Das Auftreten von Aszites stellt eine Zäsur im klinischen Verlauf eines Patienten mit Leberzirrhose dar, weil nach der ersten hydropen Dekompensation die Überlebensprognose stetig sinkt. Die symptomatischen Therapiemöglichkeiten können den Progress nicht aufhalten, sondern nur verzögern. Deswegen muss die Indikation zur Lebertransplantation als einzig kurative Therapie rechtzeitig geprüft werden. Kommt es zur Entwicklung von therapierefraktärem Aszites, sollte eine TIPS-Anlage früh evaluiert und bei fehlenden Kontraindikationen einer wiederholten Parazentese gegenüber bevorzugt werden. Sekundärkomplikationen von Aszites müssen eindeutig diagnostiziert und prophylaktisch therapiert werden, da sie ansonsten häufig zum Tod des Patienten führen.

Keywords:
Aszites, Parazentese, Spontan bakterielle Peritonitis, SBP, Hepatorenales Syndrom, HRS, Transjugulärer intrahepatischer portosystemischer Shunt, TIPS
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© 2012 S. Karger AG, Basel
2012
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