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  • Abdominal decompression plays a major role in early postparacentesis haemodynamic changes in cirrhotic patients with tense ascites

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Hepatobiliary disease
Abdominal decompression plays a major role in early postparacentesis haemodynamic changes in cirrhotic patients with tense ascites
  1. J Cabreraa,
  2. L Falcóna,
  3. E Gorrizb,
  4. M D Pardob,
  5. R Granadosa,
  6. A Quinonesa,
  7. M Maynarb
  1. aHepatology Section, Unit of Investigation, Hospital General Universitario de Gran Canaria, Doctor Negrín, Universidad de Las Palmas de Gran Canaria, Spain, bInterventional Vascular Radiology Section, Unit of Investigation, Hospital General Universitario de Gran Canaria, Doctor Negrín, Universidad de Las Palmas de Gran Canaria, Spain
  1. Dr J Cabrera, Unidad de Investigación del Hospital General Universitario de Gran Canaria, Doctor Negrín, Las Palmas de Gran Canaria, Spain. med004083{at}nacom.es

Abstract

BACKGROUND Some cirrhotic patients with tense ascites who undergo paracentesis develop a circulatory dysfunction syndrome, manifested by an increase in plasma renin activity. Recently, a significant inverse correlation between postparacentesis changes in plasma renin activity and systemic vascular resistance has been demonstrated in these patients, suggesting that peripheral arterial vasodilatation could be responsible for this circulatory dysfunction, but the mechanisms by which tense ascites removal induces such changes are unknown

AIM To investigate the role of a decrease in intra-abdominal pressure (IAP) in the development of early postparacentesis haemodynamic changes

METHODS Eleven cirrhotic patients with tense ascites received a large volume paracentesis. A specially designed pneumatic girdle was used to compress the abdomen to avoid a decrease in IAP during ascites removal. Haemodynamic studies were performed before paracentesis, one hour after ascites flow stopped, and 30 minutes after pneumatic girdle deflation

RESULTS When IAP was maintained at its original level, no haemodynamic changes were observed, despite large volume paracentesis. However, a significant decrease in systemic vascular resistance was seen immediately after pneumatic girdle deflation

CONCLUSIONS Early haemodynamic changes after paracentesis are avoided if IAP is maintained at its original level. The abrupt decrease in IAP could be the trigger for the development of the initial haemodynamic changes that eventually produce postparacentesis circulatory dysfunction.

  • cirrhosis
  • ascites
  • postparacentesis circulatory dysfunction
  • haemodynamic changes
  • intra-abdominal pressure

  • Abbreviations used in this paper

    PRA
    plasma renin activity
    FHVP
    free hepatic vein pressure
    WHVP
    wedge hepatic vein pressure
    HVPG
    hepatic venous pressure gradient
    IAP
    intra-abdominal pressure
    CO
    cardiac output
    MAP
    mean arterial pressure
    RAP
    right atrial pressure
    SVR
    systemic vascular resistance
    PCD
    postparacentesis circulatory dysfunction

    • https://doi.org/10.1136/gut.48.3.384

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    • Abbreviations used in this paper

      PRA
      plasma renin activity
      FHVP
      free hepatic vein pressure
      WHVP
      wedge hepatic vein pressure
      HVPG
      hepatic venous pressure gradient
      IAP
      intra-abdominal pressure
      CO
      cardiac output
      MAP
      mean arterial pressure
      RAP
      right atrial pressure
      SVR
      systemic vascular resistance
      PCD
      postparacentesis circulatory dysfunction
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