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Innere Medizin up2date 2014; 2(04): 249-262
DOI: 10.1055/s-0034-1387461
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© Georg Thieme Verlag KG Stuttgart · New York

Aszites Update 2014

Pathogenese – Diagnostik – Therapie und neue Therapieverfahren
Markus Escher
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Publication Date:
09 December 2014 (online)

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Kernaussagen

  • Aszites kann im Rahmen der körperlichen Untersuchung und sonografisch einfach diagnostiziert werden und ist zu 85 % hepatisch bedingt.

  • Neu aufgetretener Aszites bedarf der diagnostischen Abklärung. Bestimmung der Zellzahl und des SAAG, eine Zelldifferenzierung und mikrobiologische Kultur sind die wesentlichen diagnostischen Säulen.

  • Die Zelldifferenzierung ist der Goldstandard bei der Diagnostik der SBP.

  • Bei V. a. malignen Aszites zytologische Beurteilung mittels ausreichender Probe (50 – 100 ml).

  • Therapeutische Säulen bei hepatisch bedingtem Aszites sind Kochsalzrestriktion und Gabe eines Aldosteronantagonisten, ggf. mit einem Schleifendiuretikum.

  • Bei therapierefraktärem Aszites sind Indikationen für TIPS und Lebertransplantation zu prüfen. Die TIPS-Anlage ist rezidivierenden Parazentesen vorzuziehen.

  • Optionen wie getunnelter Asziteskatheter oder Alfa-Pumpe können die Lebensqualität verbessern und Komplikationen im Rahmen häufiger großvolumiger Parazentesen (z. B. hepatorenales Syndrom, Punktionsfolgen) reduzieren.

 

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