According to the ICD 10 classification, ascites of the abdominal cavity is encoded as R18. Under these symbols lies a pathological secondary state of accumulation in the peritoneum of fluid secretions - exudate, transudate. The condition is accompanied by an increase in the size of the abdomen. A person suffers pain, breathing is disturbed, a feeling of heaviness arises. Other unpleasant conditions caused by fluid accumulation are possible. Doctors sometimes call the pathology of abdominal dropsy.
general information
From medical studies it is known that various pathological conditions can become the causes of ascites of the abdominal cavity in women and men. Sometimes the accumulation of fluid is explained by gynecological disorders, gastroenterological malfunctions. A possible cause is a disease of the urinary and reproductive systems, heart and related parts of the body. Sometimes ascites is due to impaired functioning of the lymphatic system. Cancer can provoke it. The condition does not belong to the number of independent ones and is only a symptom of a certain disease, impaired functionality of structures and organs.
The accumulation of fluid in the abdominal cavity (ascites) is observed only in severe pathological conditions. A mild illness cannot cause such a disorder. The occurrence of ascites indicates a threat to the patient's life. Lack of adequate treatment is associated with a risk of death.
Relevance of the issue
As specialized studies have shown, the most common cause of ascites in the abdominal cavity is liver disease. On average, such primary sources account for up to 70% of all identified abdominal dropsy. This is especially true for adult patients. Approximately one in ten patients suffers from ascites due to cancer, and the condition is detected two times less often against the background of cardiac dysfunction. Among patients of the minor age group, abdominal dropsy is more common in people suffering from kidney diseases.
A study of registered cases showed that in the abdominal cavity with dropsy, up to 25 liters of liquid secretions can accumulate.
What provokes?
Of course, many are interested in what are the principles of treatment, the causes of ascites in the abdominal cavity, what is the danger of the condition and what can be the prognosis for the patient. Doctors assure: there are a lot of reasons for the pathological condition, and it’s very difficult to list everything that can cause dropsy. In any case, ascites indicates a serious pathology. The cavity is an enclosed space. The human body is designed in such a way that excess fluid does not accumulate in this part - vital organs are located here and there is no place for any secretions. Normally, the peritoneum is the area of localization of the liver, gastrointestinal tract, spleen and some other organs.
Two layers of tissue are distinguished in the peritoneum. Outside there is a shell attached to the wall of the abdomen, and the inner one is adjacent to the organs. The sheets are separated from each other by a small volume of fluid, which is formed due to the functioning of the circulatory, lymphatic system. However, in this case, ascites of the abdominal cavity is not observed in women, men, and children - there is no accumulation, all that is secreted will soon be absorbed through the capillary network. Small volumes of matter located between the sheets provide mobility of the intestinal loops and other organs located inside the peritoneum. Excess discharge is observed if absorption is disrupted or the substance is generated in too large a volume; the barrier function of any zone is violated.
Start of pathology
A possible cause of abdominal ascites is hepatic cirrhosis. Among others, it is she who is most often found. The condition can also be caused by other organ pathologies, including the proliferation area of atypical cells, and Budd-Chiari disease. Often cirrhosis is accompanied by steatosis, hepatitis. The problem is possible against the background of liver toxic drugs. Often, pathology accompanies an addiction to alcohol. Common to all conditions is the development mechanism, starting with the death of the cellular structures of the organ. Instead, scar tissue forms. This leads to hypertrophy of the liver, disruption of the portal vein. The result is ascites.
Against the background of pathological conditions, a drop in oncotic pressure is possible. This creates the conditions in which fluid easily enters the abdominal cavity in excess. Hepatic cells cannot generate albumin, plasma proteins, and this worsens the condition of the patient. Such a cause of ascites in the abdominal cavity is aggravated by reflexes initiated in the body as an attempt to eliminate liver failure.
