The intraabdominal pressure in decompensated cirrhosis: relationship with ascites volume and turn-over.
The values of the intraabdominal pressure (IAP) were determined in 23 subjects with decompensated cirrhosis, both in basal conditions and after diuretic treatment (furosemide 75 mg/day orally for one week). In order to investigate the role of IAP in the regulation of ascites turn-over, ascites volume and free-water peritoneal clearance (FWPC) were estimated in the same patients by means of a methylene-blue dilution method. In wash-out conditions, no linear correlation was found between IAP and the values of ascites volume or FWPC. After diuretic treatment, we observed a significant reduction of ascites volumes (from 9.0 +/- 0.98 to 4.9 +/- 0.6 litres; p < 0.0005), IAP (from 17.5 +/- 1.3 to 11.3 +/- 0.8 cmH2O; p < 0.0005) and FWPC (from 99.8 +/- 6.7 to 76.2 +/- 6.6 ml/min; p < 0.001). In this situation, IAP values showed a significant linear correlation both with ascites volumes and clearances. These results may be due to the different weight of the two components of total IAP (hydrostatic pressure and abdominal tension): in the untreated patients (with larger ascites volumes) a considerable amount of the total IAP originates from the abdominal tension, and the correlation between IAP and ascites volumes or turn-over is biased. In the treated subjects (with lower ascites volumes) the tension component is minimal, and the correlation is resumed.
Istituto di Patologia Medica Università Cattolica del Sacro Cuore, Rome.
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Milani
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Ciammella
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Rossi
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001201:Ascites / Q000188:drug therapy / Q000503:physiopathology*; D005260:Female; D005665:Furosemide / Q000008:administration & dosage; D006801:Humans; D006874:Hydrostatic Pressure; D008103:Liver Cirrhosis / Q000188:drug therapy / Q000503:physiopathology*; D008297:Male; D008657:Metabolic Clearance Rate / Q000187:drug effects / Q000502:physiology; D008875:Middle Aged
D005665:Furosemide