Single, Total Paracentesis for Tense Ascites: Sequential Hemodynamic Changes and Right Atrial Size

Panos, Marios Z.; Moore, Kevin; Vlavianos, Panayiotis; Chambers, John; Anderson, J.; Gimson, Alexander; Slater, J. D. H.; Rees, Lesley; Westaby, David; Williams, Roger

doi:10.1002/hep.1840110420

Cited by 98 publications

(34 citation statements)

References 26 publications

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“…30 The issue of whether paracentesis should be repeated daily with 5-liter paracentesis or a single total paracentesis has been resolved. 31,32 Titò et al 31 showed that total paracentesis was as effective and as safe as repeated partial paracentesis. Paracentesis causes an acute increase of cardiac output and a lowering of systemic vascular resistance, leading to a modest reduction of blood pressure.…”

Section: Paracentesismentioning

confidence: 99%

“…Paracentesis causes an acute increase of cardiac output and a lowering of systemic vascular resistance, leading to a modest reduction of blood pressure. 32 Pulmonary capillary wedge pressure decreases at ϳ6 hours postparacentesis, whereas the right atrial pressure falls acutely following the onset of paracentesis, secondary to a reduction of intrathoracic pressure. 32 Since postparacentesis effective hypovolemia (PPH) can occur hours or days after the procedure (see below), volume expansion should commence once the paracentesis has been completed.…”

Section: Paracentesismentioning

confidence: 99%

“…32 Pulmonary capillary wedge pressure decreases at ϳ6 hours postparacentesis, whereas the right atrial pressure falls acutely following the onset of paracentesis, secondary to a reduction of intrathoracic pressure. 32 Since postparacentesis effective hypovolemia (PPH) can occur hours or days after the procedure (see below), volume expansion should commence once the paracentesis has been completed. Total paracentesis shortens the period of hospitalization and can be done as an outpatient procedure.…”

Section: Paracentesismentioning

confidence: 99%

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The Management of Ascites in Cirrhosis: Report on the Consensus Conference of the International Ascites Club

et al. 2003

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Ascites is a common complication of cirrhosis, and heralds a new phase of hepatic decompensation in the progression of the cirrhotic process. The development of ascites carries a significant worsening of the prognosis. It is important to diagnose noncirrhotic causes of ascites such as malignancy, tuberculosis, and pancreatic ascites since these occur with increased frequency in patients with liver disease. The International Ascites Club, representing the spectrum of clinical practice from North America to Europe, have developed guidelines by consensus in the management of cirrhotic ascites from the early ascitic stage to the stage of refractory ascites. Mild to moderate ascites should be managed by modest salt restriction and diuretic therapy with spironolactone or an equivalent in the first instance. Diuretics should be added in a stepwise fashion while maintaining sodium restriction. Gross ascites should be treated with therapeutic paracentesis followed by colloid volume expansion, and diuretic therapy. Refractory ascites is managed by repeated large volume paracentesis or insertion of a transjugular intrahepatic portosystemic stent shunt (TIPS). Successful placement of TIPS results in improved renal function, sodium excretion, and general well-being of the patient but without proven survival benefits. Clinicians caring for these patients should be aware of the potential complications of each treatment modality and be prepared to discontinue diuretics or not proceed with TIPS placement should complications or contraindications develop. Liver transplantation should be considered for all ascitic patients, and this should preferably be performed prior to the development of renal dysfunction to prevent further compromise of their prognosis. (HEPATOLOGY 2003;38:258-266.)

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Section: Paracentesismentioning

confidence: 99%

Section: Paracentesismentioning

confidence: 99%

Section: Paracentesismentioning

confidence: 99%

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The Management of Ascites in Cirrhosis: Report on the Consensus Conference of the International Ascites Club

et al. 2003

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“…In addition, it is not possible to obtain the abdominal pressure produce hemodynamic modifications. 11,12 A mechanical increase of abdominal pressure produced an esophageal luminal pressure with this method, and pressures obtained cannot be recorded. Direct puncture of varices at increase in wedge and free hepatic venous pressures without changes in hepatic venous pressure gradient with a concomi-endoscopy with 22-24 and without saline 20,25-28 perfusion appears to be the most reliable and sensitive technique for detant decrease in hepatic blood flow and an increase in variceal blood flow.…”

