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Zusammenfassung

Der Begriff Aszites bezeichnet die Ansammlung von Flüssigkeit in der freien Bauchhöhle. Aszites kann bei verschiedenen Erkrankungen auftreten; seine Ätiologie und Pathogenese sind nicht einheitlich. In der Regel ist ein Aszites das Symptom einer weit fortgeschrittenen Erkrankung und weist auf eine schlechte Prognose hin. Da die Therapie somit in den meisten Fällen palliativer Natur ist, sollten sich alle Maßnahmen zur Diagnostik und Therapie diesem Gesichtspunkt unterordnen.

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Literatur

  1. Bard C, Lafortune M, Breton G (1986) Ascites: ultrasound guidance or blind paracentesis? Can Med Assoc J135: 209–210

    CAS  Google Scholar 

  2. Bernardi M, De Palma R, Trevisani F et al. (1986) Effects of a new loop diuretic (muzolimine) in cirrhosis with ascites: comparison with furosemide. Hepatology6: 400–405

    Article  PubMed  CAS  Google Scholar 

  3. Better OS, Schrier RW (1983) Disturbed volume homeostasis in patients with cirrhosis of the liver. Kidney Int23: 303–311

    Article  PubMed  CAS  Google Scholar 

  4. Bichet DG, van Putten VJ, Schrier RW (1982) Potential role of increased sympathetic activity in impaired sodium and water excretion in cirrhotis. N Engl J Med307: 1552–1557

    Article  PubMed  CAS  Google Scholar 

  5. Billmann P, Schölmerich J, Wilms H (1983) Die Funktionsuntersuchung des peritoneo-venösen Shunt-systems. ROEFO138: 288–291

    Article  CAS  Google Scholar 

  6. Billmann P, Volk BA, Schölmerich J, Hasler K, Wilms H (1986) Lokale Lysetherapie bei thrombotischen Komplikationen des peritoneo-venösen Shunts. Z Gastroenterol24: 426–429

    PubMed  CAS  Google Scholar 

  7. Blendis LM, Harrison JE, Russell DM, Miller C, Taylor BR, Greig PD, Langer B (1986) Effects of peritoneovenous shunting on body composition. Gastroenterology90: 127–134

    PubMed  CAS  Google Scholar 

  8. Bloom D, McCalden TA, Rosendorff C (1975) Effects of jaundice plasma on vascular sensitivity to noradrenalin. Kidney Int8: 149–157

    Article  PubMed  CAS  Google Scholar 

  9. de Bold AJ (1985) Atrial natriuretic factor. A hormone produced by the heart. Science230: 767–770

    Article  PubMed  Google Scholar 

  10. Bories P, Compean DG, Michel H et al. (1986) The treatment of refractory ascites by the LeVeen shunt. A multi-centre controlled trial (57 patients). J Hepatology3: 212–218

    Article  CAS  Google Scholar 

  11. Burmeister P, Schölmerich J, Diener W, Gerok W (1986) Renin, aldosterone, and arginine vasopressin in patients with liver cirrhosis - the influence of ascites retransfusion. Eur J Clin Invest16: 117–123

    Article  PubMed  CAS  Google Scholar 

  12. Decaux G, Mols P, Cauchie P, Flamion B, Delwiche F (1986) Treatment of hyponatremic cirrhosis with ascites resistant to diuretics by urea. Nephron44: 337–343

    Article  PubMed  CAS  Google Scholar 

  13. Descos L, Gauthier A, Levy VG et al. (1983) Comparison of six treatments of ascites in patients with liver cirrhosis. A clinical trial. Hepatogastroenterol30: 15–20

    CAS  Google Scholar 

  14. Epstein M, Berk DP, Hollenberg NK, Adams DF, Chalmers TC, Abrams HL, Merrill JP (1970) Renal failure in the patient with cirrhosis. The role of active vasoconstriction. Am J Med49: 175–185

    Article  PubMed  CAS  Google Scholar 

  15. Epstein M (1982) Peritoneovenous shunt in the management of ascites and the hepatorenal syndrome. Gastroenterology82: 790–799

