In the article, consider the signs of ascites.
Abdominal dropsy, or ascites, is often the result of a more difficult and dangerous disease to treat. However, this disease itself can complicate the patient's life and lead to negative consequences.
What is this pathology?
In medicine, ascites is understood as a secondary pathological condition, which is characterized by the 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 sickness occur?
The main causes of ascites in the peritoneal cavity, according to statistics, are: liver disease (70%); oncological diseases (10%); heart failure (5%). In addition, dropsy may be accompanied by such pathologies: kidney disease; gynecological diseases; defeat of the peritoneum by tuberculosis; endocrine abnormalities; rheumatoid arthritis; rheumatism; the second type of diabetes; lupus erythematosus;uremia; digestive diseases; non-infectious origin peritonitis; defect of lymphatic outflow from the peritoneal cavity.
The appearance of signs of ascites, in addition to the listed diseases, can be facilitated by such factors: injections of narcotic drugs; alcohol abuse leading to cirrhosis of the liver; blood transfusion; high cholesterol; living in an area that is characterized by the occurrence of viral hepatitis; obesity; tattoo. 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, it can hang down in the form of an apron, in a supine position it forms the so-called frog belly. Skin stretch marks and protrusion of the navel may appear.
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 anterior wall of the peritoneum. Such a design is called the "head of Medusa" because of its distant resemblance to the mythological Gorgon Medusa, on whose head there were writhing snakes instead of hair. There is a feeling of distension and pain in the abdomen. The person has difficulty bending the torso.
External signs of ascites are also swelling of the lowerlimbs, face, hands, cyanosis 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. Accompanying all this is pain and flatulence.
Instrumental and laboratory studies
With instrumental and laboratory studies, the specialist confirms the diagnosis and determines the cause that provoked ascites. For this purpose, MRI, ultrasound, laboratory tests and diagnostic laparocentesis are performed. By means of ultrasound, the presence of free fluid in the abdominal cavity and its amount, enlargement of the spleen and liver, expansion of the portal and vena cava, defects in the renal structure, the presence of metastases and tumors are determined. 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 the help of 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 the study of percussion sounds. If ascites is pronounced, 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 erythrocytes, an increase in the number of ESR and leukocytes, may increasethe content of bilirubin (if cirrhosis of the liver), as well as proteins during inflammation of the acute phase. Analysis of urine at the initial stage of ascites may reflect a larger volume of urine of less density, since ascites causes deviations in the activity of the urinary system. The density of urine in the terminal stage may be normal, but its amount as a whole decreases to a large extent.
Signs of abdominal ascites may vary depending on the cause of the pathology.
Development of ascites in liver cirrhosis
An organ like the liver performs many different functions in the human body. For example, it is a biological "filtrate" that collects blood from the intestines through the portal vein and cleanses it of toxic elements.
With cancer and cirrhosis of the liver, pressure in the portal vein rises - a condition that experts call portal hypertension develops. This contributes to the beginning of the accumulation of fluid in the abdominal cavity.
Swelling of the lower extremities, ascites, liver enlargement 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, albumin deficiency increases the permeability 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 becomecause of pathology. Since the liver with cirrhosis loses the ability to control the concentration of sodium in the human body, its level begins to rise, which also causes retention of urine in the internal organs and tissues, causing serious edema. With cirrhosis of the liver, signs of ascites may 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 at later stages. In 83% of situations, this leads to death. If it is not possible to go to a qualified hepatologist, you need to read the details regarding the prevention, cleansing, treatment and restoration of the liver.
If we talk about what causes the appearance of signs of ascites in the abdominal cavity in humans, we must also mention that with cirrhosis, the lymphatic system is disrupted, since it is the liver that produces lymph. Due to the fact that this organ cannot fully work with this pathology, the lymphatic system is also subject to failures. The pressure of the lymph in the body increases, 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. This is how the first signs of ascites appear in liver cirrhosis.
