In the article, we consider the signs of ascites.
Abdominal dropsy, or ascites, is often the result of a more difficult to treat and dangerous disease. However, this ailment in itself can complicate the life of the patient and lead to negative consequences.
What is this pathology?
In medicine, ascites refers to a secondary pathological condition, which is characterized by accumulation of fluid in the abdominal cavity. Abdominal dropsy is most often caused by defects in the regulation of fluid metabolism in the body as a result of dangerous pathological conditions.
The signs and symptoms of ascites should be known to everyone.
Why does the disease arise?
The main causes of ascites in the peritoneal cavity, according to statistics, are: liver diseases (70%); oncological diseases (10%); heart failure (5%). In addition, dropsy can be accompanied by such pathologies: kidney disease; gynecological diseases; defeat of the peritoneum with tuberculosis; endocrine abnormalities; rheumatoid arthritis; rheumatism; the second type of diabetes; lupus erythematosus; uremia; digestive diseases; non-infectious origin of peritonitis; defect in lymphatic outflow from the peritoneal cavity.
In addition to the listed diseases, the following factors can contribute to the appearance of ascites symptoms: injections of drugs; alcohol abuse leading to cirrhosis; blood transfusion; high cholesterol; living in an area characterized by the occurrence of viral hepatitis; obesity; tattooing. The appearance of the first signs of the disease in all cases is based on a complex combination of deviations of the vital functions of the human body, which leads to the accumulation of fluid in the peritoneal cavity.
The main symptoms of this pathology
One of the main external signs of ascites is an increase in the size of the abdomen. In a patient in a standing position, he can hang in the form of an apron, in a lying position forms the so-called belly of a frog. Perhaps the appearance of skin stretch marks and protrusion of the navel.
What other signs of abdominal ascites can be? With portal hypertension due to increased pressure in the hepatic portal vein, a pattern of veins appears on the front wall of the peritoneum. This design is called the “head of the Medusa” because of its distant resemblance to the mythological Gorgon Medusa, on the head of which there were wriggling snakes instead of hair. In the stomach there is a feeling of fullness and pain. A person experiences difficulties when he tilts his torso.
External signs of ascites are also swelling of the lower extremities, face, hands, cyanosis of the integument of the skin. The patient develops tachycardia, respiratory failure. Nausea, constipation, loss of appetite and belching may occur.
The first signs of ascites in men and women appear after the accumulation of 1000 ml of fluid or more. Accompanied by all this pain and flatulence.
Instrumental and laboratory studies
In instrumental and laboratory studies, the specialist confirms the diagnosis and determines the cause of the ascites. For this purpose, MRI, ultrasound, laboratory tests and diagnostic laparocentesis are performed. Ultrasound determines the presence of free fluid in the abdominal cavity and its amount, an increase in the spleen and liver, expansion of the portal and vena cava, defects in the renal structure, and the presence of metastases and tumors. MRI allows you to study layer-by-layer certain tissues, determine even a small amount of ascitic fluid and determine the underlying disease that provoked ascites. The doctor, in addition, examines the patient with percussion and palpation. Palpation makes it possible to identify symptoms that indicate a violation of a particular organ (spleen or liver). Percussion is taken directly to determine ascites. Its essence is based on tapping the patient’s peritoneal cavity and studying percussion sounds. If ascites is expressed, then a dull percussion sound is noted over the entire surface of the abdomen.
What does a blood test show?
Blood laboratory tests show a decrease in the concentration of red blood cells, an increase in the number of ESR and white blood cells, the content of bilirubin (if cirrhosis of the liver), as well as proteins during inflammation of the acute phase can increase. Analysis of urine at the initial stage of ascites may reflect a larger volume of urine of lower density, since ascites causes deviations in the activity of the urinary system. The density of urine at the terminal stage may be normal, but its amount as a whole decreases significantly.
Signs of ascites ascites may vary depending on the cause of the pathology.
The development of ascites in cirrhosis
An organ such as the liver performs many different functions in the human body. For example, it is a biological "filtrate" that collects blood through the portal vein from the intestines and cleanses it of toxic elements.
With cancer and cirrhosis of the liver, pressure increases in the portal vein - a condition develops that experts call portal hypertension. This contributes to the onset of fluid accumulation in the abdominal cavity.
Swelling of the lower extremities, ascites, an increase in the liver are signs of cirrhosis.
