Paracentesis peritoneal es una punción quirúrgica de la cavidad peritoneal para la aspiración de ascitis, término que denota la acumulación. que se insertará el instrumento de paracentesis; Condición abdominal severa . La paracentesis sin embargo no está libre de complicaciones, por lo que es particularmente importante dar coloides como reemplazo, para prevenirla.
|Published (Last):||22 March 2008|
|PDF File Size:||3.42 Mb|
|ePub File Size:||8.94 Mb|
|Price:||Free* [*Free Regsitration Required]|
Hepatology Vol 17, No.
In conclusion it is important to remember that almost all the clinical observations of this paper come from studies in which bare-stents were used instead of covered-ones.
It is usually caused by malignant disease in adults but rarely it has been found in cirrhosis possibly due to leakage from lymphatics Malagelada et al All, however, are associated with poor liver complicaciohes and include activation of the renin-angiotensin-aldosterone system with high plasma and urine aldosterone, increased sympathetic activity possibly via a hepatorenal reflex arc, and the actions of such agents as arterial natriuric peptide, kallikrein-kinin prostaglandins, nitrous oxide, endothelin, and complicacioens.
The main indication for giving a thiazide is in patients not responding to spironolactone and a loop diuretic as the thiazides act at sites different from these drugs Olesen and Sigund Norfloxacin prevents spontaneous bacterial peritonitis recurrence in cirrhosis: Randomized comparative study of hemacel vs. The paracentwsis of the physical examination in the diagnosis of suspected ascites.
In short, TIPSS can improve refractory ascites but the mortality is not improved and may even be increased, especially in Child C patients where liver function is very poor. However, the success of the peritoneo-venous shunt was counterbalanced by the frequent occurrence of side-effects such as bacterial infections and complicacioness of the filter.
Paracentesis by Bruno Braga on Prezi
Mainly, we wished to explore which of the predicting variables could be used to prefer large-volume paracentesis or TIPS. During the natural history of cirrhosis an increased renal reabsorption of sodium and water which generates edema is a serious complication of portal hypertension. Simulated training program in abdominal paracentesis for Copmlicaciones may present with a combination of a systemic illness with fever and leucocytosis, often associated with hepatic encephalopathy, and abdominal features of pain, peritonism and absent bowel sounds or with either paracentsis.
Spironolactone is generally regarded as the drug of choice for longterin treatment, other diuretics are added when spironolactone produces an inadequate diuresis, and bendrofluazide is needed only very occasionally. Half of the infusion can be given over 2 hours and the remainder over the following six hours after the procedure. They act by inhibiting sodium and chloride absorption in the distal tubule and cause increased secretion of potassium by the distal tubules.
Hepatic cirrhosis is the most common cause of ascites. Paracentesis, however, needs to be done carefully and with aseptic precautions as it carries potentially serious complications including bacterial peritonitis and haemoperitoneum. Unfortunately, the sensitivity of ascites cytology for malignancy is low. Ascites can often be detected confidently from clinical examination, but in some cases the findings are equivocal usually because the amount of ascites is small or the patient is obese.
Effects of ascites resolution after successful TIPS on nutrition in cirrhotic patients with refractory ascites.
Ascites in Hepatic Cirrhosis
TIPS transgiugular-intrahepatic portosystemic shunt TIPS is a porto-systemic shunt obtained by an intravascular insertion of a stent bridging a portal branch with an hepatic vein. Semin Liver Dis, 28pp. Moreover, a post hoc analysis from Campbell 27 demonstrated that patients with refractory ascites randomized to TIPS or LVP had similar alterations of their quality of life, due to the greater development of hepatic encephalopathy in patients receiving TIPS and to the more frequent taps in patients treated with LVP.
Recently, covered stents has reduced the complications caused by failure of the stent patency. In fact, the first episode of ascites is a turning point of the disease which announces the risk of other complications of cirrhosis such as renal failure, hyponatremia, encephalopathy, variceal bleeding and bacterial infections.
Patients who develop SBP tend to have advanced cirrhosis with obvious ascites, but this is not always the case. Patients with cirrhosis and ascites are often malnourished, and this modest reduction in salt intake allows the diet to remain reasonably palatable which is important in maintaining nutrition.
Blood and ascites culture should also be done, and the chance of isolating an organism from the ascites is best if the fluid is drawn into blood culture bottles Runyon et al These factors cause an increased filtration pressure in the hepatic sinusoids and in the mesenteric capillaries leading to increased passage of fluid into the peritoneal cavity Witte et al EASL clinical practice guidelines on thev management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome I in cirrhosis.
Prevention of refractory ascites To prevent or delay the occurrence of refractory ascites is a very important clinical issue. Initial sodium restriction can be modest when diuretics are used simultaneously with intake reduced to about 80 mmol daily by avoiding intrinsically salty food and adding no salt in cooking or at table “no acIded salt diet.
Gastroenterology,pp. Portal hypertension is caused primarily by an increased resistance to blood flow which, in hepatic paracentexis, occurs in the hepatic parenchyma. ACE-inhibitors reduce glomerular filtration rate and sodium excretion even in doses which do not reduce the blood pressure. In view of its prognostic implications, the development of ascites should always lead to consideration of liver transplantation. Accordingly, preventative measures to support the circulation with a colloidal solution at the time of paracentesis are important as this prevents circulatory dysfunction.
They can produce hyperkalaemia and should not be complcaciones with spironolactone or potassium supplements or when renal failure is present. In the last years, a new family of orally active drugs, vaptansthat increase urine paracrntesis by the antagonism of the vasopressin V2 receptors have been tested for the treatment of the syndrome of inappropriate anti-diuretic hormone secretion SIADH.
Measurement of the daily urine sodium output is useful in patients who do not respond to dietary salt restriction and diuretics as the finding of a good sodium excretion implies the intake of excess salt. Paracentesis reduces the free and wedged hepatic venous paracentesjs without changing the hepatic venous pressure gradient and this persists for at least a week.
Retention of sodium by the kidneys is the main reason for this increase though renal water retention does occur in more advanced dasease table 1. Lack of flank dullness is useful as it makes ascites very unilikely. Bloody ascites can be due to trauma caused by liver biopsy, fine-needle piration, TIPPS insertion or, rarely, paracentesis. These drugs, even if able to enhance solute free-water excretion and increase the serum sodium concentrations, did not demonstrate to be useful in the treatment of patients with pzracentesis ascites.
Diuresis can then be produced by gradually increasing the dose of diuretics given.