Stressful ascites (ICD-10 code: R18) is a minor condition in which a collection of specific fluid inside the abdomen occurs. Pathology is expressed by the growth of the abdomen in volume, discomfort and pain, shortness of breath, a feeling of heaviness and other signs.
In medicine, this type of disease is called abdominal dropsy, which can accompany a large number of diseases from other areas. Dropsy is not considered an independent disease, but acts as a sign of severe pathology in the body.
Infographics of ascites species indicate that in seventy percent of adults it is formed due to liver diseases. Cancer leads to the formation of ascites in 10% of situations, another 5% is due to heart disease and other diseases. At the same time, ascites in a child indicates kidney disease.
It is proved that the greatest amount of water accumulating in the abdominal cavity with intense ascites (ICD-10 code: R18) in a patient can reach 25 liters.
Causes
Ascites factors are diverse and always combined with some significant pathology. The abdominal cavity is considered a closed place in which unnecessary fluid should not occur.
The peritoneum has two layers. Normally, between these sheets there is always a small amount of water, which is the result of the activity of the blood and lymph vessels in the peritoneal cavity. However, this fluid does not accumulate, since almost immediately after separation it is absorbed by the lymphoid capillaries. The remaining small fraction is needed so that the loops of the intestinal tract and internal organs can easily move inside the body and not come into contact with each other.
When a violation of the barrier, excretory and resorptive functions occurs, the exudate ceases to be normally absorbed and accumulates in the abdomen, as a result of which intense ascites is formed.
Disorders in the liver
In the first place it is worth putting a disease called cirrhosis, as well as an organ tumor and Budd-Chiari syndrome. Cirrhosis is able to progress against hepatitis, steatosis, the use of toxic pharmaceuticals, drunkenness and other conditions, but is constantly accompanied by the death of hepatocytes. As a result, good liver cells are replaced by scar tissue, the organ grows in volume, compresses the portal vein, and for this reason, intense ascites is formed. In addition, a decrease in oncotic pressure contributes to the release of waste water, due to the fact that the liver itself is no longer able to produce plasma proteins and albumin. Enhances the pathological process with intense ascites with cirrhosis of the liver a number of reflex interactions launched by the body in response to liver failure.
Heart diseases
Stressful ascites can progress due to heart failure, or due to constrictive pericarditis. It can be the result of almost all cardiac diseases. The mechanism of ascites formation in this case will be associated with the fact that a hypertrophied heart muscle is not able to pump the required amount of blood, which begins to accumulate in the blood vessels, including in the system of the inferior vena cava. Due to high pressure, the fluid will begin to exit the vascular bed, creating ascites. The system of ascites formation in pericarditis is approximately the same, however, in this case, the outer layer of the heart becomes inflamed, which makes it impossible to fill it with blood normally. Subsequently, this affects the functioning of the venous system.
Kidney disease
Dropsy is caused by chronic renal failure, which appears due to various diseases (pyelonephritis, glomerulonephritis, urolithiasis, etc.). Kidney diseases lead to an increase in blood pressure, sodium, together with the fluid, is retained in the body, and ascites is created as a result. A reduction in plasma oncotic pressure, which leads to ascites, can also occur against the background of nephrotic syndrome.
Other factors
Ascites is able to progress with a defect in the lymphatic vessels. This is due to trauma, due to the presence of a tumor in the body that provides metastases, due to infection with filarias (worms that lay eggs in large lymphatic vessels).
Various lesions of the peritoneum often cause ascites. Among them - diffuse, tuberculous and fungal peritonitis, peritoneal carcinosis, a tumor of the large intestine, stomach, breast, ovaries, endometrium. Pseudomyxoma and peritoneal mesothelioma also belong here.
Polyserositis is considered a disease in which dropsy appears in combination with other signs, including pleurisy and pericarditis.
Systemic diseases are ready to lead to the accumulation of water in the peritoneum. This is rheumatism, rheumatoid arthritis, lupus erythematosus and more.
Ascites in newly born babies is also found and is most often considered the result of a hemolytic disease of the fetus. It, in turn, is formed during intrauterine immunological conflict, if the blood of the fetus and mother are not combined in the order of antigens.
Digestive apparatus diseases can cause an excessive concentration of water in the abdominal cavity. It can be pancreatitis, prolonged diarrhea, Crohn's disease. It is also possible to classify here all processes that occur in the peritoneum and interfere with lymphatic withdrawal.
Localis status of intense ascites (symptoms)
The initial sign of ascites is considered to be rapid growth of the abdomen, and more specifically, its bloating. The main factor is that a very large amount of water then accumulates, which almost does not come out. A person reveals in himself ascites, as a rule, when he is not able to fit into ordinary clothes, which not so long ago suited him in volume.
