Pancreatic Ascites

A brief review of TPN might more clearly point out and explain some of the major areas of this protocol. The use of subclavian vein catheterization for hyperosmolar solutions is the key to TPN. The tip of the catheter resides in the superior vena cava, so solutions with a concentration of 1,500-2,200 mOsm/l. (over five times the osmolarity of serum) can be infused at a rate of 2-3 ml./min. while being diluted by a blood flow of 2-5 l./min. (a dilution factor of a thousand). The site of the catheter is in a large vein. The cutaneous entry site of the catheter is in the pectoral skin below the clavicle; site must be kept scrupulously clean and dressed sterilely. Because of potential complications, the patient should be carefully observed and monitored.     

Central Vein Hyperalimentation in Pancreatic Ascites

Central vein hyperalimentation completely relieved pancreatic ascites associated with rupture of the main pancreatic duct in a patient after unsuccessful peripheral vein alimentation therapy. In two patients with pancreatic ascites associated with pseudocysts, central vein hyperalimentation was associated with complete relief of ascites in one and marked reduction in the other. Endoscopic pancreatography and ultrasonographic or computerized scanning studies revealed lesions that were considered requiring operative treatment in all the three patients; these studies should therefore be done even in patients whose ascites is completely relieved during medical therapy.     

Pancreatic Ascites: Treatment by Continuous Somatostatin Infusion

Two male patients with recurrent acute pancreatitis due to alcohol abuse were admitted with pancreatic ascites (high concentration of amylase, raised protein concentration, no specific cytologic features). Ultrasound (US) and computed tomography (CT) confirmed gross ascites and inflammation of the pancreas in both patients, and a pseudocyst in the head of the pancreas in one of them. Treatment with total parenteral nutrition (TPN) and a H2-blocking agent was instituted and continued for 4 and 2 wk, respectively. Due to lack of improvement, somatostatin infusion (250 micrograms/h) was started. During the next few days, there was a rapid improvement of the clinical status, and the production of ascites ceased. We conclude that somatostatin infusion should be tried before any invasive diagnostic or therapeutic intervention in patients with pancreatic ascites.     

Peritoneal Lavage in the Treatment of Acute Pancreatic Ascites

A case of intraperitoneal rupture of a pseudocyst associated with ascites is presented. Peritoneal lavage was successful in the initial management and allowed definitive surgery to be performed at a more opportune time. When faced with a case of intraperitoneal rupture of a pseudocyst, peritoneal lavage should be considered as an alternative to emergency surgery.     

CASE REPORT: Pancreatic Ascites in an Infant: Lack of Symptoms and Normal Amylase

A 4-month-old boy presented with 9 days of abdominal distension. The abdomen was tense, distended, and nontender, with a fluid wave. Hypoalbuminemia, hyponatremia, high lipase, normal amylase, high ascitic fluid: lipase, amylase, and serum-ascites albumin gradient < 1.1 were present. Abdominal CT showed large ascites, edema, and pancreatic cyst. No improvement was noted with bowel rest, TPN, albumin, furosemide, octreotide, and paracentesis. Endoscopic retrograde cholangiopancreatography showed disrupted pancreatic duct and a cyst. Pancreatic duct stenting was complicated by early outward migration of the stent and was thus ineffective. An exploratory laporatomy revealed a cyst. Cystogastrostomy resolved the pancreatitis and ascites. The patient was discharged off TPN and tolerating enteral nutrition. Pancreatic ascites is rare, producing few or no symptoms in infants. In conclusion, our patient may have had viral pancreatitis, complicated by a disrupted duct and/or ruptured pseudocyst with ascites formation. Medical management was ineffective. Surgery appears to have been curative.     

Ascites

Opinion statement  

Ascites

Ascites is the pathologic accumulation of fluid in the peritoneum. It is the most common complication of cirrhosis, with a prevalence of approximately 10%. Over a 10-year period, 50% of patients with previously compensated cirrhosis are expected to develop ascites. As a marker of hepatic decompensation, ascites is associated with a poor prognosis, with only a 56% survival 3 years after onset. In addition, morbidity is increased because of the risk of additional complications, such as spontaneous bacterial peritonitis and hepatorenal syndrome. Understanding the pathophysiology of ascites is essential for its proper management.     

Ascites

This article reviews the progress made during the last century in understanding and managing ascites. The list of known causes of ascites has lengthened considerably. There is improved understanding of the mechanism of ascites formation and the pathophysiology of the renal sodium retention that accompanies portal hypertensive ascites. Management of ascites has become substantially easier with the advent of new diuretics, and new procedures such as peritoneovenous shunting, transjugular intrahepatic portosystemic stent placement, and liver transplantation.     

乳糜性腹水

乳糜性腹水是一种极为少见的临床疾病。近几年，随着国内腹腔穿刺的广泛开展．乳糜性腹水的发生率不断提高。本文通过对乳糜性腹水发生的解剖、病因、机制、临床表现、诊断方法、治疗和预防进行探讨．以帮助临床医师更好的认识该病，从而对患者进行及时有效的治疗。     

Nephrogenous Ascites

The etiology of exudative ascites in patients maintained by hemodialysis is unknown. Previous reports have implicated prior peritoneal dialysis using a hypertonic (7%) glucose solution as a factor. Other factors include congestive heart failure, noncompliance to hemodialysis program and peritoneal inflammation. The pathogenesis of peritoneal fluid accumulation is probably multifactorial and not solely dependent on hypertonic glucose solution peritoneal dialysis.     

腹水的处理

腹水的发生是腹腔内液体的产生和吸收之间病理性失衡的结果。腹水外观及其成分因其发生的病理生理机制不同而异。腹水最常发生于肝硬化失代偿、腹膜转移癌或结核。某些患者腹水的病因诊断和治疗很困难,是对临床医师的挑战。本文对腹水病因诊断的关键点和相关流程进行了描述,强调血清-腹水白蛋白梯度在病因诊断中的作用,对肝硬化失代偿所致的难治性腹水的处理进行讨论。