Paracentesis

Ascites is one of the most prevalent complications of cirrhosis. Ascites can hamper the patients’ quality of life as well as predispose them to develop spontaneous bacterial peritonitis. Paracentesis is often used for diagnostic as well as therapeutic purposes in the management of cirrhotics with ascites. It is often performed as an outpatient procedure with or without the aid of ultrasound marking and the preferred site is the left lower quadrant. Diagnostic paracentesis is needed to ascertain the etiology of ascites as well as to exclude spontaneous bacterial peritonitis. Therapeutic paracentesis, total or large volume, is employed to relieve patient discomfort in cases refractory or resistant to diuretics. While coagulopathy is common in cirrhosis, it is not a contraindication to paracentesis, unless there is evidence of hyperfibrinolysis. Post-paracentesis circulatory dysfunction can occur in 20% of patients after therapeutic paracentesis and should be prevented by using albumin infusion during the procedure. Paracentesis, both diagnostic and therapeutic, is an essential and safe procedure for the management of end-stage liver disease and cirrhosis.