If ascites appeared, then in the body, of course, there are at least two significant multifunctional pathologies that need to be cured. Most of all, this is the pathological work of the intestinal tract, upset stomach or liver abnormalities.
The rate of growth of signs is directly related to what actually became an ascites factor. The procedure can progress rapidly, and may take a couple of months.
Local status of intense ascites:
- Severity in the abdominal cavity.
- Discomfort and pain in the abdomen and pelvis.
- Bloating, signs of flatulence.
- Burning in the esophagus.
- Difficulties with going to the toilet and eating.
- Bouts of nausea.
- The increase in abdomen in size. If the patient is in a horizontal state, then the stomach bulges along the edges and resembles the appearance of a frog’s belly. If a person is in an upright position, the stomach hangs.
- Bulging navel.
- Symptom of swinging tummy or fluctuation. Constantly appears when filled with liquid.
- The more water accumulates in the abdominal cavity, the more shortness of breath will melt, swelling of the lower extremities is aggravated, movements become slower. It is especially difficult for the patient to lean forward.
- Due to an increase in intra-abdominal pressure, a bulge of a femoral or umbilical hernia is likely. Against the same background, hemorrhoids and varicocele are able to form. Rectal prolapse is not ruled out.
Symptoms depending on the factor
Highlight ascites ascites localis status and such:
Tuberculous peritonitis. In this case, dropsy is considered the result of a tuberculosis lesion of the reproductive system or intestinal tract. The sick person begins to rapidly lose weight, his body temperature rises, signs of intoxication increase. Lymph nodes grow that pass along the mesentery of the intestinal tract. In the sediment taken by exudate puncture, in addition to lymphocytes and erythrocytes, mycobacterium tuberculosis will be isolated.
Peritoneal carcinosis. If dropsy develops due to the presence of a tumor in the peritoneum, then the signs of the disease will primarily be there, which organ it struck. Nevertheless, constantly with ascites of oncological etiology, an increase in lymph nodes occurs, which can be probed through the wall. Atypical cells will be in the sediment of the effusion.
Heart failure. The patient has a blue-violet color of the dermatological integument. The lower limbs, especially the feet and lower legs, will become very swollen. At the same time, the liver increases in volume, pains appear that are localized in the right hypochondrium.
Portal vein. The patient will complain of intense pain, the liver increases in volume, but not much. There is a great risk of powerful bleeding. In addition to liver enlargement, a fascination with the volume of the spleen can be traced.
Diagnosis of ascites
Diagnosis of intense ascites (in ICD-10: R18) begins with the exclusion of other causes of increased abdominal volume. For example, cysts, pregnancy, tumors, obesity. As part of the verification, the following actions are used:
- Palpation, visual inspection, percussion.
- Ultrasound examination.
- Ultrasound of vessels.
- Scintigraphy.
- Laparoscopic examination of the abdominal cavity.
- Analysis of ascitic fluid.
During percussion, a muffled sound is characteristic, during palpation of the lateral part, fluctuation symptoms are recognized. Radiography makes it possible to diagnose ascites if more than 0.5 l of free fluid accumulates in the abdominal cavity. As for ultrasound, in the process of this examination, attention is paid to the tissues of the liver and spleen, their condition is examined, the peritoneum is checked for tumors and mechanical damage.
Laboratory research
An important stage of manipulation after complaints with intense ascites is a collection of tests:
- Coagulogram.
- Biochemistry of the liver.
- Checking the level of antibodies.
- General urine analysis.
If ascites is first detected in a patient, the doctor prescribes laparocentesis to study the fluid itself. In laboratory conditions, the composition, density, level of protein content is checked, bacteriological culture is done.
Drug treatment
Drug treatment of ascites is performed both with diuretics and potassium preparations, albumin solution, asparkam. This is done for a reason, and for plasma pressure, thereby increasing the volume of blood. If the patient has a severe form of ascites, together with medication, he is sent to the laparocentesis procedure using ultrasound navigation. Piercing with a trocar removes fluid from the abdominal cavity. Sometimes doctors put drainage for prolonged excretion or transudate excretion.
For excretion of ascitic fluid, it is necessary:
- reduce the intake of sodium in the body;
- Withdraw urine as soon as possible.
