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Ascites and intraabdominal infection

Ludwig Kramer1, Wilfred Druml

  • 1Department of Medicine IV, Vienna University Medical School, A-1090 Vienna, Austria. L.Kramer@akh-wien.ac.at

Current Opinion in Critical Care
|April 13, 2004
PubMed
Abstract

Insights

New insights into ascites and intraabdominal infection reveal bacterial translocation and inflammation drive these conditions in critically ill patients. Diagnosis and treatment strategies are evolving for cirrhotic and noncirrhotic patients.

Area of Science:

  • Critical care medicine
  • Gastroenterology
  • Infectious disease

Background:

  • Ascites and intraabdominal infections are common complications in critically ill patients, particularly those with cirrhosis.
  • Traditional understanding focused on hydrostatic and Starling forces, but emerging evidence points to complex pathophysiological mechanisms.

Purpose of the Study:

  • To review current trends in the diagnosis, treatment, and pathogenesis of ascites and intraabdominal infection.
  • To provide an overview for critically ill patients, both cirrhotic and noncirrhotic.

Main Methods:

  • Literature review of recent studies on ascites and intraabdominal infection.
  • Analysis of pathophysiological concepts, diagnostic tools, and therapeutic interventions.

Main Results:

  • Bacterial translocation from the gut is a key factor, evidenced by bacterial DNA in sterile ascites and serum.
  • Splanchnic vasodilatation, induced by factors like hypoxia and carbon monoxide, contributes to disease progression.
  • Novel diagnostic methods like colorimetric test strips and automated counters improve spontaneous bacterial peritonitis detection.
  • Vasopressin V2-antagonists offer new therapeutic options for hyponatremia.

Conclusions:

  • Pathogenesis is redefined by bacterial translocation, mesenteric inflammation, and altered splanchnic circulation.
  • These dynamic processes, rather than solely hydrostatic forces, dictate the occurrence, severity, and outcomes of ascites and infection.
  • Updated diagnostic and therapeutic approaches are crucial for managing these complex conditions in critically ill patients.

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