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.

Author: Voodoolkree Tojajin
Country: Thailand
Language: English (Spanish)
Genre: Education
Published (Last): 15 February 2007
Pages: 267
PDF File Size: 10.72 Mb
ePub File Size: 4.47 Mb
ISBN: 319-9-78440-506-7
Downloads: 50979
Price: Free* [*Free Regsitration Required]
Uploader: Nikorg

Please review our privacy policy. Management of patients with ascites in end-stage cirrhosis is becoming more common in palliative care. National Center for Biotechnology InformationU. The procedure is often performed in a doctor’s office or an outpatient clinic.


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. Esophagogastroduodenoscopy Barium swallow Upper gastrointestinal series.

Goals and direction of care are discussed with Mr G. He is no longer able to swallow his medications including his diuretics. Transjugular intrahepatic portosystemic shunt in refractory ascites: Paracenese care for malignant ascites in palliative phase: First-line therapy includes sodium restriction.

The natural history of cirrhotic liver disease progresses from a compensated to a decompensated phase. Parzcentese mg oral dose of metoclopramide is started 3 times daily before meals and a fourth dose at bedtime.

He is being seen today at home because of a rapid decline in function and escalation of symptoms.


Portal hypertension and ascites. 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.

Current management of the complications of portal hypertension: Radiographically, an abdominal ultrasound is useful in defining the extent of ascites in new-onset or worsening ascites.

Prospective evaluation of the PleurX catheter when used to treat recurrent ascites associated with malignancy. Epub Sep 4. Archived copy as title All articles with unsourced statements Articles with unsourced statements from August Malignant ascites, Paracentesis, Diuretics.

Within 7 days, Mr G. 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. Peritoneum Diagnostic peritoneal lavage Intraperitoneal injection Laparoscopy Omentopexy Paracentesis Peritoneal dialysis. The series explores common situations experienced by family physicians doing palliative care as part of their primary care practice.

Anal sphincterotomy Anorectal manometry Lateral internal sphincterotomy Rubber band ligation Transanal hemorrhoidal dearterialization. Despite this, Mr G.

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.

At end-stage paracenntese, ascites causes symptoms including abdominal distention, nausea and vomiting, early satiety, dyspnea, lower-extremity edema, and reduced mobility. This article has been cited by other articles in PMC. Colonoscopy Paradentese Capsule endoscopy Enteroscopy Proctoscopy Sigmoidoscopy Abdominal ultrasonography Defecography Double-contrast barium enema Endoanal ultrasound Enteroclysis Lower gastrointestinal series Small-bowel follow-through Transrectal ultrasonography Virtual colonoscopy.


Cirrhosis ascitee chronic liver failure: 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. In an expert’s hands it is usually very safe, although there is a small risk of infection, excessive bleeding or perforating a loop of bowel.

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.

Ascites in patients with cirrhosis

Clinically, on investigation of a full, bulging abdomen, percussion of the flanks and checking for shifting dullness can detect ascites. His overall appetite has declined, and this is distressing to his family.

Tunneled catheters are preferred over pigtail catheters owing to stability and lower rates of infection. The serum-ascites albumin gradient can help determine the cause of the ascites.

Ascites in patients with cirrhosis

Definition, features, and investigation Ascites is defined as the presence of excessive fluid in the peritoneal cavity. On pzracentese, Mr G. The patient is requested to urinate before the procedure; alternately, a Foley catheter is used to empty the bladder.