Ascites surgery: Difference between revisions
No edit summary |
No edit summary |
||
| Line 7: | Line 7: | ||
==Surgery== | ==Surgery== | ||
{{family tree/start}} | |||
{{family tree| | | | | | A01 | | | | | | | | | |A01='''Refractory Ascites''' }} | |||
{{family tree| | | | | | |!| | | | | | | | | | |}} | |||
{{family tree| | | | | | B01 | | | | | | | | | |B01='''''Large volume [[paracentesis]]'''''}} | |||
{{family tree| | | | | | |!| | | | | | | | | | |}} | |||
{{family tree| | | | | | C01 | | | | | | | | | |C01=Salt restriction and [[diuretics]]}} | |||
{{family tree| | | |,|-|-|^|-|-|-|.| | | | | | |}} | |||
{{family tree| | | B01 | | | | | B02 | | | | | |B01=Controlled|B02=Not controlled}} | |||
{{family tree| | | |!| | | |,|-|-|^|-|-|.| | | |}} | |||
{{family tree| | | C01 | | C02 | | | | C03 | | |C01=Salt restriction and [[diuretics]]|C02=[[TIPS]] possible|C03=[[TIPS]] not possible}} | |||
{{family tree| | | | | | | |!| | | | | |!| | | |}} | |||
{{family tree| | | | | | | D01 | | | | D02 | | |D01='''''[[TIPS]]'''''|D02=Repeated '''''Large volume [[paracentesis]]'''''}} | |||
{{family tree| | | | | | | | | | | | | |!| | | |}} | |||
{{family tree| | | | | | | | | | | | | E01 | | |E01='''''[[Liver transplant]]'''''}} | |||
{{family tree/end}} | |||
===Liver transplantation=== | ===Liver transplantation=== | ||
{{main|liver transplantation}} | {{main|liver transplantation}} | ||
Revision as of 14:29, 19 January 2018
|
Ascites Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Ascites surgery On the Web |
|
American Roentgen Ray Society Images of Ascites surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]
Overview
Surgery
| Refractory Ascites | |||||||||||||||||||||||||||||||||||
| Large volume paracentesis | |||||||||||||||||||||||||||||||||||
| Salt restriction and diuretics | |||||||||||||||||||||||||||||||||||
| Controlled | Not controlled | ||||||||||||||||||||||||||||||||||
| Salt restriction and diuretics | TIPS possible | TIPS not possible | |||||||||||||||||||||||||||||||||
| TIPS | Repeated Large volume paracentesis | ||||||||||||||||||||||||||||||||||
| Liver transplant | |||||||||||||||||||||||||||||||||||
Liver transplantation
Ascites that is refractory to medical therapy is considered an indication for liver transplantation. In the United States, the MELD score (online calculator)[1] is used to prioritize patients for transplantation.
Shunting
In a minority of the patient with advanced cirrhosis that have recurrent ascites, shunts may be used. Typical shunts used are portacaval shunt, peritoneovenous shunt, and the transjugular intrahepatic portosystemic shunt (TIPS). However, none of these shunts has been shown to extend life expectancy, and are considered to be bridges to liver transplantation. A meta-analysis of randomized controlled trials by the international Cochrane Collaboration concluded that "TIPS was more effective at removing ascites as compared with paracentesis...however, TIPS patients develop hepatic encephalopathy significantly more often" [2]
References
- ↑ Cosby RL, Yee B, Schrier RW (1989). "New classification with prognostic value in cirrhotic patients". Mineral and electrolyte metabolism. 15 (5): 261–6. PMID 2682175.
- ↑ Saab S, Nieto JM, Lewis SK, Runyon BA (2006). "TIPS versus paracentesis for cirrhotic patients with refractory ascites". Cochrane database of systematic reviews (Online) (4): CD004889. doi:10.1002/14651858.CD004889.pub2. PMID 17054221.