Ascites is the most common complication of cirrhosis leading to hospitalization. (Ascites marks a threshold in the nature of the underlying liver disease and is associated with a 50% mortality rate within 3 years.)

1. Standard initial therapy for portal hypertensive ascites is salt restriction. (Hyponatremia is common among cirrhotic patients with ascites, and rapid correction is undesirable because cirrhotic patients are particularly at risk for central pontine myelinolysis.)
2. Refractory ascites (immutable to sodium restriction, maximum doses of diuretics, and paracentesis) is the hallmark complication of type II HRS and indicates increased disease severity.
   1. When patients become refractory to maximum standard medical therapy, the 6-month mortality rate is 21%.
   2. Therapeutic options for patients are limited and include serial paracentesis, liver transplantation, transjugular intrahepatic shunt (TIPS) placement, and peritoneovenous shunt.
3. Although current practice is to replace albumin when ascitic fluid is drained, this practice is not well supported by randomized prospective trials.
4. Infections (bacterial translocation from the bowel) of ascitic fluid are common.

The Liver: Surgery and Anesthesia

1. Assessment of Hepatic Function
2. Hepatobiliary Imaging
3. Liver Biopsy
4. Hepatic and Hepatobiliary Diseases
5. Acute Liver Failure
6. Acute Hepatitis
7. Alcoholic Hepatitis
8. Drug-Induced Liver Injury
9. Pregnancy-Related Liver Diseases
10. Cirrhosis and Portal Hypertension
11. Hemostasis
12. Cardiac Manifestations
13. Renal Dysfunction
14. Pulmonary Complications
15. Hepatic Encephalopathy (HE)
16. Ascites
17. Varices
18. Chronic Cholestatic Disease
19. Chronic Hepatocellular Disease
20. Hepatocellular Carcinoma (HCC)
21. Nonalcoholic Fatty Liver Disease
22. Preoperative Management
23. Intraoperative Management
24. Transjugular Intrahepatic Portosystemic Shunt Procedure
25. Hepatic Resection
26. Postoperative Liver Dysfunction