Z Gastroenterol 2011; 49(6): 749-779
DOI: 10.1055/s-0031-1273405
Leitlinie

© Georg Thieme Verlag KG Stuttgart · New York

S3-Leitlinie „Aszites, spontan bakterielle Peritonitis, hepatorenales Syndrom”

German S 3-Guideline ”Ascites, spontaneous bacterial peritonitis, hepatorenal syndrome”A. L. Gerbes1 , V. Gülberg2 , T. Sauerbruch3 , R. Wiest4 , B. Appenrodt3 , M. J. Bahr5 , M. M. Dollinger6 , M. Rössle7 , M. Schepke8
  • 1Med. Klinik und Poliklinik 2, Leber Centrum München, Klinikum der LMU München
  • 2Medizinische Klinik Innenstadt mit Schwerpunkt Gastroenterologie, Klinikum der Universität München
  • 3Medizinische Klinik und Poliklinik I, Universitätsklinikum Bonn
  • 4Innere Medizin I, Universitätsklinikum Regensburg
  • 5Medizinische Klinik I, Sana Kliniken, Lübeck
  • 6Universitätsklinik und Poliklinik für Innere Medizin I, Universitätsklinikum Halle
  • 7Facharzt für innere Medizin, Gastroenterologie/Endokrinologie, Freiburg
  • 8Medizinische Klinik für Gastroenterologie u. Hepatologie, Helios-Klinikum Siegburg
Further Information

Publication History

Publication Date:
01 June 2011 (online)

I. Diagnostik des Aszites I.1. Einleitung: Ursachen des Aszites I.2. Wann soll eine diagnostische Aszitespunktion durchgeführt werden? I.3. Technik, Komplikationen und Kontraindikationen der Aszitespunktion I.3.1 Sollen Gerinnungsfaktoren vor einer Aszitespunktion substituiert werden? I.3.2 Welche Kontraindikationen zur Aszitespunktion bestehen? I.4. Diagnostik bei Aszitespunktion I.4.1 Welche Untersuchungen sind obligater Bestandteil der initialen Aszitespunktion? I.4.2 Welche Untersuchungen sind optionaler Bestandteil einer Aszitespunktion? I.4.3 Welche zytologischen Untersuchungen sollen durchgeführt werden? I.5. Spezifische Diagnostik bei Patienten mit Aszites bedingt durch ein Budd-Chiari-Syndrom (BCS) oder sinusoidales Obstruktionssyndrom I.6. Welche Parameter weisen auf eine sekundäre bakterielle Peritonitis hin? II. Therapie des Aszites II.1. Wann bedarf ein Patient mit Aszites einer Therapie? II.2. Was ist die Rolle der nicht medikamentösen Basistherapie? II.3. Wie wird die medikamentöse Therapie des Aszites durchgeführt? II.4. Wie wird der therapierefraktäre und rezidivierende Aszites behandelt? III. Spontan bakterielle Peritonitis III.1. Einleitung: Definition, Inzidenz und Prognose einer spontanbakteriellen Peritonitis (SBP) bzw. eines Bakteraszites III.2. Wann und wie sollte eine Primärprophylaxe einer SBP durchgeführt werden? III.3. Wie sollte eine SBP behandelt werden? III.4. Wie sollte die Sekundärprophylaxe und Nachsorge einer SBP aussehen ? IV. Hepatorenales Syndrom IV.1. Einleitung: Definition IV.2. Welchen Stellenwert hat die Albumingabe in der Therapie des HRS? IV.3. Welchen Stellenwert haben Vasokonstriktoren in der Therapie des HRS? IV.4. Gibt es einen Stellenwert des transjugulären intrahepatischen portosystemischen Shunts (TIPS) bei HRS? IV.5. Wann ist ein Nierenersatzverfahren beim HRS indiziert und welchen Stellenwert haben Leberersatzverfahren? IV.6. Wie beeinflusst das HRS die Indikation zur und den Verlauf nach Lebertransplantation? V. Hepatischer Hydrothorax V.1. Einleitung: Definition V.2. Welche Untersuchungen sind zur Abklärung eines hepatischen Hydrothoraxes notwendig? V.3. Wie sollten Patienten mit hepatischem Hydrothorax therapiert werden? V.4. Wie sollten Patienten mit rezidivierendem hepatischem Hydrothorax therapiert werden? V.5. Spontan bakterielles Empyem (SBEM) V.5.1 Wie wird ein spontan bakterielles Empyem (SBEM) diagnostiziert und therapiert? Abkürzungsverzeichnis Literatur

Die vorliegende Leitlinie wurde erstellt durch die Deutsche Gesellschaft für Verdauungs- und Stoffwechselkrankheiten (Leitung: Prof. Dr. med. A. L. Gerbes, Medizinische Klinik und Poliklinik II, Klinikum der Universität München Großhadern; Prof. Dr. T. Sauerbruch, Medizinische Klinik und Poliklinik I, Universitätsklinikum Bonn) in Zusammenarbeit mit folgenden Fachgesellschaften/Organisationen:

Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV) Deutsche Gesellschaft für Ernährungsmedizin (DGEM) Deutsche Gesellschaft für Infektiologie (DGI) Deutsche Gesellschaft für Nephrologie (DGfN) Deutsche Gesellschaft für Pathologie (DGP) Deutsche Röntgengesellschaft (DRG) Lebertransplantierte Deutschland e. V.

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Prof. Dr. Alexander L. Gerbes

Med. Klinik und Poliklinik 2, Leber Centrum München, Klinikum der LMU München

Marchioninistr. 15

81377 München

Email: sekretariat.gerbes@med.uni-muenchen.de

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