The main cause of this disease is the lack of albumin (protein) in the body, which causes a decrease in the ability of blood to stay in the blood vessels. In other words, a deficiency in the content of albumin enhances the passage of fluid through the vascular walls, as a result of which it easily penetrates into the peritoneal cavity, where it accumulates.
However, not only protein deficiency can cause pathology. Since the liver with cirrhosis loses the ability to control the concentration of sodium in the human body, its level begins to increase, which also causes a delay in urine in the internal organs and tissues, causing serious edema. With cirrhosis, signs of ascites can be especially pronounced.
The liver has no nerve endings, and therefore its diseases do not manifest themselves for a long time and are diagnosed only in the later stages. In 83% of situations, this is fatal. If it is not possible to go to a qualified hepatologist, you need to familiarize yourself with the details regarding the prevention, cleaning, treatment and restoration of the liver.
If we talk about what are the reasons for the appearance of signs of ascites of the abdominal cavity in humans, it should also be mentioned that with cirrhosis, the lymphatic system malfunctions, since it is the liver that produces lymph. Due to the fact that this organ cannot fully function with this pathology, the lymphatic system is also malfunctioning. Lymph pressure rises in the body, which also causes the penetration of fluid into the peritoneal cavity. Due to the deterioration of the functioning of the liver every day, the fluid gradually begins to accumulate. So there are the first signs of ascites in cirrhosis.
Summarizing the above, it should be noted that the basis for the occurrence of ascites is a number of factors:
- malfunctioning of the lymphatic system;
- high vascular permeability;
- high concentration of sodium in the blood with impaired liver and kidney activity;
- high liver pressure.
Signs of ascites in oncology
Ascites is a pathological accumulation of fluid in the peritoneum, which appears as a complication of tumors in the lungs, gastrointestinal tract, mammary gland, liver or ovaries. Such an ailment develops in the third and fourth stages of cancer. Due to ascites, the patient may die.
Ascites on the background of oncology appears due to the destruction of lymph nodes. Thus, in a certain area there is a violation of lymphatic drainage. In addition, during the pathology, cancer cells spread throughout the body, exacerbating the patient's condition.
The disease can cause both excessive accumulation in the fluid cavity and an increase in pressure inside the peritoneum, due to which the diaphragm moves to the chest area.
In rare cases, the pathology develops in the period after the operation. Sometimes a complication of the peritoneal cavity is formed due to chemotherapy, in which the body receives intoxication.
In addition to such sources of the onset of the disease, doctors identify several more etiological factors:
- stages of the dense finding of the abdominal folds relative to each other;
- ingestion of atypical cells during surgery;
- high concentration of lymphatic and blood vessels;
- germination of the tumor beyond the abdominal limits.
Ascites in oncology has three formations:
- transient - the formation of not more than 400 milliliters of fluid in the peritoneum;
- moderate - about five liters of watery substance;
- strained - accumulation in the peritoneum of about twenty liters.
What are the first signs of abdominal ascites in this case? At the initial stages, a person’s stomach is small, flattened in a supine position. When the patient is standing, the stomach hangs down. Ascites in the later stages is characterized by a significant increase in the abdomen, regardless of the position of the body, it looks like a dome. The skin at the same time begins to shine and stretches.
In addition to external signs, the disease has common symptoms: difficulty breathing; malaise; fast saturation; dyspnea; a feeling of enlarged abdomen; severe pain; heartburn; nausea.
How is medication used for ascites?
The main drugs that help remove excess fluid from the body are diuretics. Their use allows for the transfer of excess fluid from the peritoneal cavity into the bloodstream, which helps to reduce signs of ascites. To begin with, patients are prescribed the smallest dosage to minimize the likelihood of side effects. The main principle of diuretic therapy is a slow increase in urine output so that it does not lead to severe losses of potassium and other important metabolites. It is mainly recommended to use the preparations Amilorid, Triamteren, Veroshpiron, Aldacton. In parallel, potassium preparations are prescribed. Hepatoprotectors are simultaneously introduced into the treatment regimen.
At the same time, doctors daily monitor the patient’s diuresis, and if the treatment is ineffective, the dosage of the drugs increases, or they are replaced by stronger drugs, for example, “Dichlothiazide” or “Triampur”.
In addition to diuretics, patients are prescribed medications that strengthen the vascular walls (vitamins P and C, Diosmin), drugs that prevent the removal of fluid from the bloodstream (Reopoliglyukin).
