Karen L. Krok, MD, Assistant Professor of Medicine, Division of Gastroenterology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Andrés Cárdenas, MD, MMSc, Institut de Malalties Digestives i Metaboliques, Hospital Clinic, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.

Ascites is the accumulation of free fluid in the peritoneal cavity. In over 80% of cases, it is a result of cirrhosis. Ascites develops in 60% of patients with cirrhosis within 10 years of the diagnosis of cirrhosis, and its development marks a turning point in the natural history of the disease. The mainstays of treatment are twofold: sodium restriction and diuretics. The development of spontaneous bacterial peritonitis is another ominous sign that requires indefinite antibiotic prophylaxis to prevent future infections. A referral to a transplant centre is essential once ascites or spontaneous bacterial peritonitis develop.
Key words: ascites, portal hypertension, cirrhosis, spontaneous bacterial peritonitis, paracentesis, albumin infusion.

Dr. Faisal M. Sanai, MD, ABIM, Hepatology Fellow, London Health Sciences Centre, University of Western Ontario, London, ON.
Dr. Cameron N. Ghent, MD, FRCP(C), Consultant Hepatologist, Adjunct Professor, University of Western Ontario, London Health Sciences Centre, London, ON.

Cirrhosis of the liver is highlighted essentially by its portal hypertensive complications. The incidence of these complications in elderly cirrhotic individuals has been rising due to better management of this disease in the younger population. Moreover, improved diagnostic techniques have further contributed to this rising incidence. Early recognition of the cirrhotic complications coupled with aggressive intervention has led to reductions in mortality. Special consideration is given to elderly patients in view of the higher incidence of comorbidity and the variability in disease presentation. We present here a review of cirrhosis and its sequelae in this distinct population group with emphasis on recent trends towards diagnosis and management.
Key words: cirrhosis, portal hypertension, ascites, liver.

Robert J. Fingerote, MD, MSc, FRCPC, Consultant in Gastroenterology and Internal Medicine, Queensway Carlton Hospital, Ottawa, ON.

Primary biliary cirrhosis (PBC) is a disease of unknown origin that causes chronic liver injury. It has an insidious onset, is associated with slow progression and ultimately leads to liver failure and either death or liver transplantation. It is presumed to be of autoimmune origin, is frequently associated with other autoimmune disorders and typically affects middle-aged and elderly women. Patients may be asymptomatic at diagnosis or present with typical symptoms of fatigue, pruritus and jaundice. Although current therapy may slow the progression of disease, no therapy has yet been proven to arrest or reverse the disease process.
Key words: cirrhosis, fatigue, autoimmune, cholestasis, antimitochondrial antibodies.