Prise en charge symptomatique de l’ascite maligne en phase palliative: place de la paracentèse et des diurétiques. Supportive care for malignant ascites in. Chez dix patients cirrhotiques porteurs d’une ascite sous tension, la pression voie endoscopique au moyen d’une fine aiguille, avant et après paracentèse. Mr G. presented for acute care 3 weeks ago with tense ascites, which was managed with a large volume paracentesis (LVP) of approximately 4 L. He was.

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Epub Nov 9.

Ascites in patients with cirrhosis

The patient is usually discharged within several hours following post-procedure observation provided that blood pressure is otherwise normal and the patient experiences no dizziness. Every 1 to 2 days, Mr G. From Wikipedia, the free encyclopedia. Clinically, on investigation of a full, paracentwse abdomen, percussion of the flanks and checking for shifting dullness can detect ascites.

The serum-ascites albumin gradient is superior to the exudate-transudate concept in the differential diagnosis of ascites. Findings from his cardiopulmonary examination are unremarkable.

The procedure is often performed in a doctor’s office or an outpatient clinic. Natural history and prognostic indicators of survival in cirrhosis: The patient is positioned in the bed with the head elevated at degrees to allow fluid to accumulate in lower abdomen. A common decision-making point is whether to start diuretics as monotherapy or as combined therapy.

Epub Mar Gale Encyclopedia of Medicine.

Ascites in patients with cirrhosis

Diagnostic peritoneal lavage Intraperitoneal injection Laparoscopy Omentopexy Paracentesis Peritoneal dialysis. The natural history of cirrhotic liver disease progresses from a compensated to a decompensated phase. Refractory ascites occurs in patients who do not respond to diuretic therapy, who have diuretic-induced complications, or for whom ascites recurs rapidly after therapeutic paracentesis.


Transjugular intrahepatic portosystemic shunt in refractory ascites: Esophagogastroduodenoscopy Barium swallow Upper gastrointestinal series.

Paracentesis – Wikipedia

Place of paracentesis and diuretics. Fecal fat test Fecal pH test Stool guaiac test. Articles with incomplete citations from June All articles with incomplete citations CS1 maint: The needle is removed, leaving the plastic sheath to allow drainage of the fluid. Author information Copyright and License information Disclaimer.

By using this site, you agree to the Terms of Use and Privacy Policy. Management of patients with ascites in end-stage cirrhosis is becoming more common in palliative care. A count of WBC per ml or higher is considered diagnostic for spontaneous bacterial peritonitis. In North America, cirrhosis has become the eighth leading cause of death, 1 with alcoholic liver disease, hepatitis C, and nonalcoholic fatty liver disease as the 3 main causes.

Spironolactone is considered the first-line diuretic because aldosterone is the main factor responsible for renal sodium retention in cirrhosis. Common side effects of furosemide include the following: Indwelling peritoneal catheters The decision whether to continue serial therapeutic paracentesis versus considering a permanent indwelling catheter is guided by the patient and his or her burden of disease, prognosis, and goals of care.

Epub Jun New England Journal of Medicine. Current management of the complications of portal hypertension: These last two risks can be minimized greatly with the use of ultrasound guidance. He is given an enema with good results, and then starts taking 2 senna tablets orally once daily at bedtime. Top of the page – Article Outline.


Fundamental to the formation of ascites in cirrhosis are portal hypertension, which causes splanchnic vasodilation, and activation of the renin-angiotensin-aldosterone system, further resulting in renal sodium retention. Cirrhosis is characterized by diffuse fibrosis of liver parenchyma asciet in structurally abnormal liver nodules.

Despite this, Mr G.

Studies have shown that psracentese monotherapy and combination therapy with spironolactone and furosemide are equally effective at relieving ascites. Epub Oct Liver Artificial extracorporeal liver support Bioartificial liver devices Liver dialysis Hepatectomy Liver biopsy Liver transplantation Portal hypertension Transjugular intrahepatic portosystemic shunt [TIPS] Distal splenorenal shunt procedure.

Epub Sep 4. Artificial extracorporeal liver support Bioartificial liver devices Liver dialysis Hepatectomy Liver biopsy Liver transplantation Portal hypertension Transjugular intrahepatic portosystemic shunt [TIPS] Distal splenorenal shunt procedure.

Back to the case Mr G. He agrees to have a permanent indwelling catheter inserted. Sodium restriction First-line therapy includes sodium restriction. He is paracntese longer able to swallow his medications including his diuretics.