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Ascites abdominal cavity

Ascites – what is it?

Ascites is a secondary condition in which there is accumulation of transudate or exudate in the abdominal cavity. Symptoms of pathology appear enlarged abdomen, pain, shortness of breath, feeling of heaviness and other signs.

Even ascites, in medicine is called the abdominal edema, which can accompany many diseases of the gynecology, gastroenterology, urology, cardiology, lymphology and Oncology St. Ascites is not an independent disease, but acts as a symptom of or other serious violations in the body. Ascites abdominal cavity does not occur when lung pathologies, it is always accompanied by diseases that threaten human life.

Statistics of ascites indicates that it is more than 70% of adults develops as a result of liver disease. Tumors of internal organs lead to the development of ascites in 10% of cases, another 5% is in heart failure and other diseases. While in children the development of ascites often indicates kidney disease.

It is established that the maximum amount of fluid accumulates in the peritoneal cavity in ascites the patient may reach 25 liters.

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Causes of ascites

Causes of ascites the abdominal cavity is varied and always associated with some serious disorders in the human body. The abdominal cavity is a closed space which is formed to excess fluid. This place is meant for the internal organs – there is a stomach, liver, gall bladder, intestinal tract, spleen, pancreas.

The peritoneum is lined by two layers: an outer, which is fastened to the wall of the stomach, and internal, which is adjacent to the bodies and surrounds them. In norm between these sheets there is always a small amount of liquid, which is the result of work of blood and lymphatic vessels located in the peritoneal cavity. But this fluid does not accumulate, as almost immediately after selecting it absorbed the lymphaticcapillaries. The remaining minor part of the necessary to ensure that the loops of intestines and internal organs can move freely in the abdominal cavity and not glued with each other.

When there is a violation of the barrier, secretory and resorptive functions, exudate stops normally absorbed and accumulates in the abdomen, causing ascites and develops.

Causes of ascites following:

  • Diseases of the liver. First and foremost, this cirrhosisand cancer of the body and Budd-Chiari. Cirrhosis may develop on the background of hepatitis, steatosis, administration of toxic drugs, alcoholism and other factors, but is always accompanied by death of hepatocytes. In the end, the normal liver cells are replaced by scar tissue, the organ increases in size, pressing against the portal vein and, therefore, ascites develops. Also helps to release excess fluid reduced oncotic pressure, because the liver is no longer able to synthesize plasma proteins and albumin. Aggravates the pathological process a number of reflex reactions triggered by the body in response to liver failure;

  • Heart disease. Ascites can develop due to heart failureor because of constrictive pericarditis. Heart failure may be a consequence of almost all cardiac diseases. The mechanism of development of ascites in this case is related to the fact that the hypertrophied heart muscle is unable to pump required amounts of blood that starts to accumulate in the blood vessels, including the Vena cava inferior system. As a result, high pressure fluid will leave the vascular bed, forming ascites. The mechanism of development of ascites when pericarditis is about the same, but in this case inflamed outer layer of the heart which leads to the impossibility of its normal filling with blood. In the future, will this affect the venous system;

  • Kidney disease. Ascites is caused by chronic renal failure, which occurs as a result of a variety of diseases (pyelonephritis, glomerulonephritis, urolithiasis , etc.). Kidney disease cause high blood pressure, sodium along with the fluid retained in the body, the result is ascites. Reduced oncotic pressure of the plasma, leading to ascites, can also occur in the backgroundnephrotic syndrome;

  • Ascites may develop when damage to the lymphatic vessels. This can occur due to trauma, due to the presence in the body of the tumor which gives metastasesdue to infection with filarial (wormslay eggs in large lymph vessels);

  • Various lesions of the peritoneum may cause ascites, diffuse among them, tuberculous and fungal peritonitis, peritoneal kartsinoz, cancer of the colon, stomach, breast, ovaries, endometrium. This includes pseudomyxoma and mesothelioma of the peritoneum;

  • Polyserositis is a disease in which ascites acts in conjunction with other symptoms, including pleurisy and pericarditis;

  • Systemic diseases can lead to accumulation of fluid in the peritoneum. It is rheumatism, rheumatoid arthritis, lupus erythematosus , etc.;

  • Ascites in newborns is also common and is often the result of hemolytic disease of the fetus. She, in turn, develops in utero immunological conflict, when the blood of fetus and mother do not mix for a number of antigens;

  • Protein deficiency is one of the factors predisposing to the formation of ascites;

  • Diseases of the digestive system is able to provoke an excessive accumulation of fluid in the abdominal cavity. It could be pancreatitis, chronic diarrhea, Crohn's disease. This may also include any processes in the peritoneum and prevents the outflow of lymph;

  • Lead to ascites are capable of myxedema. This disease is accompanied by swelling of the soft tissues and mucous membranes, manifested in violation of the synthesis of thyroxine and triiodothyronine (thyroid hormones);

  • Grave errors in diet can cause ascites abdominal cavity. Especially dangerous in this respect, fasting and strict diets. They lead to the fact that the body runs out of protein reserves, decreases the concentration of protein in the blood, which leads to a marked reduction in oncotic pressure. In the end, the liquid part of blood comes out of the vasculature and formed ascites;

  • At an early age ascites accompanied by exudative enteropathy, malnutrition and congenital nephrotic syndrome.

