Ascitis: diagnóstico diferencial y tratamiento

  1. L. Téllez
  2. M. Aicart-Ramos
  3. M.A. Rodríguez-Gandía
  4. J. Martínez
  5. A. Albillos
Revista:
Medicine: Programa de Formación Médica Continuada Acreditado

ISSN: 0304-5412

Año de publicación: 2016

Título del ejemplar: Enfermedades del aparato digestivo (XII) Enfermedades hepáticas. Complicaciones de la cirrosis hepática

Serie: 12

Número: 12

Páginas: 673-682

Tipo: Artículo

DOI: 10.1016/J.MED.2016.05.021 DIALNET GOOGLE SCHOLAR

Otras publicaciones en: Medicine: Programa de Formación Médica Continuada Acreditado

Resumen

Introducción La ascitis es un hallazgo exploratorio frecuente, sobre todo en los pacientes con cirrosis hepática. Etiología Existen otras muchas causas de ascitis, como los tumores diseminados o las infecciones sistémicas. Diagnóstico El análisis del líquido ascítico es fundamental para establecer un adecuado diagnóstico diferencial. Tratamiento El tratamiento de la ascitis varía en función de su causa, siendo complejo en los pacientes con cirrosis hepática por el alto riesgo de desarrollar complicaciones.

Referencias bibliográficas

  • Tarn AC, Lapworth R. Biochemical análisis of ascitic (peritoneal) fluid: what should we measure? Ann Clin Biochem. 2010;47:397-407.
  • McVay PA, Toy PTCY. Lack of increased bleeding after paracentesis and thoracocentesis in patients with mild coagulation abnormalities. Transfu-sion. 1991;31:164-71.
  • Grabau CM, Crago SF, Hoff LK, Simon JA, Melton CA, Ott BJ et al. Performance standards for therapeutic abdominal paracente-sis. Hepatology. 2004;40:484-8.
  • Thomsen TW, Shaffer RW, White B, Setnik GS. Paracentesis. N Engl J Med. 2006;355:e21.
  • McHutchison JG. Differential diagnosis of ascites. Semin Liver Dis. 1997;17:191-202.
  • Runyon BA, Hoefs JC, Morgan TR. Ascitic fluid analysis in malignancy-related ascites. Hepatology. 1988;8:1104-9.
  • Senosiain Lalastra C, Martínez González J, Mesonero Gismero F, Morei-ra Vicente V. Octreotide treatment for postoperative chylous ascites in an adult. Gastroenterol Hepatol. 2012;35:567-71.
  • Browse N, Wilson N, Russo F, Al-Hassan H, Allen D. Aetiology and treatment of chylous ascites. Br J Surg. 1992;79:1145-50.
  • Boyer TD, Kahn AM, Reynolds TB. Diagnostic value of ascetic fluid lactic dehydrogenase, protein and WBC levels. Arch Intern Med. 1978;138:1103-5.
  • Sampliner RE, Iber FL. High protein ascites in patient with uncomplicated hepatic cirrhosis. Am J Med Sci. 1974;267:275-9.
  • Runyon BA. Manegement of adult patients with ascites due to cirrhosis: an update. Hepatology. 2009;49:2087-107.
  • Gordon FD. Ascites. Clin Liver Dis. 2012;16:285-99.
  • Sevinc A, Sari R, Fadillioglu E. The utility of lactate dehydrogenase isoenzyme pattern in the diagnostic evaluation of malignant and non-malignant ascites. J Natl Med Assoc. 2005;97:79-84.
  • Dever JB, Sheikj MY. Review article: spontaneous bacterial peritonitis—bacteriology, diagnosis, treatment, risk factors and prevention. Aliment Pharmacol Ther. 2015;41:116-31.
  • Runyon BA. Amylase levels in ascetic fluid. J Clin Gastroenterol. 1987;9:172-4.
  • Riquelme A, Calvo M, Salech F, Valderrama S, Pattillo A, Arellano M, et al. Value of adenosine deaminasa (ADA) in ascetic fluid for the diagnosis of tuberculous peritonitis: a meta-analysis. J Clin Gastroenterol. 2006;40:705-10.
  • Rana SV, Babu SGV. Usefulness of ascitic fluid choresterol as a marker for malignant ascites. Med Sci Mon. 2005;11:136-42.
  • Rimola A, García-Tsao G, Navasa M, Piddock LJ, Planas R, Bernard B, et al. Diagnosis, treatment and prophylaxis of sponta-neous bacterial peritonitis: a consensus document. International Ascites Club. J Hepatol. 2000;32:142-53.
  • Guirat A, Koubaa M, Mzali R, Abid B, Ellouz S, Affres N, et al. Peritoneal tuberculosis. Clin Res Hepatol Gastroenterol. 2011;35:60-9.
  • Adam RA, Adam YG. Malignant ascites: past, present, future. J Am Coll Surg. 2004;198:999-1011.
  • Valla DC. Budd-Chiari syndrome and veno-occlusive disease/sinusoidal obstruction syndrome. Gut. 2008;57:1469-78.
  • Arroyo V, Bernardi M, Epstein M, Henriksen JH, Schrier RW, Rodes J. Pathophysiology of ascites and functional renal failure in cirrhosis. J Hepatol. 1988;6:239-57.
  • Bucsics T, Mandorfer M, Schwabl P, Bota S, Sieghart W, Trauner M, et al. Impact of acute kidney injury on prognosis of patients with liver cirrhosis and ascites: a retrospective cohort study. J Gastroenterol Hepatol. 2015;30(11):1657-65.
  • Samuel D. MELD-Na as a prognostic score for cirrhotic patients: Hyponatremia and ascites are the back in the game. J Hepatol. 2009;50:836-8.Estudio clínico.