Section: Discussionmentioning

confidence: 99%

“…15,16 These changes in blood flows determine a decrease in the renin-angiotensin-aldosterone system and in the output of the sympathetic nervous system. 9,12,15 As a result, these changes in intra-abdominal pressure and vasoactive hormones could cause a reduction of intrahepatic vascular resistance and portal pressure, 17 with a concomitant decrease in variceal blood flow. 9 In our study, a reduction of variceal pressure of 30% was noted, which is similar to the 28% decrease in azygos blood flow previously observed.…”

Section: Discussionmentioning

confidence: 99%

Total volume paracentesis decreases variceal pressure, size, and variceal wall tension in cirrhotic patients

Kravetz¹

1997

Hepatology

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the development of variceal bleeding, 4-6 the effects of TVP It has been suggested that ascites is a risk factor for on splanchnic hemodynamics has acquired a new interest. variceal bleeding in cirrhotic patients. However, no data Several studies have demonstrated that total paracentesis 1 of total volume paracentesis (TVP) effects on variceal or implantation of a peritoneovenous shunt 7,8 results in a hemodynamics has yet been published. The aim of this significant decrease of free and wedge hepatic venous presstudy was to investigate the effects of TVP on variceal sures without modifications in the hepatic venous pressure pressure, size, and tension in cirrhotic patients. Before gradient, a change that arises from the reduction of intrasclerotherapy, 18 cirrhotic patients with grade II esophabdominal pressure. 1,4,5 However, Luca et al. 9 recently demageal varices were studied. The following measurements onstrated that TVP in cirrhotic patients with tense ascites were performed on 12 patients at basal condition and could favorably influence hepatic hemodynamics by causing after TVP: inferior vena cava pressure, esophageal presa significant decrease in wedge hepatic venous pressure and sure (EP), and intravariceal pressure (IVP) by direct hepatic venous pressure gradient, in addition to a marked punction and variceal size at endoscopy. The same meadecrease in portocollateral blood flow as estimated by azygos surements were performed at basal condition and 1 hour blood flow determination. If these changes are confirmed, it later without TVP on the other 6 patients used as a conwould add an important hemodynamic effect to the overall trol group. Variceal pressure gradient (VPG) and variconsequences of TVP. If TVP decreases variceal blood flow, ceal wall tension (WT) were calculated. Paracentesis and a reduction in variceal pressure could ensue, an effect that intra-abdominal pressure were obtained with a direct could justify its use for the treatment of variceal hemorrhage punction. No demographic differences were observed in patients with cirrhosis and ascites. However, the complex between both groups. Paracentesis produced a signifirelation between portal and portocollateral hemodynamics cant reduction of IVP (from 25.6 { 2.4 to 17.9 { 2.1 mm does not assure that changes in flow are always followed Hg, means { SEM, 030%, P õ .05), VPG (from 16.6 { 2. 4 by changes in pressure. 10 We therefore designed the present to 10.8 { 1.4 mm Hg, 035%, P õ .05). TVP also reduced study to investigate the effects of TVP on variceal pressure, variceal size (from 9 { 0.3 to 5.6 { 0.4 mm, 038%, P õ size, and tension in cirrhotic patients with tense ascites. .05) and WT (from 75.3 { 11.6 to 30 { 4.7 mm Hg. mm, 060%, P õ .05). Intra-abdominal pressure decreased PATIENTS AND METHODS from 18 { 2.2 to 4 { 0.9 mm Hg (P õ .05), and IVC de-The study was performed from September 1993 to March 1995 on creased from 15.5 { 2.4 to 5.7 { 1.5 mm Hg (P õ .05). No 18 cirrhotic patients admitted to our Liver Unit. The diagnosis of significant diff...

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Session 6 ‒ Treatment of the Acute Bleeding Episode

Laine¹,

Burroughs²,

Silvain³

et al. 2001

Portal Hypertension III: Proceedings of the Third Baverno International Consensus Workshop on Definitions, Methodology and Ther

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Single, Total Paracentesis for Tense Ascites: Sequential Hemodynamic Changes and Right Atrial Size

Cited by 98 publications

References 26 publications

The Management of Ascites in Cirrhosis: Report on the Consensus Conference of the International Ascites Club

The Management of Ascites in Cirrhosis: Report on the Consensus Conference of the International Ascites Club

Total volume paracentesis decreases variceal pressure, size, and variceal wall tension in cirrhotic patients

Session 6 ‒ Treatment of the Acute Bleeding Episode

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