The origin of such a pathological condition as ascites may be due to a number of reasons. Dropsy, as it is called by the people, can provoke cirrhosis of the liver, chronic heart failure, accompanied by congestion in the pulmonary circulation, hepatic vein thrombosis, nephrotic syndrome, intestinal diseases and other disorders. Patients with oncological pathologies of the abdominal organs or cirrhosis of the liver have to think about how ascites is treated.
Specificity of the disease
In some cases, ascites is associated with profuse swelling. If the ailment proceeds against the background of an acute inflammatory process, the development of ascites-peritonitis, an extremely dangerous, life-threatening condition, is not ruled out. It can be recognized by the analysis of intra-abdominal fluid. If protein compounds are significantly higher than normal, and the precipitate consists of a huge number of white blood cells and red blood cells, the disease is confirmed.
The most characteristic symptom of ascites (how to treat an ailment, we will discuss later) is an increase in the abdomen. Unlike usual bloating in flatulence in the intestines, the presence of cystic formations of the ovaries or uterus, in which the abdomen can also become larger, dropsy is characterized by a dull percussion sound. If the patient takes a standing position, the fluid will concentrate in the lower abdomen, if it lies horizontally - blunt percussion will be heard on the sides.
Briefly about diagnostics
Complaints of the patient, the study of the anamnesis and examination data are often quite enough in order not to make a mistake in the diagnosis. Instrumental and laboratory procedures are more designed to determine the causes of ascites.
Before treating ascites of the abdominal cavity, as a rule, the following types of diagnostics are performed:
- Ultrasound of the peritoneal organs - during the ultrasound examination, it is possible to identify foci of liver damage, neoplasm and other disorders.
- Laparoscopy - this procedure involves the introduction of a special device through a small puncture in the front wall of the abdomen in order to collect material for laboratory analysis.
- CT and MRI of the abdominal organs - allows you to detect a tumor, its exact location, size.
- Hepatoscintigraphy - a liver test is performed in patients with cirrhosis.
Disease therapy
How to treat abdominal ascites? The treatment of this pathology should be started immediately. To begin with, it is fundamentally important to determine the stage of the disease and evaluate the general condition of the patient. If ascites becomes the cause of the development of respiratory or heart failure, urgent measures must be taken to remove excess fluid in the abdomen and reduce pressure in the cavity.
When is an operation needed?
Speaking about how ascites is treated, the likelihood of surgical intervention cannot be ruled out. The most radical method of treatment is resorted to if it is impossible to eliminate the factor provoking the disease in another way. The help of a surgeon may be required with ascites, which developed against the background of:
- liver cancer;
- heart defects;
- oncological diseases of the abdominal cavity;
- bacterial peritonitis.
Surgical treatment of ascites is contraindicated in decompensated heart and respiratory failure, but if intervention in the abdominal cavity is unavoidable, the patient is first prescribed a course of diuretics and treatment is performed to remove at least a partial volume of fluid. Otherwise, the patient may not survive anesthesia. Serious complications can occur when treating a patient with intense dropsy due to the sudden removal of a significant amount of fluid.
After surgery, many patients undergo ascitic fluid return procedure. The essence of the method is to reintroduce the lost proteins and other trace elements contained in the liquid into the patient's body.
Diuretic drugs
It turns out that ascites can be treated at home. At an early stage of the pathology, the doctor prescribes outpatient therapy, the purpose of which is to remove excess fluid from the body. To reduce the volume of the abdomen taking diuretics is of great importance:
- "Furosemide." This tool helps to rid the body of excess sodium. With ascites, this drug is administered intravenously.
- Mannitol. It is an osmotic diuretic that increases blood plasma pressure, helping fluid from the intercellular space to pass into the vascular bed. It is taken by intravenous infusion.
- "Spironolactone." A diuretic that prevents excessive loss of potassium. Available in tablet form.
When prescribing diuretics to the patient, the doctor should not forget that the optimal rate of fluid removal from the abdominal cavity should not exceed 400 ml in 24 hours. If the specified norm is exceeded, the patient may develop dehydration.
Other medicines used for ascites
In addition to diuretic drugs, other medications can be used during the treatment of this disease:
- agents used to strengthen the vascular wall (Diosmin, vitamin and mineral complexes containing vitamins C and P);
- drugs that retain fluid in the vascular bed (Polyglukin, Gelatin, Reopoliglukin);
- drugs containing albumin - a protein that guarantees a normal level of oncotic blood pressure and prevents the passage of fluid into the intercellular space);
- antibacterial drugs - are used for ascites-peritonitis of a bacterial or tuberculosis type.
Depending on the primary disease, which provoked dropsy of the abdominal cavity, ascites is treated differently. As a rule, the list of medications expands significantly with cirrhosis, liver cancer, heart or kidney failure.
Cirrhosis of the liver
The first step in the fight against dropsy should be measures to delay the pathological process and at least partially restore healthy liver tissue. Unfortunately, in most cases the prognosis is poor, and the therapy itself is palliative. The question of how to treat ascites in cirrhosis of the liver, it would be more correct to sound different: what drugs are prescribed for the treatment of cirrhosis and alleviation of the patient's condition?
