Study of Gastrointestinal and Liver Diseases

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  • NAFLD & Metabolic syndrome & Insulin resistance


  • Abdominal US in hepatobiliary Diseases


  • New endoscopic modalities

    Mobilization of Ascites defined as a decrease of ascites at least to grade 1. (1:mild, 2:moderate, 3:massive or tense), early recurrence is defined as the reappearance of grade 2 or 3 ascites within 4 weeks of initial mobilization.

    Two subgroups defined:

    1. Diuretic-resistance ascites: ascites that can’t be mobilized or the early recurrence of which can’t be prevented due to a lack of response to dietary sodium restriction and intensive diuretic treatment (e.g. 400mg of spironolactone or 30mg of amiloride plus up to 160mg of furosemide daily).

    2. Diuretic Intractable Ascites that can’t be mobilized or the early recurrence of which can’t be prevented due to the development of diuretic-induced complication that preclude the use of an effective diuretic dosage.

    Refractory Ascites occurs in approximately 5-10% of all cases of Ascites and is associated with poor prognosis:

    Four therapeutic approaches are currently used for the treatment of Refractory Ascites

    1. Large volume paracentesis with or without volume substitution

    2. Peritoneovenous shunt (PVS)

    3. Transjugular intrahepatic portosystemic stent shunt (TIPS)

    4. Orthotopic liver transplantation (OLTX)

    The widely available therapeutic approach is (LVP) .

    Large-volume (LVP) or total paracentesis is safe and effective if volume expansion is performed after tapping large amount of ascites. Effective hypovelemia was suggested to be due to increased arterial compliance rather than decrease of circulating blood volume Vila et al. J Hepatol 1999, 28: 6399-45.

    To prevent post-paracentesis effective hypovolimia:

    Until now the most employed method is to associate the infusion with a plasma expand. When the volume of ascites is less than 5 liters the use of synthetic expanders such as dextrose 70 or Hemaccel is as effective as albumin. But if the volume of ascites exceed 5 liters albumin is more effective than synthetic plasma expander.

    Dose of albumin: 8 grams for any liter of tapped fluid. Time of infusion: matter of debate-at the beginning-at the end-some hours after the end.


















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