Mobilization of malignant ascites with diuretics is dependent on ascitic fluid characteristics

Pockros, Paul J.; Esrason, Karl T.; Nguyen, Cuong; Duque, John J.; Woods, Steven D.

doi:10.1016/0016-5085(92)91520-e

Cited by 91 publications

(41 citation statements)

References 12 publications

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“…Successful treatment depends on an accurate diagnosis of the cause of ascites, e.g., peritoneal carcinomatosis does not respond to diuretic therapy. 8 Patients with ascites should be questioned about risk factors for liver disease, including alcohol, intravenous and recreational drug use, transfusions, homosexuality, acupuncture, tattoos, ear-piercing, country of origin, family history, history of jaundice or hepatitis, etc. Past history of cancer, heart failure, or tuberculosis is also relevant.…”

Section: Discussionmentioning

confidence: 99%

“…The serum-ascites albumin gradient can be helpful diagnostically, as well as in therapeutic in decision making. Patients with low serum-ascites albumin gradient ascites usually do not have portal hypertension and do not respond to salt restriction and diuretics, 8 except when patients have nephrotic syndrome. In contrast, patients with a high serum-ascites albumin gradient have portal hypertension and usually are responsive to these measures.…”

Section: Treatmentmentioning

confidence: 99%

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Management of adult patients with ascites caused by cirrhosis†

Runyon¹

1998

Hepatology

302

131

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Ascites is the most common of the major complications of cirrhosis. The development of ascites is an important landmark in the natural history of cirrhosis and has been proposed as an indication for liver transplantation. The initial evaluation of a patient with ascites should include a history, physical evaluation, and abdominal paracentesis with ascitic fluid analysis. Treatment should consist of abstinence from alcohol, sodium restricted diet, and diuretics. This regimen is effective in Ϸ90% of patients. The treatment options for the diuretic-resistant patients include serial therapeutic paracenteses, liver transplantation, and peritoneovenous shunting. (HEPATOLOGY 1998;27;264-272.) PREAMBLE These guidelines provide a data-supported approach to the care of patients with ascites. They are based on the following: 1) a formal review and analysis of the published world literature (1,045 papers) on ascites (Medline Search from 1966-1996, search terms included ascites, diet therapy, drug therapy, radiotherapy, surgery, and therapy); 2) the American College of Physician' s Manual for Assessing Health Practices and Designing Practice Guidelines 1 ; and 3) several published and draft guidelines, including the American Association for the Study of Liver Diseases' Policy Statement on Development and Use of Practice Guidelines and American Gastroenterological Association' s Policy Statement on Guidelines 2 ; and 4) 15 years of experience on the part of the author in the clinical and laboratory investigations of and care for patients with this problem.These guidelines, intended for use by physicians, suggest preferable approaches to the diagnostic, therapeutic, and preventative aspects of care. These guidelines are intended to be flexible, in contrast with ''standards of care,'' which are inflexible policies to be followed in almost every case. 1 Furthermore, these guidelines were developed for the care of adult patients with clinically detectable ascites. Although the general approach may be applicable to children, the pediatric data base is much smaller and there may be unanticipated differences between adults and children. Patients with ascites that is detected by imaging modalities alone, but not yet clinically evident, are not included because of the lack of published information regarding the natural history of this entity.Specific recommendations are based on relevant published information. In an attempt to standardize recommendations, the Practice Guidelines Committee of the American Association for the Study of Liver Diseases modified the categories of the Infectious Diseases Society of America' s Quality Standards. 3 These categories are reported with each recommendation, using the letters A through E to determine the strength of recommendation and roman numerals I through III to determine quality of evidence upon which recommendations are based, as follows: A, survival benefit; B, improved diagnosis; C, improvement in quality of life; D, relevant pathophysiologic parameters improved; E, impacts cost of heal...

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Section: Discussionmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Management of adult patients with ascites caused by cirrhosis†

Runyon¹

1998

Hepatology

302

131

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“…Pockros et al proved in his paper that renin levels were elevated in patients with hepatic metastases, whereas normal renin levels were confirmed in carcinomatosis without hepatic metastases [99]. Patients without hepatic metastases and with diuretic use had 1 kg/d in weight loss without hypotension, and those without metastases and in carcinomatosis group had 0.5 kg/d in weight loss with hypotension and renal dysfunction.…”

Section: Therapeutic Approach For the Patients With Ascitesmentioning

confidence: 95%

Ascitic Fluid in Ovarian Carcinoma – From Pathophysiology to the Treatment

Živadinović¹,

Petrić²,

Krtinić³

et al. 2017

Ascites - Physiopathology, Treatment, Complications and Prognosis

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Due to low symptomatology, a lack of screening, and relatively complicated diagnostic procedures of ovarian carcinoma, more and more women are believed to visit their doctors in advanced stage of the disease, complicated with ascitic fluid. There is an increasing evidence that peritoneal cytology is a subjective assessment with certain percentage of false-positive and false-negative results that may cause application of unnecessary chemotherapy or nonapplication of necessary chemotherapy. Maximal cytoreductive surgery followed by intraperitoneal or systemic chemotherapy remains to be the gold standard in preventing ascites. Ascites is not only a symptom of a disease, but a specific microenvironment for formation and mediation of protumorigenic signals that control ovarian cancer progression, proliferation, invasion, anti-apoptosis, chemoresistance and tumor heterogeneity. Acellular cytokines and immunological factors influence ovarian cancer progression and its ability to prevent immune responses of the body and tumor reaction to chemotherapy. Ascites contributes to disease dissemination, changing its course and final outcomes. Management of patients with ascites and ovarian carcinoma is complex and often the goal of the treatment is to target palliative procedures. Multidisciplinary approach is necessary in the management of these patients. Further investigations of new drugs and immunomodulators are needed aiming at prolonged periods between relapses.

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“…However, phase II data [13] suggest that response to diuretics is restricted to patients with a SAAG >1.1 g/dL (congruent to benign ascites due to liver cirrhoses), whereas malignant ascites with a SAAG <1.1 g/dL is highly resistant to diuretic use. Some authors even state that medical therapies, such as diuretics as well as sodium and fl uid restriction, are not eff ective in most oncological patients independent from SAAG [14].…”

Section: Diuretic Treatmentmentioning

confidence: 99%

Malignant ascites – current treatment and novel therapeutic options

Stange

2012

memo

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Malignant ascites is a common problem in patients with advanced malignancies and peritoneal spread of tumour. Treatment strategies include paracentesis, diuretics and peritoneovenous shunts; however, there are no established evidence-based guidelines for optimal therapy. Th is review is intended to add clarity to the current procedures for the management of malignant ascites, and furthermore discusses new promising approaches.

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Mobilization of malignant ascites with diuretics is dependent on ascitic fluid characteristics

Cited by 91 publications

References 12 publications

Management of adult patients with ascites caused by cirrhosis†

Management of adult patients with ascites caused by cirrhosis†

Ascitic Fluid in Ovarian Carcinoma – From Pathophysiology to the Treatment

Malignant ascites – current treatment and novel therapeutic options

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