- Hepatoprotectors based on ursodeoxycholic acid. Such drugs improve metabolism in liver cells, protecting them from exposure to toxins.
- Phospholipids. Designed to restore damaged cells and increase their resistance to toxic effects ("Phosphogliv", "Essential").
- Flavonoids are necessary to neutralize the free radicals of oxygen and destructive substances that occur during the development of cirrhosis ("Hepabene", "Carsil").
- Amino acids for the liver - used for accelerated growth and tissue renewal (Heptral, Hepasol A).
Liver transplant
If viral hepatitis was the cause of cirrhosis, appropriate antiviral drugs are prescribed (for example, Pegasis, Ribavirin). Before treating ascites in cirrhosis, the doctor should weigh the pros and cons of the appropriateness of conservative therapy. In a number of clinical cases, the only treatment that can save a person’s life and solve the problem of intraperitoneal dropsy is a transplant of the gland. How to treat ascites in cirrhosis, only a qualified hepatologist can say for sure in each case.
Ascites and cancer
To treat ascites in oncology, no matter how strange it sounds, is completely useless. When the peritoneum is damaged by cancer cells, it is important to remove malignant neoplasms. If it is possible to overcome oncology, dropsy will go away by itself. An indispensable method of treating malignant diseases of the liver and peritoneum is chemotherapy (drugs “Cisplatin”, “Azathioprine”, “Methotrexate” are used).
In combination with chemotherapy, the patient can be prescribed a course of radiation, due to which it is possible to achieve the death of cancer cells and reduce the size of the tumor. The prognosis and quality of life can be improved after successful surgical removal of the malignant formation.
Dropsy treatment for heart failure
How to treat ascites in this case? If dropsy is a consequence of the development of this disease, therapy should be based on the principles of lowering blood pressure, preventing stagnant processes and achieving maximum myocardial functionality. With heart failure, you need to start treating abdominal ascites as soon as possible, since the patient is at risk of death. Therapy in this case involves the use of:
- diuretics, in order to reduce the volume of circulating blood;
- antihypertensive drugs to minimize the load on the heart muscle;
- cardiac glycosides, which increase the strength of myocardial contractions.
In the treatment of ascites in heart failure, the maintenance of a salt-free diet, a limited drinking regimen and the correct daily regimen is of great importance. If the patient's condition allows, one should not forget about moderate physical activity.
Impaired renal function as a cause of dropsy
How to treat abdominal ascites if it is provoked by renal failure? The reason for the development of dropsy in this case is the retention of fluid and metabolic by-products due to renal dysfunction. In the initial stages of the disease, medications can have a positive effect, but as the pathology progresses, the drugs become ineffective.
One of the effective methods for treating renal failure accompanied by ascites is hemodialysis. As well as other methods of blood purification (peritoneal dialysis, plasmapheresis) prolongs the life of patients with chronic renal dysfunction. An even more radical method of treatment is the replacement of a diseased kidney that does not cope with its donor function.
Folk therapy
Alternative methods are widely used in the treatment of ascites. Most folk remedies (how to treat ascites with their help and what contraindications such drugs have, the attending physician will explain in detail) are suitable for dropsy, provoked by various diseases. Most of the medicinal herbs and plants used to treat ascites have a diuretic effect. Effective folk remedies are:
- Infusion of parsley. To cook it, take 40 grams of fresh herbs and roots, pour boiling water and leave overnight. Ready infusion is drunk every day for 1 tbsp. l
- Infusion of bean pods. Prepared in a similar way: 1 liter of boiling water requires 2 tbsp. l chopped bean pods.
- Decoction of leaves of coltsfoot. For one glass of boiling water use 1 tbsp. l dry grass, then the mixture is sent to the stove and boiled for 10-15 minutes. After the therapeutic drug has cooled, it is filtered and taken several times a day before meals.
- Apricot compote. This is a simple and healthy potassium-sparing drink, but with severe ascites you can consume no more than 300 ml of compote per day.
Where is ascites treated in our country?
Given that ascites, as a rule, develops in patients with cirrhosis and cancerous tumors, you need to look for an institution of the appropriate profile. To date, several research institutes in Moscow and other cities of Russia are engaged in the diagnosis and treatment of liver diseases. The most famous medical centers:
- "Research Institute of Epidemiology and Microbiology named after G. N. Gabrichevsky Ministry of Health and Social Development of the Russian Federation
- "The Central Research Institute of Gastroenterology of the DZ of Moscow".
- "Clinical City Hospital No. 20" on the street. Lenskaya.
- "Clinic of Oncoimmunology and Cytokine Therapy."
Foreign clinics
According to patients, for the treatment of ascites and diseases that are its causes, should go to Germany and Israel. Among the German institutions, it is worth noting the "University Clinic" in Dusseldorf, whose specialists offer patients the latest techniques and technologies, including cyberknives, the use of advanced ion radiation. Similar techniques are not used in the territory of post-Soviet states. In Israel, there are two institutions that are considered the largest and most popular in the country - this is the medical center. Chaim Sheba in Tel Hashomer and the Hadassah Clinic in Jerusalem.