Heart ache
A possible cause of ascites in the abdominal cavity is cardiopulmonary problems. Insufficiency of the heart, an inflammatory process in the pericardium can provoke the phenomenon. Failure develops against the background of most serious cardiac pathologies. Ascites is formed due to the growth of the heart muscle. The organ cannot pump blood in the volumes necessary for the normal functioning of the body. Fluid builds up in the vascular system, and is especially noticeable in the vena cava. Elevated pressure leads to seepage from the bloodstream through the vascular walls.
Pericarditis initiates similar processes, but a feature of the condition will be the focus of inflammation in the outer heart membrane. In this case, the site does not let blood through in normal mode. The work of the veins is disrupted, the result is the accumulation of fluid in the peritoneum.
Renal impairment
Diseases affecting the kidneys can cause abdominal ascites. As a rule, this is due to chronic organ failure — a complication of most serious diseases. Ascites can develop in a person with pyelo-, glomerulonephritis, stones in the bladder. The pathological condition is accompanied by an increase in pressure in the circulatory system and the accumulation of sodium, as well as fluid. Plasma oncotic pressure drops, a pathological condition is initiated, often accompanied by nephrotic syndrome.
Causes and consequences
Doctors, studying the types, symptoms, causes of ascites in the abdominal cavity, found that the phenomenon may be due to malfunction and violation of the integrity of the elements of the lymphatic system. Usually the root cause is an injury or tumor process. Ascites is possible against the background of metastasis in the presence of cancer, as well as with filar invasion. The term refers to a special kind of helminths that can secrete eggs in large vessels with lymph.
For one type of ascites of the abdominal cavity, the cause is damage to the abdominal region. Sometimes this is observed against the background of peritonitis of various forms: due to infection with fungi, mycobacteria, as well as with spilled form. Possible abdominal dropsy with malignant processes in the large intestine, stomach, reproductive system. Peritoneal carcinosis can cause the phenomenon. Sometimes dropsy is formed in patients with mesothelioma, pseudomyxoma.
Diagnoses and consequences
Certain abdominal ascites can develop due to polyserositis. The term refers to a pathological condition in which at the same time a person is sick with pericarditis, inflammation of the pleural pulmonary membranes and dropsy, localized in the abdominal cavity. The accumulation of liquid secretions is possible with a variety of systemic pathologies. For example, considerable risks are associated with lupus erythematosus. Sometimes ascites provokes arthritis, rheumatism.
There are known cases of development for various reasons of the symptoms of the type of ascites of the abdominal cavity, characteristic of infants. In most cases, the pathological condition is explained by a hemolytic disease that develops in the fetus even during gestation. This is usually due to an immunological conflict: maternal, children's blood differ in antigens. Ascites can provoke protein deficiency. Sometimes the reason is pathology, covering the digestive tract. Abdominal dropsy can occur with Crohn’s disease, chronic diarrhea, and inflammation of the pancreas. Certain risks are associated with pathological processes in organs localized in the peritoneum, if they impede the flow of lymph.
Aspects and Diseases
Myxedema is a possible cause of abdominal ascites in humans. The pathological condition causes swelling of the soft tissues, mucous membranes. The disease is clearly manifested if the processes of generating thyroxine, triiodothyronine, normally produced by the pancreas, are confused in the body.
Another reason for the occurrence of ascites in the abdominal cavity in people is poor, unbalanced nutrition. True, only very serious violations of the diet can lead to such negative consequences - a complete rejection of food or an extreme form of food restriction. The body loses its protein reserves, the content of protein structures in the circulatory system decreases. The result is a drop in oncotic pressure, and liquid fractions of blood seep through the vascular walls.
In children, ascites is possible with certain types of enteropathy. The risks associated with nephrotic syndrome, which the baby is sick from birth, as well as malnutrition.
How to notice?
Knowing the main manifestations of the pathological condition, it is possible to suspect abdominal ascites as a result of symptoms. Photos in specialized sources can help little - visually, many patients look quite intimidating, while the appearance of others does not hint at a life-threatening condition. In general, it is believed that the first manifestation indicating ascites is bloating associated with fluid accumulation. The phenomenon is stronger as the large volumes leak into the cavity and remain in it. Usually a symptom attracts attention at the moment when a person notes that the usual clothes became small in the belt.