  • European Association for the Study of the Liver. EASL clinical practice guidelines on the management of ascites, spontaneous bac-terial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol. 2010;53:397-417.
  • Cárdenas A, Ginés P. Management of patients with cirrhosis awaiting liver transplantation. Gut. 2011;60:412-21.
  • Gines P, Guevara M. Hyponatremia in cirrhosis: pathogenesis, clinical significance, and management. Hepatology. 2008;48:1002-10.
  • Bowman JD, Kim H, Bustamante JJ. Drug-induced gynecomastia. Pharmacotherapy. 2012;32:1123-40.
  • Sica DA, Carter B, Cushman W, Hamm L. Thiazide and loop diuretics. J Clin Hypertens. 2011;13:639-43.
  • Dimitriadis G, Papadopoulos V, Mimidis K. Eplerenone reverses spiro-nolactone-induced painful gynecomastia in cirrhotics. Hepatol Int. 2011;5:738-9.
  • Albillos A, Bañares R, González M, Catalina MV, Molinero LM. A meta-analysis of transjugular intrahepatic portosystemic shunt versus paracentesis for refractory ascites. J Hepatol. 2005;43:990-6.
  • Tan HK, James PD, Sniderman KW, Wong F. Long-term clinical outcome of patients with cirrhosis and refractory ascites treates with transjugular intrahepatic portosystemic shunt insertion. J Gastroenterol Hepatol. 2015;30:389-95.
  • Salerno F, Camma C, Enea M, Rössle M, Wong F. Transjugu-lar intrahepatic portosystemic shunt for refractory ascites: a meta-analysis of individual patient data. Gastroenterology. 2007;133:825-34.
  • Ginès P, Uriz J, Calahorra B, García-Tsao G, Kamath PS, Del Arbol LR, et al. Transjugular intrahepatic portosystemic shunting versus paracentesis plus albumin for refractory ascites in cirrhosis. Gastroenterology. 2002;123:1839-47.
  • Salerno F, Merli M, Riggio O, Cazzaniga M, Valeriano V, Pozzi M, et al. Randomized controlled study of TIPS versus paracentesis plus albumin in cirrhosis with severe ascites. Hepatology. 2004;40:629-35.
  • Bellot P, Welker MW, Soriano G, von Schaewen M, Appenrodt B, Wiest R, et al. Automated low flow pump system for the treatment of refractoryascites: a multicenter safety and efficacy study. J Hepatol. 2013;58:922-7.
  • Martínez J, Albillos A. Tratamiento de la ascitis refractaria. Gastroenterol Hepatol. 2014;37:68-73.
  • Villanueva C, Aracil C, Colomo A, Hernández-Gea V, López-Balaguer JM, Alvarez-Urturi C. Acute hemodynamic response to betablockers and prediction of long-term outcome in primary prophylaxis of variceal bleeding. Gastroenterology. 2009;137:119-28.
  • Senzolo M, Cholongitas E, Burra P, Leandro G, Thalheimer U, Patch D. BetaBlockers protect aganist spontaneous bacterial peritonitis in cirrhotic patients: a meta-analysis. Liver Int. 2009;29:1189-98.
  • Henández-Gea V, Colomo A, Aracil C, Graupera I, Poca M, Torras X, et al. Development of ascites in compensated cirrhisis with severe portal hypertension treated with b-blockers. Am J Gastroenterol. 2012;107:418-27.
  • Sersté T, Melot C, Francoz C, Durand F, Rautou PE, Valla D, et al. Deleterious effects of BB on survival in patients with cirrhosis and refractory ascites. Hepatology. 2010;52:1017-22.
  • Mandorfer M, Bota S, Schwabl P, Bucsics T, Pfisterer N, Kruzik M, et al. NSBB increase risk for hepatorenal syndrome and death in patients with cirrhosis and spontaneous bacterial peritonitis. Gastroenterology. 2014;146:1680-90.
  • Kimer N, Feineis M, Møller S, Bendtsen F. BB in cirrhosis and refractory ascites: a retrospective study and review of the literature. Scand J Gastroenterol. 2015;50:129-37.
  • Leithead JA, Rajoriya N, Tehami N, Hodson J, Gunson BK, Tripathi D, et al. NSBB are associated with improved survival in patients with ascites listed for liver transplantation. Gut. 2015;64:1111-9.
  • Galbois A, Das V, Thabut D, Maury E, Ait-Oufella H, Housset C, et al. BB have no effect on outcomes in patients with cirrhosis and severe infections. Hepatology. 2011;53:1412-3.
  • Robins A, Bowden A, Watson W, Smith F, Gelson W, Griffiths W. BB in cirrhosis patients with refractory ascites. Hepatology. 2014;59:2054-5.
  • De Franchis R; Baveno VI Faculty. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. J Hepatol. 2015;63(3):743-52.
  • Albillos A, Martínez J, Téllez L. Continued controversy over the safaty of beta-blockers in decompensated cirrhosis. Hepatology. Hepatology. 2016;63(5):1726-9.
  • Becker G, Galandi D, Blum HE. Malignant ascites: systematic review and guideline for treatment. Eur J Cancer. 2006;42:589-97.
  • Rosenberg SM. Palliation of malignant ascites. Gastroenterol Clin NA. 2006;35:198-9.