Ascites
Call 999 or go to A&E if
- Call 999 or go to A&E if you are vomiting blood, your poo is very dark or black, or you suddenly become confused or have slurred speech.
Do not drive to A&E. Ask someone to drive you or call 999 and ask for an ambulance. Bring any medicines you take with you.
Ask for an urgent GP appointment or get help from NHS 111 if
- If you have been diagnosed with cirrhosis, ask for an urgent GP appointment or get help from NHS 111 if you have a swollen tummy, legs, ankles or feet, your skin or the whites of your eyes look yellow, or you have difficulty breathing.
Ascites is a build-up of fluid in the abdomen. It is one of the complications that cirrhosis can cause.
Most people with ascites are not given antibiotics to prevent infection in the fluid. Antibiotics are not used routinely because they are not helpful for everyone and carry their own risks.
Where this came from
Recommendation 1.8.1 [2023] · this recommendation was last revisited in 2023 · status: current, verified 2026-09-01
Open
Do not routinely offer antibiotics to prevent spontaneous bacterial peritonitis (SBP) in people with cirrhosis and ascites.
Some people are offered antibiotics to prevent infection. This is considered when liver disease is severe. It is also considered when an infection would badly disrupt care that is already planned, such as a transplant assessment. Your team will explain if this applies to you.
Where this came from
Recommendation 1.8.2 [2023] · this recommendation was last revisited in 2023 · status: current, verified 2026-09-01
Open
Consider antibiotics to prevent SBP only if: the person is at high risk of developing SBP because they have severe liver disease (for example, they have an ascitic protein of 15 g per litre or less, a Child-Pugh score of more than 9, or a MELD score of more than 16)
If antibiotics are started to prevent infection, they are usually continued until the fluid has gone.
Where this came from
Recommendation 1.8.3 [2023] · this recommendation was last revisited in 2023 · status: current, verified 2026-09-01
Open
follow local microbiological advice ... continue with treatment until the ascites is resolved
Sometimes the fluid keeps coming back despite treatment. One option doctors consider is a TIPS. This is a small channel made inside the liver. It lowers the pressure that is driving the fluid.
Where this came from
Recommendation 1.10.1 [2016] · this recommendation was last revisited in 2016 · status: current, verified 2026-09-01
Open
Consider a TIPS procedure for people with cirrhosis who have refractory ascites.
A medicine called carvedilol, used to lower pressure in the liver's blood vessels, is usually avoided when there is a large amount of fluid or when fluid keeps returning.
Where this came from
Recommendation 1.5.1 [2023] · this recommendation was last revisited in 2023 · status: current, verified 2026-09-01
Open
carvedilol should be avoided in people with severe hepatic impairment (for example, in those with large-volume or refractory ascites)
Related
- Cirrhosis — can arise as a complication of
- Acute decompensation — can be a presentation of
- Diagnostic ascitic tap — is assessed using
- Alcohol-related liver disease — related through cirrhosis
- Hepatocellular carcinoma — related through cirrhosis
- Hepatic encephalopathy — related through cirrhosis
What we have not established
Relationships involving Ascites that we have not evidenced are listed, never drawn — a line would read as a weak relationship, which is a different and false claim.
- Synthetic function → Ascites — not established
- Portal hypertension → Ascites — not established
- Ascites → Spontaneous bacterial peritonitis — not established
- Ascites → Paracentesis — not established
Evidence search date: 2026-09-01
Content reviewed and approved
What we have not established here
Known gaps on this concept:
RESOLVED in Phase 3: the orientation statement is now claim-bound (CLM-CIR-0005) and an emergency block is present.
Still missing: mechanism of ascites formation (portal hypertension, sodium and water retention). Needs EASL 2018 decompensated cirrhosis full text.
Still missing: diagnostic ascitic tap, serum-ascites albumin gradient and fluid analysis. BSG/BASL 2025 care bundle full text is the likely UK anchor and was rate-limited on 2026-09-01.
Still missing: diuretics, sodium restriction, large-volume paracentesis and albumin replacement.
Still missing: the definition of refractory ascites, although CLM-ASC-0004 depends on the concept.
Still missing: specialist and research resolutions.