In the management of cirrhosis with ascites, which of the following is NOT part of the stepwise approach?

In the management of cirrhosis with ascites, a stepwise approach typically includes strategies aimed at alleviating symptoms and managing fluid retention. The correct choice—dialysis—is not part of this approach for several reasons.

First, dialysis is generally reserved for patients with acute kidney injury or end-stage renal disease. In the context of cirrhosis with ascites, the primary concern is managing fluid overload due to portal hypertension and liver dysfunction, rather than addressing renal failure. Therefore, dialysis would not be a standard component of ascites management in cirrhosis.

Conversely, frequent paracentesis is often utilized to relieve discomfort from significant ascites and can provide symptomatic relief for patients. Loop diuretics, such as furosemide, and spironolactone, an aldosterone antagonist, are cornerstone medications used to manage fluid retention in these patients. Spironolactone is particularly important for promoting diuresis and correcting electrolyte imbalances.

Thus, while the other options play a vital role in treating ascites in cirrhosis, dialysis does not fit into the stepwise management of this condition, making it the correct answer.