    PubMed  CAS  Google Scholar 

  16. Epstein M (1983) Renal sodium handling in cirrhosis. In: Epstein M (ed) The kidney in liver disease. Elsevier, New York, pp 25–53

    Google Scholar 

  17. Epstein M, Larios O, Johnson G (1985) Effects of water immersion on plasma cate-cholamines in decompensated cirrhosis. Implications for deranged sodium and water homeostasis. Miner Electrolyte Metab11: 25–34

    PubMed  CAS  Google Scholar 

  18. Epstein M (1986) Renal prostaglandins and the control of renal function inliver disease. Am J Med80 [Suppl 1 A]: 46–55

    Article  PubMed  CAS  Google Scholar 

  19. Fine LG, Sakhrani LM (1983) Toward a physiological definition of the hepatorenal syndrome. In: Epstein M (ed) The kidney in liver disease. Elsevier, New York, pp 107–117

    Google Scholar 

  20. Fogel MR, Sawhney VK, Neal EA, Miller RG, Knauer CM, Gregory PB (1981) Diuresis in the ascitic patient: a randomized controlled trial of three regimens. J Clin Gastroenterol 3 [Suppl 1]: 73 - 80

    Article  PubMed  Google Scholar 

  21. Gauthier A, Levy VG, Quinton A et al. (1986) Salt or no salt in the treatment of cirrhotic ascites: a randomized study. Gut27: 705–709

    Article  PubMed  CAS  Google Scholar 

  22. Gerbes AL, Arendt R, Wernze H, Riedel A, Xie Y, Liebermeister R, Paumgartner G (1986) Atrialer natriuretischer Faktor (ANF), Noradrenalin und Natriumausscheidung nach Wasserimmersion bei Patienten mit Leberzirrhose. Z Gastroenterol24: 38–39

    Google Scholar 

  23. Gerok W (1986) Biotransformation von Diuretika bei Leberkrankheiten. In: Knauf H, Mutschier E (Hrsg) Diuretika. Prinzipien der klinischen Anwendung. Urban amp; Schwarzenberg, München, S 73–92

    Google Scholar 

  24. Greig PD, Blendis LM, Langer B, Taylor BR, Colapinto RF (1981) Renal and hemody-namic effects of the peritonevenous shunt. II. Long-term effects. Gastroenterology80: 119–125

    PubMed  CAS  Google Scholar 

  25. Häussinger D, Kaiser S, Stehle T, Gerok W (1986) Liver carbonic anhydrase and urea synthesis. The effect of diuretics. Biochem Pharmacol35: 3317–3322

    Article  PubMed  Google Scholar 

  26. Heinrich F, Loew D, Dycka J (1983) Repeated-dose, double-blind comparative trial of muzolimine-spironolactone, furosemide-spironolactone, and placebo-spironolactone. Clin Nephrol19 [Suppl 1]: 69–75

    Google Scholar 

  27. Herzog P, Walther C, Holtermüller KH (1987) Natriumgehalt flüssiger Antacidum- Präparate. Dtsch Med Wochenschr112: 302–304

    Article  PubMed  CAS  Google Scholar 

  28. Huber M, Kästner S, Schölmerich J, Gerok W, Keppler D (1989) Analysis of leucotrienes in human urine: Enhanced excretion in patients with liver cirrhosis and hepatorenal syndrome. Eur J Clin Invest19: 53–60

    PubMed  CAS  Google Scholar 

  29. Iwatsuki S, Popovtzer MM, Corman JL, Ishikawa M, Putnam CW, Katz FH, Starzl TE (1973) Recovery from “hepatorenal syndrome” after orthotopic liver transplantation. N Engl J Med289: 1155–1159

    Article  PubMed  CAS  Google Scholar 

  30. Jüngst D, Gerbes AL, Martin R, Paumgartner G (1986) Value of ascitic lipids in the differentiation between cirrhotic and malignant ascites. Hepatology6: 239–243

    Article  PubMed  Google Scholar 

  31. Kanel GC, Peters RL (1984) Glomerular tubular reflux — a morphologic renal lesion associated with the hepatorenal syndrome. Hepatology4: 242–246

