Cirrhotic ascites

Spontaneous bacterial peritonitis (SBP) is a serious complication of cirrhotic ascites, arising most frequently in those with advanced liver disease. Its development leads to a further reduction in the effective arterial blood volume, and it has a mortality rate equivalent to that of a variceal bleed [202], Since hepatic blood flow and func-... 

In 60-80% of patients with cirrhotic ascites, the Gram stain is negative. 

The use of lUDs in patients with CLD has complicating factors. Owing to reduced hepatic complement synthesis and reticuloendothelial system dysfunction, patients with cirrhosis and ascites are prone to develop repeated episodes of spontaneous bacterial peritonitis (SBP). Historically, the risk of pelvic inflammatory disease (PID) was considered to be increased in lUD users during the first year after insertion, therefore it was thought that the presence of an lUD in approximation with the peritoneal surface in a patient with cirrhotic ascites might lead to SBP... 

Evans, L.T., Kim, W.R., Poterucha, J.J., Kamath, P.S. Spontaneous bacterial peritonitis in asymptomatic outpatients with cirrhotic ascites. Hepatology 2003 37 897-901... 

Fuller, R.K., Khambatta, P.B., Gobezie, G.C. An optimal diuretic regimen for cirrhotic ascites. A controlled trial evaluating safety and efficacy of spironolactone and furosemide. J. Amer. Med. Ass. 1977 237 972-975... 

Angnelra, C.E., Kadakia, S. Effects of large-volume paracentesis on pulmonary function in patients with tense cirrhotic ascites. Hepatology 1994 20 825-828... 

Sdderlund, C. Denver peritoneovenous shunting for malignant or cirrhotic ascites. A prospective consecutive series. and. J. Gastroenterol. 1986 21 1161-1172... 

Bnrchell, A.R., Rousselot, L.M., Panke, W.F. A seven-year experience with side-to-side portacaval shunt for cirrhotic ascites. Ann. Surg. 1968 168 655-668... 

Coodley, E.L., Matsnmoto Thoracic duct-subclavian vein anastomosis in management of cirrhotic ascites. Amer. J. Med. Sci. 1980 279 163-168... 

El-Toraei, I. Surgical treatment of cirrhotic ascites with a new operation (Pleuroperitoneostomy). J. Int. Coll. Surg. 1961 35 436—445... 

Gage, AA. Hepatopexy for chronic cirrhotic ascites. Surgery 1966 60 1129-1136... 

Stewart, J. Surgical treatment of cirrhotic ascites. Brit. Med. J. 1906 ... 

Strauss RM, Boyer TD. Diagnosis and management of cirrhotic ascites. In Zakim D, Boyer TD, eds. Hepatology A Textbook of Liver Disease, 3rd ed. Philadelphia, Saunders, 1996 764-788. 

SungaUa 1, Bartle WR, Walker SE, et al. Spironolactone pharmacokinetics and pharmacodynamics in patients with cirrhotic ascites. Gastroenterology 1992 102 1680-1685. 

The usual duration of therapy for peritonitis associated with CAPD is 10 to 14 days, but up to 3 weeks of therapy may be required. Antimicrobial therapy should be continued until dialysate fluid is clear, cultures are negative for 2 to 3 days, and the patient is asymptomatic. When parenteral agents are administered, the initial dose would be the same as that for patients with normal renal function, whereas subsequent doses should be much less or given less frequently for renally excreted agents and should account for possible loss through peritoneal dialysis. Serum concentrations should be performed for aminoglycosides and vancomycin. Some studies have demonstrated that for patients with spontaneous bacterial peritonitis associated with cirrhotic ascites, treatment duration may be as short as 5 days when ascitic fluid polymorphonuclear cell counts are used to guide treatment. 

Satavaptan [36], a vasopressin V2 receptor antagonist was developed as a potential treatment for hyponatremia in syndrome of inappropriate secretion of antidiuretic hormone (SIADH, Schwartz-Bartter syndrome) and cirrhotic ascites. However, by Febmary 2009, development was terminated for both indications. 

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