To reduce the amount of sodium in the body, it is required to limit its intake with food. To do this, eat up to 3 grams of salt per day. After all, it is proved that the absence of salt has a very bad effect on the protein metabolism of the body. Now many have started taking drugs such as Captopril, Fosinopril, Enalapril for the treatment of ascites. They are known to accelerate the removal of sodium from the body and increase the amount of urine per day. And also contribute to the retention of potassium in the body. Do not forget that diuretics not only reduce the amount of ascites, but also remove fluid from different tissues.
Surgery
Laparocentesis is a surgical treatment for ascites. To extract excess fluid, a puncture is made and a special instrument, a trocar, is installed. On an empty stomach and with an empty bladder, the patient is planted or laid on his side, local anesthesia is prescribed. To the side of the midline 1-2 cm between the navel and the pubis is the puncture site. Be sure to follow the rules of antiseptics. A puncture is made on the skin with a pointed scalpel, then a trocar is inserted. To avoid a sharp drop in blood pressure, the fluid is removed gradually, with interruptions of 1-2 minutes.
To extract the liquid, the body is wrapped with a towel and squeeze the patient’s stomach evenly. The fluid is either removed at a time or a permanent catheter is inserted. This is decided by the doctor. It is not recommended to extract more than 5-6 liters of liquid at a time, as complications may occur, for example, cardiac arrest. After removing the trocar, sutures are applied. When a catheter is installed, there is a chance of developing an ascitic fistula. A fistula is formed at the puncture sites or between the sutures. If the leakage of ascitic fluid lasts more than a day, it is necessary to close the hole with interrupted sutures
Alternative treatment
Ascites is, as you know, dropsy of the abdominal cavity, which primarily affects people suffering from cardiovascular diseases, renal failure and prone to the development of oncology. Treatment and prevention of ascites occupy a rather important place in medical practice, therefore, in the most difficult clinical cases, doctors also recommend additional use of alternative medicine for a comprehensive impact on the problem.
What means of fighting ascites involves the practice of healthy lifestyle:
- The use of birch leaves and buds for the preparation of medicinal potions:
- "Dry" birch baths. Birch leaves are collected and placed in a bath, a large barrel, a basin. Cover with plastic wrap and let it brew in a bright place for several hours. As soon as the leaves are locked, they are opened and dried a little. The patient is placed in such a bath completely and allowed to lie down for 30-40 minutes. The normal state after dry birch baths is characterized by slight tingling of the skin.
- Baths with a decoction of birch. 50 grams of dry or fresh birch leaves are poured into the bath and poured with 10 buckets of warm boiled water. After which the patient with ascites is placed in a decoction for 30-40 minutes. If a slight numbness of the limbs is felt at the exit from the bath and bright pink stripes and spots are visible on the body - the effect of the effect of the decoction is considered positive.
- Wraps with birch decoction. A decoction for wraps is prepared in the same way as for taking baths. The patient is wrapped in a sheet soaked in a medicinal drug from armpits to knees. Then lay on the bed and cover with several layers of woolen blankets. Let lie in this state for 45-50 minutes. Then washed with warm boiled water.
- Diuretic herbal infusions:
- A diuretic that is rich in vitamins. Dried rosehip berries, raspberry, lingonberry and blackcurrant leaves will be required in similar proportions. A quarter of a glass of these herbs pour a glass of very hot water. Boil for half an hour, then cool and take twice a day.
- Drinking liquid from bean pods. Take the husk from 20 bean pods and steam it for 10-15 minutes in boiling water. Open the container, mix the substrate and let it brew for another 30 minutes. Divide by four times and drink half an hour before eating.
What is an ascites diet?
Such a diet has its own rules that must be observed very clearly, and if this is not done, then the disease will quickly move to the next stage. One of the important rules is the use of small portions of food every three hours, moreover, the dishes must be necessarily warm. In no case should you overeat or increase the time interval between meals, as this will lead to the formation of severe edema in the abdominal cavity.
All components for dishes with ascites should be subjected to minimal heat treatment, and it is advisable to cook all the food for a couple, bake without using oil or stew. The diet of people who suffer from dropsy should consist of useful and diverse products, and emphasis should also be placed on spicy plants with a mild diuretic effect. If dropsy appeared against the background of cirrhosis, then it is imperative to include products rich in easily digestible proteins in the menu.
Allowed Dropsy Foods
The diet of people who suffer from ascites should definitely include marine fish of low-fat varieties, which should be cooked without salt in the oven or steamed. The menu should definitely include light liquid dishes that should be cooked with ingredients such as fennel, parsley or ginger. As for meat, preference should be given to turkey, rabbit or chicken without skin, and it is advisable to cook steamed dishes of these types of meat. It is desirable to prepare drinks from components with a mild diuretic effect, for example, from a currant leaf or fig.