So, based on ascites can be a variety of inflammatory, hydrostatic, metabolic,hemodynamic and other violations. They entail a number of pathological reactions that result in interstitial fluid propotevaet through the veins and accumulates in the peritoneum.

Symptoms of ascites

The first symptom of ascites is an unprecedented increase in the abdomen, or rather, bloating. The main reason for this is that there is accumulated a huge amount of liquid, and it hardly goes. Man discovers ascites usually when can not get into my usual clothes, which has recently approached it in size.

If you have any ascites of the abdominal cavity, in the body there is probably at least two serious functional disorders that need treatment. Often this malfunction of the intestine, disorder of the stomach or liver pathology.

The speed of onset of symptoms directly related to the fact that it was the cause of ascites. The process can develop quickly, and can take several months.

Symptoms of ascites the abdominal cavity, there are the following clinical signs:

  • Bloating in the abdomen;
  • The occurrence of pain in the abdomen and pelvis (abdominal pain);
  • Bloating, symptoms of bloating;

  • Burping and heartburn;

  • Problems with digestion and urination;
  • Nausea;
  • Heaviness in the abdomen;
  • Abdominal enlargement in volume. If the patient is in a horizontal position, the abdomen bulges at the sides and looks like a belly of a frog. When a person stands, the stomach hangs down;
  • Protrusion of the navel;
  • Symptom fluctuations stomach or fluctuation. Always occurs when filling the abdominal cavity with fluid;
  • The more fluid accumulates in the abdominal cavity, the greater shortness of breath, increase edema of the lower extremities, movements become slower. Especially difficult for the patient to lean forward;
  • Due to the increase in intra-abdominal pressure is possible protrusion of the femoral, or umbilical hernia. On this background may develop hemorrhoids and a varicocele. It is not excluded rectal prolapse.

Symptoms of ascites are a fewbe different depending on the etiological factor which provoked him:

  • Symptoms of ascites in tuberculous peritonitis. In this case, the ascites is a consequence of tuberculous lesions of the genital system or intestines. The patient begins to rapidly lose weight, it the body temperature rises, there are growing signs of intoxication. Enlarged lymph nodes, which pass along the mesentery of the intestine. The precipitate is collected by puncture of fluid in addition to lymphocytes and erythrocytes are highlighted in Mycobacterium tuberculosis;

  • Symptoms of ascites in peritoneal carcinoses. If ascites is formed due to the presence in the peritoneum of the tumor, the symptoms will primarily depend on what body it was struck. However, in the ascites of cancer etiology there is swollen lymph nodes that can be felt through the abdominal wall. In the sediment of the exudate will be present abnormal cells;

  • Symptoms of ascites due to heart failure. The patient has a bluish colour of the skin. Lower extremity, especially the foot and lower leg, will be very severely swollen. Thus the liver increases in size, have pain localized in the right hypochondrium. It is not excluded the accumulation of transudate in the pleural cavities;

  • Symptoms of ascites on the background of portal vein thrombosis. The patient will present complaining of severe pain, the liver increases in size, but not much. There is a high risk of massive bleeding from hemorrhoids, or from the veins of the esophagus who have undergone varicose. Besides increasing the liver there is an increase in size of the spleen.

Other symptoms of ascites:

  • If the cause of the disease is portal hypertension, the patient loses weight much, it made him sick and throw up. The skin turn yellow, the abdomen appears venous pattern of the type "Medusa head";
  • On protein deficiency as the cause of ascites, indicate severe swelling of extremities, fluid accumulation in the pleural cavity;
  • With chylous ascites (in the terminal stage of liver cirrhosis) the liquid arrives very quickly, which affects the size of the abdomen;
  • Skin symptoms come to the fore in the ascites, developing on the background of rheumatic conditions.

Stage of ascites

There are three stages of ascites, which are determined by the amount of fluid in the peritoneal cavity:

  1. The first stage is a transient ascites.The volume of liquid does not exceed 400 ml. to Notice the symptoms of ascites alone is almost impossible. Excess fluid can be seen during instrumental examinations (MRI or ultrasound). The work of the abdomen because of accumulation of such quantities of liquid is not broken. If a person notices at some of the pathological symptoms, they are linked with the primary disease causing ascites.

