title: [Hemoconcentration caused by excessive intraoperative ascites production in ulcer bleeding].
abstract: The estimation of the intraoperative fluid requirements can be particularly difficult in patients with compartmental disturbances, e.g. hepatic cirrhosis. The case history of a 41 year old female with a known history of liver cirrhosis is reported who underwent emergency surgery due to upper gastro-intestinal bleeding. In order to maintain hemodynamic stability preoperative blood loss was replaced with fresh blood. During the operation 4 liters of bank and fresh blood with 5 liters of erythrocyte-free fluids were administered. After operation reliable clinical signs of hypovolemia and a marked increase in hematocrit were noted. The severe hemoconcentration was explained by excessive fluid shifts away from the intravascular compartment since a total amount of 10 liters of ascites was collected for the next 24 hours. This overproduction can be related to portal hypertension, hypoalbuminemia and activation of the renin-angiotensin-aldosterone system.
mesh_terms: D000328:Adult; D001201:Ascites / Q000150:complications* / Q000209:etiology; D004381:Duodenal Ulcer / Q000150:complications*; D004911:Erythrocyte Volume; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D008103:Liver Cirrhosis / Q000150:complications; D010438:Peptic Ulcer Hemorrhage / Q000601:surgery*; D010953:Plasma Volume
vernacular_title: Hämokonzentration durch intraoperative exzessive Aszitesproduktion bei Ulkusblutung.