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Dr Madalina Ilie, dr Gabriel Constantinescu, dr Vasile Sandru, dr Oana Plotogea,

dr Cristian Nedelcu, dr Cristina Toader, dr Bogdan Popa, Prof dr Daniela Bartos

Spitalul Clinic de Urgenta Bucuresti

SCIT, P!OB"#M# D# DIGNOSTIC

DI$#!#NTI"%

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SCOP

pre&entarea algorit'ului de e(plorare a etiologiei

ascitei si

e(e'plificarea 'etodelor de diagnostic pe cau&especifice

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MT#!I" SI M#TOD

)** pacienti cu sindro' ascitic in perioada +*+-+*) din

cadrul Spitalului Clinic de Urgenta Bucuresti

nali&e u&uale ./ Tr, C0ol, lbu'ina, Prot, IN!

Mar1eri tu'orali-nu C +23 ecografia abo'ino-pel4ina

paracente&a diagnostica

!( pul' si

56-CT toaco-abdo'ino-pel4ina2

56-"aparoscopie6laparoto'ie

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#7M#N OBI#CTIV

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ECOGRAFIA ABDOMINALA

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P!C#NT#8

Coagulopatia-contraindicatie relati4a, absoluta cand e(ista fibrinoli&a

e4identa sau CID

Transfu&ia de PPC sau 'asa tro'bocitara in ciro&a inainte de

efectuarea paracente&ei nu e sustinuta de g0iduri

Te0nic-dependenta de cantitatea e(istenta si de grosi'ea peretelui

In ca& de insucces-ecog0idata

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P!C#NT#8 #COG9IDT

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N"I8 "IC9IDU"UI D# SCIT

c D

ccident de punctie sau ascita 0e'oragica%

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N"I8 "IC9IDU"UI D# SCIT

#(a'en bioc0i'ic- u&ual-proteine totale, albu'ina

Clasificare e(udat-transudat :+,3 g proteine; nu se 'ai

foloseste, eroare in PBS ctual se foloseste GS

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Patologie peritoneala

- Carcinomatoza

-Tuberculoza

-Ascita pancreatica

-Serozite

Patologie peritoneala

- Carcinomatoza

-Tuberculoza

-Ascita pancreatica

-Serozite

Hipertensiune

sinusoidala-Ciroza-Sd. Budd-Chiari

tardiv

Hipertensiune

sinusoidala-Ciroza-Sd. Budd-Chiari

tardiv

SursaasciteiSursaascitei

Sinusoide hepatice

GASA !.!Sinusoide hepatice

GASA !.!Peritoneu

GASA " !.!Peritoneu

GASA " !.!

Sinusoid capilarizatProteine in ascita< 2.5

Sinusoid capilarizatProteine in ascita< 2.5

#im$atice peritonealeProteine in ascita> 2.5

#im$atice peritonealeProteine in ascita> 2.5

Hipertensiune post-

sinusoidala

- Ascita cardiaca- Sd. Budd-Chiari

precoce

-Boala veno-ocluziva

Hipertensiune post-

sinusoidala

- Ascita cardiaca- Sd. Budd-Chiari

precoce

-Boala veno-ocluziva

Sinusoid normalProteine in ascita> 2.5

Sinusoid normalProteine in ascita> 2.5

CLASIFICARE PRIN GASA si PROTEINE IN ASCITA

ASCITES CAN BE CHARACTERIZED BY SERUM-ASCITES ALBUMIN GRADIENT (SAAG) AND ASCITES PROTEIN

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N"I8 "IC9IDU"UI D# SCIT

lte teste bioc0i'ice>

- gluco&a, "D9, a'ila&a6lipa&a, trigliceride

#(a'en bacteriologic-nu'aratoare de ele'ente, cultura aeroba6anaeroba

-PC! pentru B? in suspiciunea de TB

#(a'en citologic-in carcino'ato&a peritoneala

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!#8U"TT#

64%5%

3%

1%

23%

ciroza hepatica

HCC si TVP

Budd-Chiari

cauze cardiace

pancreatita acuta

sepsis

TBC peritoneal

carcinomatozaperitoneala

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HCC SI TVP

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SD. BUDD-CHIARI

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ASCITA CARDIACA

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CARCI!"AT!#A P$RIT!$A%A

&'(

&'(2%5%)(

)(

5%

5%

)( 2% tumora o*ariananeo pancreas

mezoteliomuroteliala

retroperitoneala

pulmonara

mamara

colonica

+astrica

lim,om

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$!P%AS" !VARIA-ASCITACARCI!"AT!ASA

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$!P%AS" PACR$ATIC-ASCITACARCI!"AT!ASA

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!DU%I D$ CARCI!"AT!#A

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%APAR!SC!PI$%APAR!T!"I$

CARCI!"AT!#A VS. TB

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C!C%U#II

Desi in aparenta dia+nosticul etiolo+ic este ,acile/ista cazuri in care dia+nosticul di,erential este di0cilsi este 1azat mai ales pe analiza lichidului de ascitae/plorari ima+istice endoscopice si chiar laparoscopiecu 1iopsie peritoneala .