Ascites - Alternative treatment

liver411

Source:  Annals of Internal Medicine, June 15, 1990 v112 n12 p889(3).
                                                                              
    Title:  Large-volume paracentesis in treatment of ascites. (editorial)
   Author:  Paul S. Kellerman and Stuart L. Linas
                                                                              
Abstract:  Ascites is the abnormal accumulation of protein-containing liquid
in the abdomen, and can be caused by chronic degenerative diseases of the
liver, such as cirrhosis. Prior to the 1950s, ascites was treated by
paracentesis, which is a procedure where fluid is withdrawn through a needle
that has been placed in the abdomen. Clinical evidence has shown that this
procedure caused liver and kidney failure, inflammation of the brain, and a
decrease in blood pressure, as well as excessive amounts of urea and decreased
levels of sodium in the blood. The standard care for ascites up to the early
1980s included the use of diuretics, which promote sodium and water excretion,
bed rest and dietary sodium restriction. Another therapy for ascites involves
the use of peritoneovenous shunts, which drain the fluid from the abdomen into
the veins. This therapy also carries risks including infection, the formation
of blood clots, and the accumulation of fluid in the lung. One study reported
that 14 of 23 patients had major complications and 50 percent of deaths could
be directly related to the shunts. The death rate from the use of shunts has
been estimated to be 25 percent at one month after creation of shunts. A
comparative study between diuretic therapy and shunt therapy showed there was
no difference in death rates after six months or long-term survival. Recently,
the use of paracentesis with an infusion of the protein albumin has been
reinvestigated. One study reported that after five liters had been drained
from the abdomen, no changes in blood volume, blood pressure or blood
concentrations of sodium or urea occurred. Another study reported that ascites
disappeared in three to four days with paracentesis, while diuretic therapy
took fifteen days. The overall success rate in treating ascites has been
reported to be about 95 percent for paracentesis and 73 percent for diuretic
therapy. This study reported higher complication rates and longer hospital
stays with diuretic therapy than with paracentesis. Thus, paracentesis with
albumin infusion seems to be as effective as diuretics in the treatment of
ascites, as long as careful monitoring of kidney and liver function is
performed. (Consumer Summary produced by Reliance Medical Information, Inc.)
                                                                              
Subjects:  Liver cirrhosis - Complications
            Paracentesis - Evaluation
            Ascites - Alternative treatment
                                                                              
                   RN:  A9181433
                                                                              
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