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06-08-2008, 07:23 AM
Causes:
1- Weeping liver "Lymphatic ooze from its surface".
2- Hypoproteinaemia which cause decrease in O.P.which results in fluid diffusion outside blood vessels.
3- Portal hypertension results in increase transudation.
4- Increase A.D.H & Aldosterone as they are not detoxicated by liver.
5- T.B. Peritonitis found in 2% of cases.
Treatment:
Medical:
- High protein diet with salt restriction.
- Diuritics.
- Abdominal paracentesis
Ä Patients failing to respond to diuretic treatment may require repeated percutaneous aspiration of the ascites (abdominal paracentesis) combined with volume replacement using salt-poor or standard human albumin solution dependent on the serum sodium level. This is an unsatisfactory treatment but may provide some short-term symptomatic relief.
Surgical: Many operations are done with unsatisfactory results.
1- Drainage of ascitic fluid to venous circulation by saphenoperitoneal anastomosis, or synsthetic peritoneovenous shunts e.g. Le Veen shunt and Denever shunt:
A shunt is created between the jagular vein and peritonium with one way valve.
3- Establishment of good absorbtive surface to absorb ascitic fluid
Pleuro peritoneal fistula.
Newmann's operation: by isolation of loop of ileum by its intact blood supply and let it open in peritoneal cavity.



(B) BLEEDING VARICES
Why oesophageal varices is very liable for bleeding ?
Submucus unsupported veins subjected to:
Acid regurge. Trauma of food.
Negative intrathoracic pressure.
Diagnosis and management (see portal hypertension)
SOURCE: DR. AYMAN SALEM'S BOOK
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