    Article  PubMed  CAS  Google Scholar 

  32. Kao HW, Rakov NE, Savage E, Reynolds TB (1985) The effect of large volume paracentesis on plasma volume — a cause of hypovolemia? Hepatology5: 403–407

    Article  PubMed  CAS  Google Scholar 

  33. Keppler D, Hagmann W, Rapp S, Denzlinger C, Koch HK (1985) The relation of leukotrienes to liver injury. Hepatology5: 883–891

    Article  PubMed  CAS  Google Scholar 

  34. Keller E, Hoppe-Seyler G, Mumm R, Schollmeyer P (1981) Influence of hepatic cirrhosis and end-stage renal disease on pharmacokinetics and pharmacodynamics of furosemide. Eur J Clin Pharmacol20: 27–33

    Article  PubMed  CAS  Google Scholar 

  35. Kinney MJ, Schneider A, Wapnick S, Grosberg S, LeVeen H (1979) The “hepatorenal” syndrome and refractory ascites: successful therapy with the Le-Veen-type peritoneal- venous shunt and valve. Nephron23: 228–232

    Article  PubMed  CAS  Google Scholar 

  36. Knauf H, Mutschier E (1986) Wirkprofil von Diuretika. In: Knauf H, Mutschier E (Hrsg) Diuretika. Prinzipien der klinischen Anwendung. Urban amp; Schwarzenberg, München, S 93–111

    Google Scholar 

  37. Knauf H, Schollmeyer P, Gerok W (1986) Diuretika bei Nierenerkrankungen sowie Leberzirrhose mit Aszites. In: Knauf H, Mutschier E (Hrsg) Diuretika. Prinzipien der klinischen Anwendung. Urban amp; Schwarzenberg, München, S 141–160

    Google Scholar 

  38. Knauf H, Missmahl M, Schölmerich J, Gerok W, Mutschier E (1987) Altered kinetics of etozolin and its active metabolite ozolinone in hepatitis and hepatic cirrhosis with ascites. Drug Res 37: 1385–1388

    CAS  Google Scholar 

  39. Koppel MH, Coburn JW, Mims MM, Golstein H, Boyle JD, Rubini ME (1969) Transplantation of cadaveric kidneys from patients with hepatorenal syndrome. Evidence for the functional nature of renal failure in advanced liver disease. N Engl J Med280: 1367–1371

    Article  PubMed  CAS  Google Scholar 

  40. Levy VG, Pauleau N, Opolon P, Caroli J (1975) Treatment of ascites by reinfusion of concentrated peritoneal fluid - review of 318 procedures in 210 patients. Postgr Med J51: 564–566

    Article  CAS  Google Scholar 

  41. Linas SL, Anderson RJ, Miller PD, Schrier RW (1983) The rational use of diuretics in cirrhosis. In: Epstein M (ed) The kidney in liver disease. Elsevier, New York, pp 555–567

    Google Scholar 

  42. Medina JF, Prieto J, Guarner F, Quiroga J, Milazzo A (1986) Effect of spironolactone on renal prostaglandin excretion in patients with liver cirrhosis and ascites. J Hepatol 3: 206–211

    Article  PubMed  CAS  Google Scholar 

  43. Mutschier E (1986) Diuretika. Arzneimitteltherapie4: 183–190

    Google Scholar 

  44. Papper S (1983) Hepatorenal syndrome. In: Epstein M (ed) The kidney in liver disease. Elsevier, New York, pp 87–106

    Google Scholar 

  45. Pariente EA, Bataille C, Bercoff E, Lebrec D (1985) Acute effects of Captopril on systemic and renal hemodynamics and on renal function in cirrhotic patients with ascites. Gastroenterology 88: 1255–1259

    PubMed  CAS  Google Scholar 

  46. Pavlow M (1883) The antitoxin functions of the liver. Lancet2: 1092–1093

    Google Scholar 

  47. Perez-Ayuso RM, Arroyo V, Planas R et al. (1983) Randomized comparative study of efficacy of furosemide versus spironolactone in non-azotemic cirrhosis with ascites. Relationship between the diuretic response and the activity of the renin-aldosterone system. Gastroenterology 84: 961–968

