Ascites

Ascites is characterized by an accumulation of fluid in the abdominal cavity. The most common cause is a portal hypertension. Symptoms result usually from an expansion of the abdominal cavity. Diagnosis is based on physical examination and often ultrasound or computed tomography. Treatment includes bed rest, sodium restriction, diuretics and a therapeutic paracentesis. Ascites fluid can become infected (spontaneous bacterial peritonitis, which is often accompanied by pain and fever. The diagnosis of infection is made by analyzing and culture of ascites fluid. The infection is treated with antibiotics.

Ascites is characterized by an accumulation of fluid in the abdominal cavity. The most common cause is a portal hypertension. Symptoms result usually from an expansion of the abdominal cavity. Diagnosis is based on physical examination and often ultrasound or computed tomography. Treatment includes bed rest, sodium restriction, diuretics and a therapeutic paracentesis. Ascites fluid can become infected (spontaneous bacterial peritonitis, which is often accompanied by pain and fever. The diagnosis of infection is made by analyzing and culture of ascites fluid. The infection is treated with antibiotics.

See also liver structure and function and evaluation of the patient with liver disease.) Ascites is characterized by an accumulation of fluid in the abdominal cavity. The most common cause is a portal hypertension. Symptoms result usually from an expansion of the abdominal cavity. Diagnosis is based on physical examination and often ultrasound or computed tomography. Treatment includes bed rest, sodium restriction, diuretics and a therapeutic paracentesis. Ascites fluid can become infected (spontaneous bacterial peritonitis, which is often accompanied by pain and fever. The diagnosis of infection is made by analyzing and culture of ascites fluid. The infection is treated with antibiotics. Aetiology ascites may result from liver disease is generally chronic, . but sometimes acute; conditions unrelated to the liver can also cause ascites hepatic causes include the following: portal hypertension (responsible for> 90% of liver cases), usually due to cirrhosis Chronic hepatitis Severe alcoholic hepatitis without cirrhosis hepatic vein obstruction (eg . B. Budd-Chiari syndrome) a portal vein thrombosis usually gets no ascites produced unless accompanied hepatocellular injury best . Ht non-hepatic causes benihalten following: Generalized fluid accumulation associated with systemic diseases (eg. As heart failure, nephrotic syndrome, severe hypoalbuminemia, constrictive pericarditis) Peritoneal diseases (eg. As peritoneal or infectious peritonitis, bile leak due to surgery or other medical procedure) Less common causes include dialysis, pancreatitis, systemic lupus erythematosus and endocrine diseases ( z. B. myxedema). The pathophysiology mechanisms are complex and unvolldtändig understood. Factors include nitric oxide-induced splanchnic vasodilation, a modified liquid exchange in the Pfortadergefäße (low oncotic pressure due to hypoalbuminemia with increased portal pressure), severe renal sodium retention (sodium concentration in the urine is usually <5 mmol / l), and possibly increased hepatic lymph formation. Mechanisms that appear to contribute to renal sodium retention, the activation of the renin-angiotensin-aldosterone system, increased sympathetic tone, intrarenal blood flow changes through the shunt from the cortex to the medulla, increased nitric oxide formation, altered formation and metabolism of antidiuretic hormone are (ADH), kinin, prostaglandin and atrial natriuretic factor. Vasodilation in the splanchnic can be a trigger, but the specific contexts of these disorders are not yet known. Symptoms and complaints Small amounts of ascites without symptoms. Moderate amounts lead to an increase in waist circumference and body weight. A massive ascites caused a diffuse abdominal pressure, but an acute pain is unusual and suggests another cause of acute abdominal Shmerzen. When the ascites leads to elevation of the diaphragm, dyspnea may occur. The symptoms of spontaneous bacterial peritonitis (SBP) may be emerging abdominal pain and fever. Findings are a sliding damper (recognizable at a percussion of the abdomen), and the liquid waves. A volume <1500 ml must not lead to physical findings. Massive ascites causes tautness of the abdominal wall and flattening the navel. In liver or peritoneal ascites disease usually occurs in isolated or is not related to peripheral edema; in systemic