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7/25/2019 Ascita, Probleme de Diagnostic Diferential1
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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 .
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