    PubMed  CAS  Google Scholar 

  48. Pinzani M, Daskalopoulos G, Laffi G, Gentilini P, Zipser RD (1987) Altered furosemide pharmacokinetics on chronic alcoholic liver disease with ascites contributes to diuretic resistance. Gastroenterology 92: 294–296

    PubMed  CAS  Google Scholar 

  49. Pockros PJ, Reynolds TB (1986) Rapid diuresis in patients with ascites from chronic liver disease: the importance of peripheral edema. Gastroenterology90: 1827–1833

    PubMed  CAS  Google Scholar 

  50. Qazi R, Savlov ED (1982) Peritoneovenous shunt for palliation of malignant ascites. Cancer 49: 600–602

    Article  PubMed  CAS  Google Scholar 

  51. Quintero E, Gines P, Arroyo V et al. (1985) Paracentesis versus diuretics in the treatment of cirrhotics with tense ascites. Lancet1: 611–612

    Article  PubMed  CAS  Google Scholar 

  52. Runyon BA, Canawati HN, Akriviadis EA (1988) Optimization of ascitic fluid culture technique. Gastroenterology 95: 1351–1353

    PubMed  CAS  Google Scholar 

  53. Schölmerich J, Volk BA, Röttgen E, Ehlers S, Gerok W (1984) Fibronectin concentration in ascites differentiates between malignant and nonmalignant ascites. Gastroenterology87: 1160–1164

    PubMed  Google Scholar 

  54. Schölmerich J, Gerok W (1985) Diuretikatherapie bei Leberzirrhose mit Aszites. Therapiewoche35: 2185–2200

    Google Scholar 

  55. Schölmerich J, Diener W, Röttgen E, Maier KP, Costabel U, Gerok W (1985) Die extrakorporale Ascites-Reinfusion zur raschen Ascites-Elimination bei gastroenterolo-gischen Notfallpatienten. Intensivmedizin22: 308–314

    Google Scholar 

  56. Schölmerich J, Volk BA, Köttgen E, Hasler C, Wilms H, Billmann P, Gerok W (1985) Ascites — neue Aspekte zur Pathophysiologic, Diagnostik und Therapie. Dtsch Med Wochenschr110: 512–518

    Article  PubMed  Google Scholar 

  57. Schölmerich J (1986) Hepatorenales Syndrom. In: Deutsch E, Blume W, Kleinberger G, Ritz R, Schuster HP (Hrsg) Akutes Nierenversagen und extrakorporale Therapieverfahren. Schattauer, Stuttgart, S 99 - 117

    Google Scholar 

  58. Schölmerich J (1987) Diagnostik und Therapie des Nierenversagens bei Leberzirrhose. Med Welt38: 1–7

    Google Scholar 

  59. Schölmerich J (1987) Diagnostik und Therapie des Ascites. Internist28: 448–458

    PubMed  Google Scholar 

  60. Schölmerich J, Wenk E, Leser HG, Knauf H, Gerok W (1987) Xipamide in the treatment of cirrhotic ascites - results of two initial studies. Gastroenterology92: 1771

    Google Scholar 

  61. Schölmerich J, Zimmermann U, Köttgen E, Volk BA, Ehlers S, Gerok W (1987) Proteases and antiproteases related to the coagulation system in plasma and ascites. An approach to differentiate between malignant and cirrhotic ascites. Klin Wochenschr65: 634–638

    Article  PubMed  Google Scholar 

  62. Schölmerich J, Zimmermann U, Köttgen E, Volk BA, Hasler C, Diener W, Gerok W (1987) Proteases and antiproteases related to the coagulation in plasma and ascites. The influence of dexamethasone. Klin Wochenschr65: 639–642

    Article  PubMed  Google Scholar 

  63. Schölmerich J, Zimmermann U, Köttgen et al. (1988) Proteases and antiproteases related to the coagulation system in plasma and ascites. Prediction of coagulation disorder in ascites retransfusion. J Hepatol6: 359–363