The formation of abdominal dropsy indicates a serious imbalance, impaired functionality of the internal organs. Often there is ascites of the abdominal cavity in oncology. Regardless of what caused the symptoms, bloating due to accumulation inside the fluid indicates the need for urgent treatment. The rate of progression is determined by the cause and what kind of help the patient receives. For some, progress stretches for months, for others, the deterioration is almost instantaneous - it takes only a few hours.
State Clinic
Abdominal ascites in oncology, gastric diseases, cardiac pathologies and other health disorders is indicated by the feeling that the peritoneum is bursting. This area responds to soreness extending to the pelvis. Simultaneously with bloating, there is an increased gas formation in the intestinal tract. A person is bothered by belching, heartburn, nausea. The stomach feels heavy, the digestive process brings discomfort, urination is complicated.
It is quite easy to notice ascites if you look from the side at a patient lying strictly horizontally. The peritoneum region is bursting to the sides, the stomach is bulging. To some extent, this is similar to the appearance of a frog lying on its back. If the patient gets up, the stomach will sag. The navel sticks out, fluctuation is observed, intensifying as the cavity is filled with secretions. The more fluid in the peritoneum, the more significant breathing problems, swelling of the legs. A man slowly and listlessly, awkwardly moves, bends with difficulty. Some have a bulging hernia. There is a risk of hemorrhoids, varicocele. Ascites can cause intestinal prolapse.
Provoking factors and nuances of manifestations
If dropsy developed against the background of peritonitis due to infection with mycobacteria, the patient loses weight, a temperature check shows fever, and manifestations of general poisoning of the body increase. At the same time, lymph nodes become larger, especially in the intestinal mesentery. If you take exudate for the study, you can see red blood cells, lymphocytes, mycobacteria in the fluid.
Abdominal carcinosis, causing ascites, provokes various symptoms from case to case: it depends on which organ the tumor is located in. The increase in lymph nodes remains common - the areas become large enough to be felt through the front wall of the peritoneum. The exudate contains atypical cell structures.
Insufficient functioning of the heart is accompanied by blue skin, swelling of the legs, especially strong in the feet. Instrumental examinations will show an increase in the liver, and the patient will probably feel pain under the ribs on the right side. Exudate can accumulate not only in the abdominal region, but also in the lungs.
Step by step
With ascites of the abdominal cavity, the prognosis of life largely depends on at what stage of the development of the pathological condition it was possible to make a diagnosis, how successfully the patient's treatment was chosen. It is customary to distinguish three consecutive stages, and the first is transistor. At this stage of development, no more than 0.4 l of fluid accumulates in the abdominal zone. Ascites practically does not manifest itself as a symptomatology and it is possible to identify it if an MRI and ultrasound scan are completed in time. Since the fluid has accumulated in rather small volumes, the functionality of the peritoneal organs remains normal. If the patient notices health problems, then, due to their blurryness and weak expression, he does not attach special importance to the manifestations.
The moderate form is the second stage of the pathology, accompanied by the accumulation of secretions in a volume of up to four liters inclusive. The patient notices symptoms, it is visually visible how the abdomen enlarged, hangs. The ability to breathe worsens, shortness of breath is especially strong when a person lies. For diagnosis, it is enough to examine the patient and feel the abdominal zone.
Progress
Various factors can cause a pathological condition - pathologies of the heart, blood flow, tumors, cirrhosis. The prognosis for ascites in the abdominal cavity depends on both the cause and the level of progress, and the worst possibilities are inherent in patients who have an intense form. In this case, the abdominal cavity becomes the area of localization of fluid accumulations up to 10 liters. This is accompanied by increased pressure and impaired performance of organic structures. The patient needs urgent qualified help.