The exchange of liver cells by the introduction of protein substrates increases. For this purpose, concentrated plasma or a solution of "Albumin" in a concentration of 20% is most often used.
Antibacterial agents are prescribed when the ascites-causing disease has a bacterial origin.
Diet for this dangerous pathology
A human diet with signs of ascites ascites should be high-calorie and balanced, which helps to ensure the needs of the body in all trace elements. It is also important to limit the salt on the menu, in its pure form it is generally prohibited for use.
The amount of fluid taken should also be adjusted downward. It is undesirable for patients to drink more than a liter of liquid per day, not including soups.
It is very important that there are a lot of protein products in the daily diet of a person, however, its quantity should not be too high. Fat intake needs to be reduced, especially for patients in whom ascites was caused by pancreatitis.
Surgery as a way to get rid of the disease
With signs of ascites, abdominal laparocentesis is performed when the patient's condition remains resistant to medication correction. For fluid outflow, a peritoneovenous shunt can be delivered, characterized by a partial degree of deperitonization of the walls of the peritoneal cavity.
Interventions aimed at reducing pressure in the portal system appear in the form of indirect measures. These include portocaval bypass surgery, portosystemic intrahepatic bypass surgery, reduction of spleen blood flow.
Regarding liver transplantation, it must be said that such an operation is very complex, can be performed only with a stable character of ascites. However, as a rule, it is very difficult to find a donor for transplantation.
Laparocentesis of the peritoneal cavity in ascites is a surgical operation in which fluid is removed from the abdominal cavity by puncture. You can not pump out at a time more than four liters of exudate, since this is fraught with the appearance of collapse.
The frequency of puncture increases the likelihood of developing abdominal inflammation. In addition, the likelihood of the formation of junctions and the formation of complications as a result of the procedure increases. For this reason, with massive ascites, a catheter is desirable.
Indications for laparocentesis are refractory and intense ascites. It is possible to pump out the fluid through a catheter, or it can flow freely after the trocar is inserted into the abdominal cavity in a pre-prepared container.
Omentohepatophrenopexy - effective surgical manipulation
Another effective operative manipulation is omentohepatophrenopexy. Its essence is in the hemming of the omentum to the areas of the surface of the liver and diaphragm that have been previously processed.
Due to the appearance of contact between the omentum and the liver, the possibility of absorption of ascitic fluid by neighboring tissues is formed. Additionally, the pressure decreases in the venous system, the fluid exits through the vascular walls into the abdominal cavity.
TIPS, or transjugular intrahepatic portosystemic shunting, makes it possible to decompress the portal system and eliminate ascites syndrome. TIPS is mainly done with refractory ascites, which is not amenable to drug treatment.
With this procedure, a conductor is inserted into the jugular vein until the liver enters the vein. Then, through the guide, a special catheter is inserted directly into the liver itself. Using a curved long needle, a stent is installed in the portal vein, which creates a channel between the hepatic and portal veins. Blood is directed into the vein of the liver with reduced pressure, due to which portal hypertension is eliminated.
What are the first signs that ascites is leaving?
After TIPS in patients with refractory ascites, a 58% decrease in the amount of fluid is noted. Despite the fact that ascites and the diseases that cause it are very serious and difficult to correct, timely comprehensive treatment can significantly increase the likelihood of recovery or improve the quality of life of patients who are incurable. Ascites can be treated only under medical supervision, since the complexity of the disease in rare cases allows you to get by with folk or home methods. This especially applies to ascites against the background of oncology.
Life expectancy at different stages of ascites
Now many want to know what is the life expectancy of patients in the first stage of ascites. Doctors have learned to compensate for a person’s condition with the help of drugs and diuretics, correctly selected in each case. Subject to diet, adequate treatment and the implementation of laparocentesis, a favorable prognosis is given for ten years. However, this option is very rare. In addition, there are types of dropsy in which you can not be treated with medication.
The consequences of peritoneal ascites in this case become irreversible, patients die within the first year.
However, do not lose heart. Now medicine is developing, new equipment produces drainage and minimizes the risks of pathologies. It is very important to try to improve your prognosis, preventing complications, gradually eliminating all the negative consequences. Knowing the dangers of ascites, you need to act correctly in the treatment of primary diseases.
And another important point: life expectancy and a good prognosis for dropsy depend largely on the qualifications of the specialist who leads the patient. Treatment should focus on eliminating the cause of the disease, restoring the functions of internal organs.
We examined the signs of abdominal ascites in humans.