Abstract

Ascitis cirrótica y sus complicaciones en un hospital de referencia departamental. Rev Col Gastroenterol [online]. 2004, vol.19, n.2, pp.86-93. ISSN 0120-9957.

The ascitis is the more common complication of the Liver cirrhosis. Until 50% of the patients with compensated cirrhosis developed ascitis in the following 10 years of their evolution and their presence associates with a poor survive. There are some studies indicating that the parameters that estimate the systemic hemodynamic and the renal function is better predictors of the survive that those that estimate the hepatic function. Objectives. To Establish the characteristics of the patients with cirrhotic ascitis in our hospital, their etiology, clinical manifestations, hepatic functional stadium, witnesses of its complications, the grade of activation of the volume systems retainers and its correlation with the functional stadium. Materials and methods. The present is a descriptive study of series of cases, realized among June of 2.000 to June 2.002. All the patients were gathered with cirrhotic ascitis that entered to the hospital. To all the patients they are studied the etiology of the hepatic illness, hepatic profile with hepatic function, punction of the ascitic fluid to the entrance with chemical and bacteriologic study to establish the albumin gradient, the presence or not of infection (PBE or its varieties - neutroascitis, bacteriascitis), nitrogen blood urea, creatinine, blood and urinal Sodium (Na) levels, urinate of 24 Hr. for renal depuration, blood renin and angiotensin levels. We uses the classification of Child Pough to establish the hepatic functional stadium and correlates the same with the renin and angiotensin levels. We determinate the presence of other complications of the ascitis, like the hepatorenal syndrome, the frequency of upper gastrointestinal hemorrhage and the presence of hepatic encefalopathy. Results. 58 patients were gathered, 37 (63,79%) of masculine sex. The age average was of 59,5 years. Most (73,52%) they were coming from rural area of Cundinamarca and farmers (70,37%). The ascitis was the reason of main consultation (29,4%) continued by digestive hemorrhage (23,5%), jaundice (11,1%), and abdominal pain (11,1%). In 87,5% of the patients the etiology was alcoholic and in 12,5% other causes (autoinmune, viral B and C and hemocromatosis). 41,17% studied with upper gastrointestinal hemorrhage, with secondary bleeding to esophageal varices in 78,9%. Hepatic encefalopathy was presented to the entrance in 51,7% of the patients. 41.37% was presented with CHILD B, 29.3% with CHILD C, and alone 29.3% with CHILD A. 100% of the patients had albumin gradient bigger than 1,1. The average of the albumin gradient was of 1.76. Infection of the ascitic fluid was observed with neutroascitis in 17,6%. 72,7% of the patients with neutroascitis studied had ascitic fluid proteins smaller than 1,0 gr/dl. In 66,6% the urine Sodium was below 50 mg/dl. 34,48% of the patients presented nitrogens elevation, 5,1% with hepatorrenal type 1 syndrome, 13,79% with hepatorrenal type 2 syndrome, 13,79% with renal insufficence of prerenal origin and a patient (1,72%) with diabetic nefropathy. We mensurate Renin and Aldosterone levels to 33 patients. The renin levels were elevated in 22,2% of the patients with Child-Pugh A, 66,6% Child B and 77,77% Child-Pugh C and the Aldosterone risen in 46,6% of the patients with Child B and 77,77% with Child C. In the patients with neutroascitis the blood renin was elevated in 60% of the patients. The urinal sodium was shown diminished in 100% of the patients with blood Hiperreninism and hiperaldosteronism with average of 25,46 mg/dl. The patients with hepatorrenal type 1 syndrome studied had marked decrease in the urinal sodium levels, elevation of blood Renin and Aldosterone levels, all with neutroascitis, in Child C and all died. Conclusions. The present study confirms the prevalence of alcoholic etiology in our patients, most consults for the ascitis, they enter in advanced stadiums of the hepatic illness, frequently with associate complications (PBE-encefalopathy) and the correlation was demonstrated among the activation of the volume retainers systems with the advanced stadium of the illness, the diminished urinal sodium, the infection of the ascític fluid and its poor prognosis.

Keywords : Ascitis; Cirrhosis; Peritonitis; Spontaneous; Hepatorrenal; Renin; Angiotensin.

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