Avtor/Urednik		Hafner, Matjaž
Naslov		Ascites - priporočila za zdravljenje
Prevedeni naslov		Ascites - guidelines for treatment
Tip		članek
Vir		Med Razgl
Vol. in št.		Letnik 41, št. Suppl 3
Leto izdaje		2002
Obseg		str. 13-7
Jezik		slo
Abstrakt		The natural course of liver cirrhosis is frequently complicated by ascites - excessive accumulation of fluid in the peritoneal cavity. According to the arterial vasodilation theory, portal hypertension is the initial event with resulting splanchnic arteriolar vasodilation causing underfilling of the arterial circulation. Arterial receptors detect a lower effective arterial blood volume and stimulate the renin-angiotensin-aldosterone system, causing nonosmotic hypersecretion of the antidiuretic hormone. The ultimate consequence of this response is renal sodium and water retention. A reduction in salt intake favors a negative sodium balance and facilitates the disappearance of ascites. The main indications for the use of diuretics in liver cirrhosis are the treatment of patients with mild to moderate ascites and the prevention of ascites recurrence after therapeutic paracentesis. Total paracentesis has replaced diuretics as the treatment of choice for cirrhotic patients with large ascites. Therapeutic options for ascites that cannot be controlled despite dietary sodium restriction and maximal diuretic therapy include repeated total paracentesis and transjugular intrahepatic portosystemic shunt placement. Recently, liver transplantation has become the only long-term effective therapy for patients with advanced liver cirrhosis and ascites.
Izvleček		Ascites - prosta tekočina v peritonealni votlini - je pogost zaplet jetrne ciroze. Portalna hipertenzija je po arterijski vazodilatacijski teoriji sprožilni dejavnik dilatacije splanhničnih arterij. Posledično vodi do zmanjšanja prostornine krožeče arterijske krvi, kar zaznajo arterijski receptorji, ki vzbudijo os renin-angiotenzin-aldosteron in neozmotsko izločanje antidiuretskega hormona. Končni učinek tega procesa je zadrževanje vode in soli v telesu. Zmanjšan dietni vnos soli vpliva na negativno bilanco natrija in pripomore k izplavljenju ascitesa. Diuretike uporabljamo za zdravljenje bolnikov z blagim do zmernim ascitesom in za preprečevanje ponovnega ascitesa po paracentezi. Popolna paracenteza je najprimernejša izbira zdravljenja bolnikov z obilnim ascitesom. Pri bolnikih z ascitesom, ki so neodzivni na največji odmerek diuretikov, se odločimo za ponavljajoče se popolne paracenteze ali za vstavitev transjugularnega intrahepatičnega portosistemskega stenta (TIPS-a). Presaditev jeter je edini dolgoročno uspešni način zdravljenja bolnikov z napredovalo jetrno cirozo in ascitesom.
Deskriptorji		ASCITES DIURETICS PARACENTESIS PORTASYSTEMIC SHUNT, TRANSJUGULAR INTRAHEPATIC DIAGNOSIS, DIFFERENTIAL