COMPLICACIONES PARACENTESIS PDF

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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This paper considers the ascites of chronic liver disease, including its detection, diagnosis, prognosis, complications and treatment.

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

They produce a diuresis starting 6 hours and ending 24 hours after administration, and are usually parzcentesis to potentiate loop diuretics and reduce urinary potassium loss.

Occasionally, sodium restriction alone will allow resolution of ascites, particularly where a precipitating cause has been found and removed, but the great majority of patients require also diuretic drugs.

There may, therefore, be a case for paracentesis in patients with bleeding oesophageal varices and marked ascites, especially where other treatments are unsuccessful. Reduced central blood volume in cirrhosis. American Journal of the Medical Sciences, The treatment of hepatic hydrothorax is difficult and often unsuccessful.

ACE-inhibitors reduce glomerular filtration rate and sodium excretion even in doses which do not reduce the blood pressure.

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.

Several strategies to treat refractory ascites have been developed and tested with observational studies, randomized trials, and meta-analysis. Indeed, although most patients will respond well to sodium restriction and diuretic drugs, paracentesis is used increasingly as a treatment of first choice probably because it is quicker and can reduce the length of hospital stay Gines et al Severe symptoms such as fits, vomitingconfusion and ataxia or very severe hyponatraemia requires treatment in an intensive care unit owing to the risks of respiratory arrest.

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Aminoglycosides were used previously but are now avoided owing to their renal toxicity. N Engl J Med,pp.

Paracentesis Abdominal | HCA Healthcare

EASL clinical practice guidelines on thev management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome I in cirrhosis. Titanium catheter tip for peritoneovenous shunts.

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 tested for the treatment of the syndrome of inappropriate anti-diuretic hormone secretion SIADH. In these cases the administration of diuretic drugs is insufficient to increase urinary sodium excretion diuretic-resistant ascites or, more often, the diuretic copmlicaciones cannot be tolerated because of serious side-effects, such as encephalopathy, hyponatremia, renal failure diuretic intractable ascites.

Ascites in hepatic cirrhosis develops because of a considerable increase of total body sodium and water, and portal hypertension which localises much of that sodium and water to the peritoneal cavity Arroyo et al Ascites is an important development in cirrhosis as it implies a generally poor long term prognosis.

The serum ascites albumin gradient psracentesis superior to the exudate-transudate concept in the differential diagnosis of ascites. These shunts are used primarily for treating variceal haemorrhage, but intractable ascites has emerged as the second most frequent indication Stanley et al However, these patients usually have very poor liverfunction and the possibility of fiver transplantation should be considered.

Diuresis can then be produced by gradually increasing the dose of diuretics given. The causes of exclusion are advanced age, relevant comorbidities such as coronaropathy, other cardiac or vascular diseases, cancer. Ascites in hepatic cirrhosis is associated with advanced liver disease and with poor hepatic function and portal hypertension, and consequently it is also associated with a poor prognosis.

Accordingly, preventative measures to support the circulation with a colloidal solution at the time of paracentesis are important as this prevents circulatory dysfunction. This treatment takes complicacionse, and increasingly doctors use therapeutic paracentesis with sodium restriction and diuretics to prevent recurrence of ascites.

Recently, the most accepted criteria paracentesiw defining refractory ascites are an ascites that compljcaciones be mobilized or paracengesis re-accumulation after large-volume paracentesis LVP cannot be prevented by medical therapy.

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Two different dosages of cefotaxime in the, treatment of spontaneous bacterial peritonitis ccomplicaciones cirrhosis. Oral, Nonabsorbable antibiotics prevent infection in cirrhotics with gastrointestinal haemorrhage.

Many early deaths are attributable to serious complications copmlicaciones as hepatocellular carcinoma and spontaneous bacterial peritonitis, but patients with severe ascites who do not have such complications also often have a poor prognosis. Ascites not attributed to cirrhosis is usually due to intra-abdominal malignant disease and other causes are uncommon Table 6.

The clinical features are those of cough, dyspnoea, chest pain or fever in a patient with a pleural effusion, of an associated spontaneous bacterial peritonitis, or of unexplained deterioration in a patients condition.

One suggests that portal hypertension causes a loss of fluid into the peritoneun and leads to depletion of the intravascular volume underfilling theory with secondary and compensatory renal retention of sodium and water; another suggests that the fiver disease itself causes primary renal sodium and water retention leading to expansion of the vascular volume and hence the ascites overflow theory ; a third theory proposes a primary circulatory derangement resulting in a reduced effective arterial plasma volume with consequent renal retention of sodium and water Henriksen et al All these complications develop because of two pathophysiological events.

Enoxaparin prevents portal vein thrombosis and liver decompensation in patients with advanced cirrhosis. Potassium-sparing diuretics Spironolactone, an aldosterone antagonist, is widely regarded as the drug of first choice for ascites in hepatic cirrhosis, perhaps because hyperalclosteronism is relatively so important in sodium retention in this condition.

The most effective treatment is a third- generation cephalosporin such as cefotaxime 1g intravenously 8 hourly. About a half of patients with tense ascites who do not have gastrointestinal bleeding, infection, encephalopathy, severe renal failure or hepatocellular carcinoma at presentation die within a year, and poor prognostic factors in these patients are shown in Table 7.

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