| Title |
Treatment of refractory ascites
|
|---|---|
| Published in |
Current Treatment Options in Gastroenterology, November 2006
|
| DOI | 10.1007/s11938-006-0009-4 |
| Pubmed ID | |
| Authors |
Praveena G. Velamati, H. Franklin Herlong |
| Abstract |
In 1996, the International Ascites Club defined "refractory ascites" as ascites that cannot be mobilized by medical therapy or that recurs early after initial mobilization despite continued treatment. Of all patients with ascites, 5% to 10% will become refractory to medical therapy. Management of refractory ascites should attempt to control fluid accumulation, reduce the likelihood of developing complications such as spontaneous bacterial peritonitis (SBP) and the hepatorenal syndrome, and improve the patient's nutritional status and overall well-being. Measures to control ascites accumulation include documenting medication and dietary compliance and eliminating potentially nephrotoxic agents that promote sodium retention. Large volume paracentesis is an effective first step in managing these patients and can be performed routinely in an outpatient setting. When more than 5 L of fluid are removed during a paracentesis, intravenous albumin should be infused to reduce the likelihood of the patient developing postparacentesis circulatory dysfunction. Transjugular intrahepatic portosystemic shunt (TIPS) placement effectively eliminates ascites; however, there is no convincing evidence that the shunt improves mortality. Furthermore, it is associated with frequent complications of encephalopathy and shunt malfunction. We feel TIPS should be reserved for patients requiring extremely frequent paracentesis, those who develop significant postparacentesis circulatory dysfunction, or those with hepatic hydrothorax. Patients who have evidence of SBP should be treated with antibiotics and intravenous albumin infusion. Patients who have had a previous episode of SBP or an ascitic fluid protein level of less than 1.0 should receive prophylactic antibiotics. Overall, the prognosis for patients with refractory ascites remains grim, and liver transplantation is the only definitive therapy. Appropriate candidates should be identified promptly and referred for transplant evaluation. |
Mendeley readers
The data shown below were compiled from readership statistics for 30 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Poland | 1 | 3% |
| Unknown | 29 | 97% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Ph. D. Student | 4 | 13% |
| Student > Doctoral Student | 4 | 13% |
| Professor > Associate Professor | 3 | 10% |
| Student > Postgraduate | 2 | 7% |
| Researcher | 2 | 7% |
| Other | 6 | 20% |
| Unknown | 9 | 30% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 13 | 43% |
| Nursing and Health Professions | 3 | 10% |
| Psychology | 1 | 3% |
| Biochemistry, Genetics and Molecular Biology | 1 | 3% |
| Sports and Recreations | 1 | 3% |
| Other | 1 | 3% |
| Unknown | 10 | 33% |
Attention Score in Context
This research output has an Altmetric Attention Score of 6. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 04 September 2018.
All research outputs
#4,695,994
of 22,786,087 outputs
Outputs from Current Treatment Options in Gastroenterology
#50
of 267 outputs
Outputs of similar age
#12,532
of 69,312 outputs
Outputs of similar age from Current Treatment Options in Gastroenterology
#1
of 3 outputs
Altmetric has tracked 22,786,087 research outputs across all sources so far. Compared to these this one has done well and is in the 76th percentile: it's in the top 25% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 267 research outputs from this source. They typically receive a little more attention than average, with a mean Attention Score of 5.8. This one has done well, scoring higher than 79% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 69,312 tracked outputs that were published within six weeks on either side of this one in any source. This one has gotten more attention than average, scoring higher than 72% of its contemporaries.
We're also able to compare this research output to 3 others from the same source and published within six weeks on either side of this one. This one has scored higher than all of them