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Aszites und seine Komplikationen

Ascites and the complications

  • Schwerpunkt: Komplikationen der Leberzirrhose
  • Published:
Der Gastroenterologe Aims and scope

Zusammenfassung

Eine Komplikation der Leberzirrhose ist die Ausbildung von Aszites durch die portale Hypertension. Aszites kann weitere Komplikationen wie die spontane bakterielle Peritonitis (SBP) oder das hepatorenale Syndrom (HRS) mit sich bringen. Mehr als die Hälfte der Patienten mit kompensierter Leberzirrhose entwickelt im Verlauf von 10 Jahren Aszites als Folge der Leberzirrhose, was einen schweren Krankheitsverlauf und eine eingeschränkte Prognose signalisiert. Als einzige kurative Therapie steht eine Lebertransplantation zur Verfügung. Aufgrund der herrschenden Organknappheit müssen jedoch Therapieoptionen bis zu einer möglichen Transplantation angewandt werden. Dies sind neben der frühzeitigen Beseitigung der Noxen die medikamentöse Einstellung des Aszites bzw. im weiteren Verlauf die Evaluation einer TIPS-Anlage, das antibiotische Management bei Auftreten einer SBP und schließlich der Versuch der medikamentösen Therapie des fulminant verlaufenden HRS Typ I.

Abstract

A complication of liver cirrhosis is the formation of ascites due to portal hypertension. Ascites can lead to further complications, such as spontaneous bacterial peritonitis (SBP) and hepatorenal syndrome (HRS). More than half of the patients with compensated liver cirrhosis develop ascites within the course of 10 years, which signalizes a severe course of the disease along with an unfavorable prognosis. The only option for a curative therapy is a liver transplantation; however, because of the lack of donor organs other therapeutic options and bridging methods to a possible transplantation must be employed. In this case it is crucial to stabilize the patient as early as possible by abstention and elimination of toxic substances together with medical control of the ascites, possible placement of a transjugular intrahepatic portosystemic shunt (TIPS), an antibiotic treatment regimen when SBP occurs and ultimately the attempt at medical therapy of fulminant type 1 HRS.

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Authors and Affiliations

  1. Klinik für Innere Medizin II, Universitätsklinikum des Saarlandes, Kirrberger Straße 100, 66421, Homburg, Deutschland

    A. Thiel, F. Lammert & B. Appenrodt

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  1. A. Thiel
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  2. F. Lammert
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  3. B. Appenrodt
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Correspondence to A. Thiel.

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Interessenkonflikt

A.Thiel, F. Lammert und B. Appenrodt geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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C. Trautwein, Aachen

S. Zeuzem, Frankfurt a. M.

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Thiel, A., Lammert, F. & Appenrodt, B. Aszites und seine Komplikationen. Gastroenterologe 11, 16–20 (2016). https://doi.org/10.1007/s11377-015-0033-9

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  • DOI: https://doi.org/10.1007/s11377-015-0033-9

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