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REFRACTORY ASCITES

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Slide 1 :

REFRACTORY ASCITES

Slide 2 :

DEFINITIONS Refractory ascites: Is the ascites that cannot be mobilized or the early recurrence of which cannot be satisfactorily prevented by medical therapy.

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The term refractory ascites includes the following two subtypes. Diuretic-resistant ascites: is refractory ascites due to a lack of response to dietary sodium restriction and intensive diuretic therapy. Diuretic-intractable ascites: is refractory ascites due to the development of diuretic-induced complications that preclude the use of an effective diuretic dosage.

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PREVALENCE The prevalence of ascites refractory to medical therapy is 5% to 10 %.

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PATHOGENESIS The pathophysiologic factors leading to refractory ascites are an exaggeration of the factors primarily responsible for sodium and water retention in liver cirrhosis

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Cont. pathogenesis Being characterized by; Severely decreased systemic vascular resistance A hyperdynamic circulation, with an increased cardiac output, a low arterial pressure, and a high pulse rate Greatest activation of the sympathetic nervous system and renin-angiotensin-aldosterone system and non osmotic release of ADH Considerable reduction of the renal blood flow (RBF) and the glomerular filtration rate (GFR) in patients with decreased central blood volume

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PROGNOSIS Generally, the survival rate of patients with ascites is approximately 50% at 2 years, whereas the survival rate in cases of refractory ascites is reduced to 50% at 6 months .

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DIAGNOSTIC CRITERIA Treatment duration: Patients must be on intensive diuretic treatment for at least 1 week. Lack of response: Mean loss of weight less than 200g/day during the last 4 days of intensive diuretic therapy and urinary so

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Hyponatremia; Decreased serum sodium to a value lower than 125 mEq/L. Hypo or hyperkalemia; Decreas more Hyponatremia; Decreased serum sodium to a value lower than 125 mEq/L. Hypo or hyperkalemia; Decreased serum potassium to a value lower than 3 mEq /L or an increase to a value less