Another developmental step is refractory. In this case, the removal of ascites of the abdominal cavity is almost impossible. Even if treatment is prescribed, fluid will constantly arrive. With the formation of pathology in this form, with the development in this scenario, the prognosis is the most unfavorable of the possible.
How to help the patient?
The therapeutic course gives good results if you start it at an early stage of the pathological condition. Before choosing a therapy, you need to examine the patient, identify the features of the pathology, its causes. Then the doctor selects a medical course. Mostly resort to diuretics. Often prescribed for ascites of the abdominal cavity furosemide - this substance is contained in a wide variety of pharmacy products with a diuretic effect. Excess fluid moves into the circulatory system, the symptoms are weakened.
Initially, the drugs are prescribed in the lowest dosage in order to reduce the risk of side effects. The main principle of therapy is a slow increase in the strength of the program in order to avoid leaching of potassium and other important trace elements. Among the popular items it is worth noting Veroshpiron and Amilorid. Aldacton and Triamteren have a good reputation. In order to minimize the risk of potassium deficiency, it is recommended to simultaneously take preparations and additives containing this microelement. Patients are shown a course of means to protect the liver from the negative effects of drugs.
The nuances of treatment
So that treatment does not become a source of even greater malfunctions in the body, it is shown to regularly check the performance of the main internal systems. Doctors monitor diuresis. If the course does not show the desired effect, or increase the dosage, or change the selected medications to more powerful ones. Means of choice are usually Dichlothiazide, Triampur.
Diuretics are usually combined with drugs that strengthen the vascular wall. , «». , . «». , , , . , .
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A complex approach
In order for the symptoms to weaken faster, the patient soon recovered, the nutritional scheme should be changed. High-calorie food is shown, a balanced diet that provides the body with the necessary trace elements. Pure salt is excluded from the menu, and in dishes they are used in minimal amounts. Correct the amount of fluid used per day: no more than a liter. Additionally soups are allowed.
Protein-rich food in reasonable amounts is indicated. Reduce dietary intake of fats. This is especially important in case of ascites due to pancreatitis.
Need an operation
Laparocentesis is one of the treatment options for ascites. Such an event is indicated if the drug course does not give the desired result. To ensure the removal of fluid, a shunt can be mounted. Surgery that can lower portal pressure is an indirect way to get rid of ascites. This category includes protocaval, portosystemic shunting, reduction of the circulatory system that nourishes the spleen. Occasionally, liver transplantation is indicated. The operation is extremely complicated, it is prescribed only with a persistent form of ascites. One of the main problems in its implementation is the successful search for a donor.
Laparocentesis involves puncture removal of fluid accumulated in the abdominal region. One procedure allows the removal of up to 4 liters of substance. If you pump out more at a time, the risk of collapse increases. The more often punctures are taken, the greater the risk of inflammatory complications, the appearance of adhesions, and other negative consequences. With a massive form of abdominal dropsy, a catheter can be inserted. It is recommended to do laparocentesis in case of intense form of ascites and a pathological condition developing according to the refractory scenario.
Pathology Features
Studies have shown that ascites develops most slowly if dropsy is caused by heart disease. The most aggressive variant of the course of the process is characteristic of malignant diseases, a chylous form. Doctors pay attention: ascites does not change a person’s life expectancy, but prognosis of survival in the underlying disease is significantly worsened. Life expectancy is largely determined by the success of the therapeutic course. On average, with cancer, a person suffering from ascites, resistant to treatment, and often forced to deal with relapses of a pathological condition, lives a year. The probability of a twice as long period is estimated at 50%.
Possible consequences of abdominal ascites include bleeding in the upper digestive system. There is a risk of swelling of the brain tissue and other violations of the functionality and integrity of the organ. Sometimes the lungs and liver swell, the work of the heart and blood vessels goes astray. Against the background of ascites, a hernia may appear. Surgical intervention can cause a fistula in the area of the seam, a puncture. There is a danger of infection, as a result of peritonitis of a bacterial nature. Complications are highly likely to cause death.