HEP-Net opinion on the management of ascites and its complications in the setting of decompensated cirrhosis in the resource constrained environment of Pakistan

  • Bushra Ali Fatima Memorial Medical and Dental college, Lahore - Pakistan
  • Adnan Salim Shaikh Zayed Postgraduate Medical Institute, Lahore - Pakistan
  • Altaf Alam Fatima Memorial Medical and Dental college, Lahore - Pakistan
  • Bader Faiyaz Zuberi Dow University of Health Sciences
  • Zeeshan Ali Junejo Jinnah Postgraduate Medical Centre Karachi – Pakistan
  • Zahid Azam Dow University of Health Sciences
  • Lubna Kamani Liaquat National Hospital, Karachi - Pakistan.
  • Javed Iqbal Farooqi Lady Reading Hospital, Peshawar - Pakistan.
  • Muhammed Salih Quaid e Azam International Hospital Islamabad – Pakistan
  • Arif Amir Nawaz Fatima Memorial Medical and Dental college, Lahore - Pakistan
  • Asad Ali Choudhry Gujranwala Liver Centre Gujranwala – Pakistan
  • Zahid Yasin Hashmi Liver Center, Faisalabad - Pakistan.
  • Masood Saddiq innah Memorial Hospital, Rawalpindi - Pakistan.
Keywords: Cirrhosis, Ascites, Portal Hypertention, Hepatitis B, Hepatitis C, Hepatitis D, Hepatorenal Syndrome, Resistant Ascites

Abstract

Approximately one half of patients develop ascites within 10 years of diagnosis of compensated cirrhosis. It is a poor prognostic indicator, with only 50% surviving beyond two years. Mortality worsens significantly to 20% to 50% at one year if the ascites becomes refractory to medical therapy. Pakistan has one of the highest prevalence of viral hepatitis in the world and patients with ascites secondary to liver cirrhosis make a major percentage of both inpatient and outpatient burden. Studies indicate that over 80% of patients admitted with ascites have liver cirrhosis as the cause.
This expert opinion suggests proper assessment of patients with ascites in the presence of underlying cirrhosis. This expert opinion includes appropriate diagnosis and management of uncomplicated ascites, refractory ascites and complicated ascites (including spontaneous bacterial peritonitis (SBP) ascites, hepatorenal syndrome (HRS) and hyponatremia. The purpose behind this expert opinion is to help consultants, postgraduate trainees, medical officers and primary care physicians optimally manage their patients with cirrhosis and ascites in a resource constrained setting as is often encountered in a developing country like Pakistan.

doi: https://doi.org/10.12669/pjms.36.5.2407

How to cite this:
Ali B, Salim A, Alam A, Zuberi BF, Ali Z, Azam Z, et al. HEP-Net opinion on the management of ascites and its complications in the setting of decompensated cirrhosis in the resource constrained environment of Pakistan. Pak J Med Sci. 2020;36(5):1117-1132.  doi: https://doi.org/10.12669/pjms.36.5.2407

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Author Biographies

Altaf Alam, Fatima Memorial Medical and Dental college, Lahore - Pakistan

Professor

Zeeshan Ali Junejo, Jinnah Postgraduate Medical Centre Karachi – Pakistan

Associate Professor

Zahid Azam, Dow University of Health Sciences

Professor

Lubna Kamani, Liaquat National Hospital, Karachi - Pakistan.

Consultant Gastroenterologist

Javed Iqbal Farooqi, Lady Reading Hospital, Peshawar - Pakistan.

Professor

Arif Amir Nawaz, Fatima Memorial Medical and Dental college, Lahore - Pakistan

Professor

Masood Saddiq, innah Memorial Hospital, Rawalpindi - Pakistan.

Professor

Published
2020-06-26
How to Cite
Ali, B., Salim, A., Alam, A., Zuberi, B., Junejo, Z., Azam, Z., Kamani, L., Farooqi, J., Salih, M., Nawaz, A., Choudhry, A., Hashmi, Z., & Saddiq, M. (2020). HEP-Net opinion on the management of ascites and its complications in the setting of decompensated cirrhosis in the resource constrained environment of Pakistan. Pakistan Journal of Medical Sciences, 36(5). https://doi.org/10.12669/pjms.36.5.2407

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