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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Diuretics Second-line therapy includes the use of diuretics. The medical management of ascites includes sodium restriction and use of diuretics.

Management of refractory ascites 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. Additional evidences are required before guidelines can be established for the apracentese management of malignant ascites. A mg oral ascit of metoclopramide is started 3 times daily before meals and a fourth dose at bedtime. Access to the full text of this article requires a subscription.

Definition, features, and investigation Ascites is defined as the presence of excessive fluid in the peritoneal cavity. Small bowel Bariatric surgery Duodenal switch Jejunoileal bypass Bowel resection Ileostomy Intestine transplantation Jejunostomy Partial ileal bypass surgery Strictureplasty.


Management of patients with ascites in end-stage cirrhosis is becoming more common in palliative care. The procedure generally is not painful and does not require sedation. Radiographically, an abdominal ultrasound pzracentese useful in defining the extent of ascites in new-onset or worsening ascites. Second-line therapy includes the use of diuretics.


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. The patient is requested to urinate before paeacentese procedure; alternately, a Foley catheter is used to empty the bladder. Abdominal paracentesis, ascitic fluid analysis, and the use of the serum ascites albumin gradient are the most rapid and cost-effective methods of diagnosing the cause of ascites and directing management.

Prospective evaluation of the PleurX catheter when used to treat recurrent ascites associated with malignancy.

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In other projects Wikimedia Commons. Transjugular intrahepatic portosystemic shunt A TIPS is a shunt between the portal vein and the hepatic vein, designed to reduce portal hypertension and improve renal sodium excretion by directly bypassing the cirrhotic parenchymal tissue.

Paracentesis – Wikipedia

Frey’s procedure Pancreas transplantation Pancreatectomy Pancreaticoduodenectomy Puestow procedure. Epub Mar Indwelling catheters, such as a pigtail catheter or a pleural catheter, are an option for those patients who require frequent paracenteses. Archived from the original on Digestive system procedures Abdominal surgical procedures Veterinary diagnosis.

Portal hypertension and ascites. Anal sphincterotomy Anorectal manometry Lateral internal sphincterotomy Rubber band ligation Transanal hemorrhoidal dearterialization.


Place of paracentesis and diuretics. He agrees to have a permanent indwelling catheter inserted.

Ascites in patients with cirrhosis

The needle is removed, leaving the plastic sheath to allow drainage of the fluid. 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.

The serum-ascites albumin gradient can help determine the cause of the ascites. He is being seen today at home because of a rapid decline in function and escalation of symptoms. Transjugular intrahepatic portosystemic shunt in refractory ascites: The asvite albumin gradient is superior to the exudate-transudate concept in the differential diagnosis of ascites. If more rapid symptom control is required, or if the patient has recurrent ascites, then starting combination therapy from the onset should be considered.

Common side effects of furosemide include the following: Appendicectomy Colectomy Colonic polypectomy Colostomy Hartmann’s operation. Please review our paracenyese policy. First-line therapy includes sodium restriction. He is married and has 3 adult children. Management of ascites in cirrhosis. This page was last edited on 9 Novemberat As LVP does not treat the underlying cause of ascites, salt restriction and aascite therapy to slow down aacite rate of reaccumulation should be continued.