diseases (eg. as heart failure) is usually the opposite of the Fal. Diagnostic ultrasound or computed tomography, unless the physical findings give a clear diagnosis often tests the ascites fluid, the diagnosis can be made with a larger amount of liquid due to the physical examination, but imaging techniques are more sensitive tests. Ultrasound and computed tomography discover a much smaller volume of liquid (100-200 ml) than the physical examination. Suspicion of a spontaneous bacterial peritonitis is given when patients with ascites additionally include abdominal pain, fever or an unexplained clinical deterioration. Diagnostic abdominal puncture should be performed if any of the following applies: ascites is diagnosed, the cause is unknown. Suspected spontaneous bacterial peritonitis About 50 to 100 ml of fluid is taken and analyzed according to appearance, protein content, cell number and cell differentiation, cytology, culture, and, if clinically indicated, a diagnosis of amylase or acid-fast bacteria can be carried out. In contrast to ascites due to inflammation or infection due to portal hypertension ascites produced clear and straw-colored liquid, having a low protein concentration, a low number of granulocytes or nucleated cells (<250 cells / ul), and the most reliable, a high ratio of serum albumin ascites albumin, which is characterized by the serum albumin concentration minus the ascites albumin concentration. Gradients ? 1.1 g / dL are relatively specific for ascites due to portal hypertension. Turbid ascites, a salary of polymorphonuclear neutrophils> 250 cells / mm suggest an infection while bloody fluid indicates a tumor or tuberculosis. The rare chylous ascites usually occurs at a lymphoma or a closure of the ductus lymphaticus. Therapy bed rest and reduce sodium intake Sometimes spironolactone plus. Furosemide Sometimes therapeutic paracentesis (See also the practice guideline from the American Association for Study of Liver Disease Management of Adult Patients with ascites due to cirrhosis.) Bed rest and dietary restriction of sodium (2000 mg / day) are the first and the least risky treatment of ascites due to portal hypertension. Diuretics should be used when the sodium restriction is not possible to initiate diuresis within a few days. As a rule, spironolactone is effective (in oral doses of 50-200 mg twice daily). A loop diuretic (e.g., furosemide example 20-160 mg p.o. 1 times a day, or 20-80 mg p.o. 2 times a day) should be given in addition when spironolactone is not sufficiently effective. Since spironolactone may result in a potassium retention and furosemide in a reduction of potassium, often, the combination of these two drugs, the optimal drug with a low risk of changes in serum potassium. A fluid restriction is displayed only in the treatment of hyponatremia (serum sodium <120 mmol / l). Changes in body weight and lower the sodium in urine reflect the response resist to treatment. Weight loss of about 0.5 kg / day is optimal, because the ascitic compartment can not be mobilized much faster. A more aggressive diuresis withdraws liquid from the intravascular space, especially when no peripheral edema are present; This dehydration can kidney failure or an imbalance of electrolytes (eg. as hypokalemia) cause, which can speed portosystemic encephalopathy. Inadequate sodium restriction in the diet is usually the cause of persistent ascites. The therapeutic paracentesis is an alternative the paracentesis of 4 L / day is safe. Many doctors give the same albumin (approximately 40 g / paracentesis) to prevent a reduction in intravascular volume. Even a single paracentesis to remove the entire ascites can be sure. The therapeutic paracentesis shortens the hospital with a relatively low risk of electrolyte imbalance or renal failure. Nevertheless permanently patients require diuretics and tend to store liquid faster than those who do not receive paracentesis. Ascites Scott Camazine / SCIENCE PHOTO LIBRARY var model = {thumbnailUrl: '/-/media/manual/professional/images/c0278008-ascites-science-photo-library-high_de.jpg?la=de&thn=0&mw=350' imageUrl: '/-/media/manual/professional/images/c0278008-ascites-science-photo-library-high_de.jpg?la=de&thn=0', title: 'ascites' description:' u003Ca id = "v38395204 "class = " anchor "" u003e u003c / a u003e u003cdiv class = "" para "" u003e u003cp u003ePatienten with massive ascites undergoes a tympanic section. u003c / p u003e u003c / div u003e 'credits' Scott Camazine / SCIENCE PHOTO LIBRARY'

Health Life Media Team

Leave a Reply