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Revista de la Sociedad Española del Dolor

versión impresa ISSN 1134-8046


PLANCARTE, R.; GUILLEN, M. R.; GUAJARDO, J.  y  MAYER, F.. Ascites in cancer patients: Physiopathology and therapeutic options. Rev. Soc. Esp. Dolor [online]. 2004, vol.11, n.3, pp.156-162. ISSN 1134-8046.

Ascites, defined as the presence of fluid in the peritoneal cavity, is a finding associated to several pathologies, mainly hepatic and cancer diseases. Between 15 and 50 per cent of patients with cancer develop ascites. Its incidence is high in ovary, breast, endometrium, colon, stomach, pancreas and bronchus cancer. Several factors are involved in its pathogenesis, included high hydrostatic pressure, low colloid-osmotic pressure, increased capillary permeability and fluid leakage to the peritoneal cavity. The ascitic fluid is analyzed for diagnostic (serum-ascitic albumin gradient, amylase and triglyceride levels; cell count, culture and Gram staining; pH, cytology, glucose and fibronectine determination) and therapeutic purposes. A physical examination is essential for the diagnosis, with particular attention to classical signs such as convex flanks, wave sign, pleural effusion sign, limb, pelvic and genital edema, etc. Other specific studies are sometimes required in order to verify the presence of fluid in the abdominal cavity. Its treatment will depend on the etiology. In non-cancer patients, diet salt restriction and diuretics regimes obtain satisfactory results. In cancer patients, intra-peritoneal chemotherapy may be required. Patients with poor or null response are candidates for drainage of the ascitic fluid. This can be done using several techniques such as classical paracentesis, total paracentesis, placement of a semi-permanent or permanent drainage with or without image help, shunts, etc. In order to obtain the maximum benefit with the minimum risk, patient global status must be assessed prior to the procedure. It is concluded that ascites of any etiology encompass diverse physiopathological disorders that require both pharmacological and invasive therapies for their effective management.

Palabras clave : Ascites; Physiopathology; Hepatic disease; Cancer; Paracentesis.

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