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.
NICE advises against routinely offering antibiotic prophylaxis for spontaneous bacterial peritonitis in cirrhosis with ascites.
NICE — Recommendation 1.8.1, last revisited 2023
The exact wording of the source
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.
Prophylaxis is considered only in people at high risk from severe liver disease, or where infection would materially affect care such as a wait for transplantation or TIPS.
NICE — Recommendation 1.8.2, last revisited 2023
The exact wording of the source
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)
Follow local microbiological advice on agent choice, and continue prophylaxis until the ascites resolves.
NICE — Recommendation 1.8.3, last revisited 2023
The exact wording of the source
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
TIPS should be considered in refractory ascites.
NICE — Recommendation 1.10.1, last revisited 2016
The exact wording of the source
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.
Avoid carvedilol in severe hepatic impairment; NICE gives large-volume or refractory ascites as examples of that state.
NICE — Recommendation 1.5.1, last revisited 2023
The exact wording of the source
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.