
Some treatment options may include dietary changes, as well as the administration of diuretics to help the patient express fluid. If these more conservative measures don’t work, a shunt may be implanted to drain fluid from the abdomen to other areas of the patient’s body so it can be drained away. In patients with refractory ascites, fluid accumulation does not resolve with medical treatment or recurs when the course of treatment is over.
Refractory ascites can be frustrating for both patients and clinicians. The fluid in the abdomen feels uncomfortable and can interfere with the function of various organs, putting the patient at risk for further complications. The patient may also have difficulty adjusting to clothes and may develop other symptoms associated with severe liver failure, such as jaundice. Managing the patient’s liver health can help limit further fluid deposition, as can using various methods of treatment for ascites, including fluid aspiration, a procedure known as “tapping,” to relieve the pressure.
Patients with a history of liver problems are advised to closely monitor their health and follow treatment recommendations to avoid developing serious complications such as ascites. If patients begin to notice changes, a doctor can provide an assessment to see if anything can be done, including adjusting the patient’s treatment plan or providing new treatment options. Developing clinical signs such as swelling in the abdomen is a sign of concern and should be addressed. The longer a patient delays treatment, the more resistant the complications will be to treatment, although a diagnosis of refractory ascites will be delayed until all treatment options have been pursued.
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