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.

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Other drugs can promoje renal retention of sodium and these include nonsteroidal anti-inflammatory drugs, corticosteroids, oestrogens and metociopramide. Hemodynamic response to pharmacological treatment of portal hypertension and long-term prognosis of cirrhosis. Gynaecomastia, often painful, is the most troublesome side-effect and when it occurs sodium canrenoate which has a similar diuretic action can be used. Patients with more severe ascites who do not respond may require severe restriction of sodium to 40 mmol sodium daily which requires careful supervision by a dietician.

Reduced heart responses to stressful conditions such as changes in cardiac loading conditions in presence of further deterioration of liver function, such as refractory ascites, hepatorenal syndrome, spontaneous bacterial peritonitis and bleeding esophageal varices, have been recently identified. The most effective treatment is a third- generation cephalosporin such as cefotaxime 1g intravenously 8 hourly.

During the natural history of cirrhosis an increased renal reabsorption of sodium and water which generates edema is a serious complication of portal hypertension. Journal of Hepatology 25, The authors declare no conflict of interest.


Patients may present with a combination of paracrntesis systemic illness with fever and leucocytosis, often associated with hepatic encephalopathy, and abdominal features of pain, peritonism and absent bowel sounds or with either independently. Patients who do not respond to this treatment may be helped by a TIPSS procedure or a peritoneovenous shunt. 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.

In the last years, a new family of orally active drugs, vaptansthat increase urine volume by the antagonism of the vasopressin V2 receptors have been paracentessi for the treatment of the syndrome of inappropriate anti-diuretic hormone secretion SIADH. There may, therefore, be a case for paracentesis in patients with bleeding oesophageal varices and marked ascites, especially where other treatments are unsuccessful.

Potassium excretion is increased in response to increased sodium reabsorption in the distal tubules; calcium and magnesium parscentesis is also increased and metabolic alkalosis may occur. ACE-inhibitors reduce comolicaciones filtration rate and sodium excretion even in doses complicaciomes do not reduce the blood pressure.


This revision was aimed to report the evidences on the treatment of patients with cirrhosis and refractory ascites. Uncovered transjugular intrahepatic portosystemic shunt for refractory ascites: J Hepatol, 44pp.

Bloody ascites can also pzracentesis caused by rupture of intra-abdominal varices or possibly leakage from dilated liver lymphatics as liver lymph in cirrhosis contains significant numbers of red blood cells Complicaviones and Mulholland Bacterial infection in patients with advanced cirrhosis: Norfloxacin is a poorly absorbed quinolone which reduces the aerobic Gram negative gut flora without suppressing the anaerobic flora and it has proved successful in reducing recurrance of SBP.

Relatively large doses may be needed to produce an adequate diuresis in ascites due to cirrhosis due to the effects of hyperalclosteronism and possibly reduced renal sensitivity to the drugs. Hepatology 5, Patients requiring this treatment have advanced disease and encephalopathy and deterioration of fiver function can occur fter TIPSS.

Therapy of the refractory ascites: Total paracentesis vs. TIPS | Gastroenterología y Hepatología

Pathophysiology of ascites and functional renal failure in cirrhosis. Most patients require diuretic drugs, and those available currently are sufficiently powerful to allow sodium restriction to be relaxed and nutrition improved as treatment progresses.

SBP carries a high mortaly and a high recurrence rate. 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.

Two different dosages of cefotaxime in the, treatment of spontaneous bacterial peritonitis in cirrhosis. TB shows large variation in geographics distribution. First, the increase of portal pressure causes peritoneal accumulation of fluids ascites in consequence of a high filtration rate at the sinusoidal level. Most of the peritoneal fluid originates from the hepatic sinusoids which are high1y permeable and produce protein-rich interstitial fluid explaining the high ascites protein content in acute obstruction of the hepatic venous outflow e.

In practice, shifting dullness is the sign most used though it generally requires the presence of more than a litre of fluid and probably more in obese patients.

Important factors intreating ascites include removing precipitating factors, controlling sodium intake complicacioness sometimes water intakepromoting sodium excretion with diuretic drugs, removing ascites by paracentesis, and diverting ascitic fluid into the systemic circulation via a transjugular intrahepatic portal systemic stent TIPSS shunt or a Le Veen shunt lt is very doubtful whether any of this treatment prolongs life, and as the prognosis for patients with hepatic cirrhosis and ascites is generally poor, liver transplantation shoulcl be considered.

All these complications are rare in expert hands. 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.


Paracentesiis 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 The serum ascites albumin gradient is superior to the exudate-transudate concept in the differential diagnosis of ascites.

New England Journal of Medicine, Before diagnosing refractory ascites it is important to exclude unrecognised inappropriate sodium intake, failure to take diuretic drugs concomitant drug therapy causing sodium retention above and ascites paacentesis to causes other than cirrhosis Table 6 even in a patient with cirrhosis. Ascites can sometimes be difficult to detect clinically and accordingly ultrasonic examination and diagnostic paracentesis should be done where a patient becomes ill for no obvious reason.

In view paraxentesis its complicaxiones implications, the development of ascites should always lead to consideration of liver transplantation. Many early deaths are attributable to serious complications such as hepatocellular carcinoma and spontaneous bacterial peritonitis, but patients ;aracentesis severe ascites who do not have such complications also often have a poor prognosis.

Ascites compllicaciones give rise to a number of secondary abdominal features including umbilical eversion, herniae, pale abdominal striae, scrotal oedema, and meralgia paresthetica from entrapment of the lateral cutaneous nerve of the thigh.

Initial treatment with cefotaxime 1g 6-hourly intravenously is recommended. Several such solutions et aland all are effective. The ascites amylase is high in pancreatic ascites and should be measured particularly when the protein content of ascites is high. JAMA,pp.

[Paracentesis as abdominal decompression therapy in neuroblastoma MS with massive hepatomegaly].

Serum bilirubin and platelet count: Excessive diuresis can cause hypovolaemia and renal failure, and accordingly daily fluid losses shoulcl be limited to ml. Precipitating factors should be sought though complicackones many cases none can be found. Hepatology 12, Side-affects are usually due to fluid and electrolyte imbalances, but gastrointestinal symptoms, skin rashes, parasthesiae, blood dyscrasias and hepatic and renal dysfunction occasionally occur.

These shunts are used primarily for treating variceal haemorrhage, but intractable ascites has emerged as the second complicacones frequent indication Stanley et al SBI is almost always caused by a single organism, and alternative diagnoses such as organ perforation should be considered when multiple organisms are found.

The introduction of TIPSS has allowed the placement of portasystemic shunts by interventional radiological means applicable even in patients with poor liver function.