Favorable Effects of Total Paracentesis on Splanchnic Hemodynamics in Cirrhotic Patients With Tense Ascites

Abstract

Total paracentesis is widely used in the treatment of patients with cirrhosis and tense ascites. However, very little information is available regarding its consequences on splanchnic circulation, and its effects on portocollateral blood flow have not been investigated. Ten cirrhotic patients admitted because of tense ascites had measurements of hepatic and systemic hemodynamics, renal function and endogenous vasoactive neurohumoral systems at baseline, just after total paracentesis and 1 hr later. Total paracentesis caused a significant increase in cardiac output ( + 11%; 95% confidence interval, +4% to + 19%) and a rapid fall in portal pressure, as shown by significant decreases in both the wedged hepatic venous pressure ( -27% & 8%; p < 0.005) and the hepatic venous pressure gradient ( -10%; 95% confidence interval, -3% to -18%). This was accompanied by a marked decrease in azygos blood flow ( -28%; 95% confidence interval, -13% to -43%).These favorable hemodynamic effects were associated with a fall of the elevated levels of plasma renin activity ( -47% -+ 9%; p < 0.05), plasma aldosterone ( -31% 2 21%; p < 0.05) and plasma norepinephrine and by a decrease in levels of serum creatinine (-24% f 15%; p < 0.05) and blood urea nitrogen ( -4% 2 3%; p < 0.05). These changes were maintained 1 hr later. This study indicates that in patients with cirrhosis and tense ascites total paracentesis favorably influences the systemic hemodynamics, portocollateral blood flow and portal pressure. (HEPATOLOGY 1994;20: 30-33.)Total paracentesis has regained popularity in the treatment of patients with tense ascites (1-4). Although many studies have examined the effects of total paracentesis on the systemic hemodynamics (5-81, little infor- PATIENTS AND METHODS Patients.Ten patients were included, of which five were men and five were women. The mean age was 63 t 8 yr (mean 2 S.D.). The cause of cirrhosis was alcohol in five patients, hepatitis C in three and hepatitis B in one; in one patient it was cryptogenic. The mean Child-Pugh score was 10.5 t 1.7 points. Two patients were classified as Pugh grade B, and eight were classified as grade C. In addition to tense ascites, nine patients had peripheral edema, all patients had varices and two had bled from varices. Their mean urinary sodium excretion was 11 t 4 mEq/day. The criteria for inclusion were cirrhosis with tense ascites, serum bilirubin level lower than 10 mg/dl, prothrombin time greater than 40%, platelet count higher than 40,000/mm3, serum creatinine level lower than 3 mg/dl, and absence of hepatoma, of portal thrombosis, of hepatic encephalopathy, of infection and of recent hemorrhage from gastroesophageal varices (within 2 wk) (1). Patients gave informed consent to participate in the study.Study Design. After admission patients began a low-sodium diet (40 mEq/day) and did not receive diuretics or vasoactive drugs. On the fourth day, blood samples were taken to measure levels of serum creatinine and blood urea nitrogen (BUN). At 9 AM of the fifth day, after patients had...

Hepatic Blood Flow and Splanchnic Oxygen Consumption in Patients With Liver Failure. Effect of High–Volume Plasmapheresis

“…1,[23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] In these studies, ICG was used and the hepatic extraction was measured and taken into account in the calculations. The median (of the reported mean HBF in the individual studies) was 1.18 L/min (range 0.93-1.90).…”

Potential Precipitating Factors of Esophageal Variceal Bleeding: A Case–Control Study

“…Increase in intra-abdominal pressure markedly increase azygous blood fl ow, an index of gastroesophageal collateral blood fl ow, and markedly increase variceal pressure and tension ( 6,7 ). Large volume paracentesis demonstrates the benefi cial eff ect of relieving high intraabdominal pressure and reducing variceal pressure, which suggests that transient increase in intra-abdominal pressure could have a harmful eff ect on EV bleeding ( 8,9 ). Isometric exercise ( 10,11 ) and heavy alcohol binges ( 12 ) reportedly increase portal pressure.…”

Primary prophylaxis of gastroesophageal variceal bleeding: consensus recommendations of the Asian Pacific Association for the Study of the Liver

“…No role of VBL is reported in preventing enlargement or bleeding in patients with small varices. [27][28][29][30][31][32]. These findings suggest that it may be wise to advise patients with cirrhosis and portal hypertension to avoid activities that cause marked increases in IAP such as lifting heavy objects and straining while defecation.…”

“…These findings suggest that it may be wise to advise patients with cirrhosis and portal hypertension to avoid activities that cause marked increases in IAP such as lifting heavy objects and straining while defecation. Total volume paracentesis may decrease variceal pressure and may improve portal hemodynamics, which restores within 24 h of total volume paracentesis [28,29]. However, more trials are needed before it can be recommended to routinely perform total volume paracentesis in patients with esophageal varices to decrease bleeding risk.…”