  2. The second stage is the moderate ascites. The volume of fluid simultaneously located in the abdominal cavity, can achieve 4 liters. In this case, the patient already notices themselves alarming symptoms, stomach increases while standing begins to droop. Increasing shortness of breath particularly in lying position. The doctor is able to identify an ascites on the basis of examination of the patient and palpation of his abdomen.

  3. The third stage is ascites tense. Fluid volumes will exceed 10 liters. While in the abdominal cavity greatly increases the pressure that leads to problems with the functioning of internal organs. The human condition is deteriorating and requires immediate medical assistance.

Separately isolated refractory ascites. In this case, the pathology is often not treatable, and liquid, despite ongoing therapy, continued to arrive in the abdominal cavity. The prognosis unfavorable for the patient's life.


Treatments

Treatment of ascites will be effective only if they began to be implemented in a timely manner. To begin with, the physician must assess the stage of disease and find out what was the cause of its development.

Therapy is conducted in the following areas:

Pharmacological treatment of ascites

The main drugs to help rid excess fluid from the body are diuretics. Thanks to it is possible to achieve a transfer of excess fluid from the abdominal cavity into the bloodstream, which helps to reduce the symptoms of ascites. For starters, patients are prescribed the smallest dose of diuretics to minimize the risk of side effects. An important principle of treatment with diuretics is a slow increase in urine output, which will not lead to a significant loss of potassium and other essential metabolites. Often recommend taking the drug Aldactone, Veroshpiron, Triamterene, Amiloride. Parallel to appoint potassium.At the same time in the regimen administered medications.

While doctors carry out daily monitoring of urine output of the patient and the ineffectiveness of treatment, the dose of drugs increase, or replace them with more powerful means, for example, Triampur or Dihlotiazid.

In addition to the diuretics patients are prescribed drugs to strengthen the walls of blood vessels (vitamin C, vitamin e, Diosmin), as well as drugs that prevent the release of fluid outside the vascular bed (Reopoliglyukin).

Improves the metabolism of liver cells introduction protein substrates. Most often for this purpose apply the concentrated plasma or Albumin solution 20% concentration.

Antibacterial drugs are prescribed if the disease that caused the cirrhosis, are caused by bacteria.

Diet

Nutrition should be balanced and high-calorie, to ensure the needs of the body all the necessary minerals. It is important to limit the consumption of salt and pure to enable it in the menu legal.

The volume of fluid intake should also be adjusted downwards. Patients is not recommended during the day to drink more than 1 liter of fluid without regard to soups.

It is important that the daily diet of the patient were enriched protein food, but its quantity should not be excessive. Fat intake should be reduced, especially for patients in whom ascites was triggered pancreatitis.

Surgery

Laparocentesis in the ascites of the abdomen is performed in case if the patient remains resistant to medical treatment. To drain the possibility of setting peritoneovenous shunt with partial deterioritating abdominal wall.

Surgery to reduce pressure in the portal system, are indirect interventions. These include protocoale bypass surgery, the reduction of splenic blood flow, vnutripechenochny portosystemic shunting.

With regard to liver transplantation, it is a very complex operation that can be performed with stable ascites. But, as a rule, to find a donor for an organ transplant is a difficult task.

Laparocentesis the abdominal cavity in ascites

Laparocentesis the abdomen when ascites is surgical manipulation, in which the liquid is removed from the abdomen puncture. At one time should not be more pumped 4 liters exudate, as this development threatens to collapse.

The more often you carry out the puncture in ascites, the higher the risk of developing inflammation of the peritoneum. In addition, it increases the likelihood of formation of adhesions and complications from procedures. Therefore, whenmassive ascites is preferable to the installation of the catheter.

Indications for conducting laparocentesis is tense and refractory ascites. The liquid may be pumped through the catheter, or it just freely flows into the pre-prepared dishes after the installation into the abdominal cavity of the trocar.


Answers to popular questions:

  • How quickly dialed the fluid in ascites? The speed of fluid in the abdomen depends on what disease is the cause of ascites. Slow as this process occurs in cardiac pathologies, and faster all – in malignant tumor and chylous ascites.

  • How I live with ascites of the abdominal cavity in Oncology? The ascites does not directly affect the life expectancy of the patient. However, its development because cancer worsens the prognosis for survival. The life of the patient depends on the effectiveness of the treatment. It is established that the frequent recurrence of ascites that is resistant to therapy, more than 50% of patients die within a year.

  • The ascites to do an enema? Usually an enema in the ascites is performed only in a medical facility as preparations before surgery.

  • Can I eat watermelon in the ascites? Watermelon in the ascites can be included in the menu because its flesh has a diuretic effect and promotes the excretion of excess fluid from the body.