    Article  PubMed  Google Scholar 

  64. Schrier RW, Arroyo V, Bernardi M, Epstein M, Henriksen JH, Rodés J (1988) Peripheral vasodilatation hypothesis: a proposal for the initiation of renal sodium and water retention in cirrhosis. Hepatology8: 1151–1157

    Article  PubMed  CAS  Google Scholar 

  65. Schroeder ET, Anderson GH, Smulyan H (1979) Effects of a portacaval or peritoneo- venous shunt on renin in the hepatorenal syndrome. Kidney Int15: 54–61

    Article  PubMed  CAS  Google Scholar 

  66. Sellinger M, Haag K, Mielke G, Gerok W, Knauf H (1985) Akutes Nierenversagen und Tubulusnekrose bei Verschlußikterus. Effekt von Gallensäuren und Bilirubin an der Tubulusmembran des Menschen. Z Gastroenterol23: 503

    Google Scholar 

  67. Sherlock S, Senewiratne B, Scott A, Walker JG (1966) Complications of diuretic therapy in hepatic cirrhosis. Lancet1: 1049–1052

    Article  PubMed  CAS  Google Scholar 

  68. Skorecki KL, Brenner BM (1982) Body fluid homeostasis in congestive heart failure and cirrhosis with ascites. Am J Med72: 323–338

    Article  PubMed  CAS  Google Scholar 

  69. Solis-Herruzo JA, Garcia-Cabezudo J, Diaz-Rubio C et al. (1986) Urinary excretion of enzymes in cirrhotics with renal failure. J Hepatol3: 123–130

    Article  PubMed  CAS  Google Scholar 

  70. Stassen WN, McCullough AJ (1985) Management of ascites. Sem Liver Dis5: 291–307

    Article  CAS  Google Scholar 

  71. Vaamonde CA (1983) Renal water handling in liver disease. In: Epstein M (ed) The kidney in liver disease. Elsevier, New York, pp 55–86

    Google Scholar 

  72. Vassalli JD, Hamilton J, Reich E (1976) Macrophage plasminogen activator: modulation of enzyme production by antiinflammatory steroids, mitotic inhibitors, and cyclicnucle-otides. Cell8: 271–281

    Article  PubMed  CAS  Google Scholar 

  73. Volk BA, Schölmerich J, Wilms H, Hasler K, Köttgen E, Gerok W (1985) Treatment of refractory ascites by retransfusion and peritoneo venous shunting. Dig Surg2: 93–97

    Article  Google Scholar 

  74. Volk BA, Schölmerich J, Wilms H et al. (1985) Peritoneo-venöser Shunt in der Aszites-therapie: Komplikationen der Behandlung. Dtsch Med Wochenschr110: 1685–1691

    Article  PubMed  CAS  Google Scholar 

  75. Wapnick S, Grosberg SJ, Evans MI (1979) Randomized prospective matched pair study comparing peritoneovenous shunt and conventional therapy in massive ascites. Br J Surg66: 667–670

    Article  PubMed  CAS  Google Scholar 

  76. Wernze H, Spech HJ, Müller G (1978) Studies on the activity of the renin-angiotensin-al-dosterone system (RAAS) in patients with cirrhosis of the liver. Klin Wochenschr56: 389–397

    Article  PubMed  CAS  Google Scholar 

  77. Wilkinson SP, Smith IK, Williams R (1979) Changes in plasma renin activity in cirrhosis: a reappraisal based on studies in 67 patients with low-renin cirrhosis. Hypertension1: 125–129

    PubMed  CAS  Google Scholar 

  78. Wietholz H, Schölmerich J, Knauf H, Gerok W, Spahn H, Mutschier E (1984) Phar-makokinetik von Xipamid bei Nieren- und Lebererkrankungen. Verh Dtsch Ges Inn Med90: 1902–1904

    Google Scholar 

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Schölmerich, J. (1989). Therapie von Aszites und Nierenversagen bei Leberzirrhose. In: Wiedmann, K.H. (eds) Therapeutische Probleme bei chronischen Lebererkrankungen. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-74671-0_7

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