Summarizing the above, it should be noted that a number of factors underlie the occurrence of ascites:
- malfunctions of the lymphatic system;
- high vascular permeability;
- high concentration of sodium in the blood whenimpaired activity of the liver and kidneys;
- high liver pressure.
Signs of ascites in oncology
Ascites is an abnormal accumulation of fluid in the peritoneum that occurs as a complication of tumors in the lungs, gastrointestinal tract, breast, liver, or ovaries. Such an ailment develops in the third and fourth stages of cancer. The patient may die due to ascites.
Ascites on the background of oncology appears due to the destruction of the lymph nodes. Thus, in a certain area there is a violation of lymphatic drainage. In addition, during the pathology, cancer cells spread throughout the organ, aggravating the patient's condition.
The disease can cause both excessive accumulation of fluid in the cavity and an increase in pressure inside the peritoneum, which causes the diaphragm to shift into the chest area.
In rare cases, the pathology develops in the period after surgery. 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 appearance of the disease, doctors identify several more etiological factors:
- in stages, the tight location of the abdominal folds relative to each other;
- hit during the operation of atypical cells;
- high concentration of lymphatic and blood vessels;
- Tumor spreading beyond the abdominal area.
Ascites in oncology has three formations:
- transient - education no more than 400milliliters of fluid in the peritoneum;
- moderate - about five liters of watery substance;
- tense - accumulation in the peritoneum of about twenty liters.
What are the first signs of abdominal ascites in this case? In the initial stages, a person's stomach is small, spreading in a supine position. When the patient is standing, the abdomen 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 stretch.
In addition to external signs, the disease has common symptoms: difficulty breathing; malaise; fast saturation; dyspnea; feeling of an enlarged belly; severe pain; heartburn; nausea.
How is ascites treated with medication?
The main drugs that help remove excess fluid from the body are diuretics. Their use allows you to transfer excess fluid from the peritoneal cavity into the bloodstream, which helps to reduce the signs of ascites. Patients are given the smallest dosage to begin with to minimize the chance of side effects. The main principle of diuretic therapy is a slow increase in diuresis so that it does not lead to severe losses of potassium and other important metabolites. It is recommended mainly the use of drugs "Amiloride", "Triamteren", "Veroshpiron", "Aldakton". In parallel, potassium preparations are prescribed. Hepatoprotectors are simultaneously introduced into the treatment regimen.
Doctors at the same time daily monitor the patient's diuresis, and whentreatment failure, the dosage of drugs is increased, or they are replaced by stronger drugs, for example, Dichlothiazide or Triampur.
In addition to diuretics, patients are prescribed drugs that strengthen the vascular walls (vitamins P and C, "Diosmin"), drugs that prevent the removal of fluid from the blood vessels ("Reopoliglyukin").
The exchange of liver cells is increased by the introduction of protein substrates. For this purpose, concentrated plasma or a solution of "Albumin" at a concentration of 20% is most often used.
Antibacterial agents are prescribed when the disease that caused ascites is of bacterial origin.
Diet for this dangerous pathology
The diet of a person with signs of abdominal ascites should be high-calorie and balanced, which allows the body to meet the needs of all trace elements. It is also important to limit the s alt on the menu, in its pure form it is generally forbidden to use.
The amount of fluid taken should also be adjusted downwards. It is undesirable for patients to drink more than a liter of liquid per day, not including soups.
It is very important that a person's daily diet contains a lot of protein foods, but the amount should not be too high. Fat intake should be reduced, especially in patients whose ascites was caused by pancreatitis.
Surgery as a way to get rid of the disease
With signs of ascitesabdominal laparocentesis is performed when the patient's condition remains resistant to correction with medications. For fluid outflow, a peritoneovenous shunt can be placed, which differs in the partial degree of deperitonization of the walls of the peritoneal cavity.
Interventions aimed at reducing the pressure in the portal system act as indirect measures. These include portocaveal shunting, portosystemic intrahepatic shunting, reduction of splenic blood flow.
Regarding liver transplantation, it must be said that such an operation is very complicated, it can be performed only with a stable character of ascites. However, it is usually very difficult to find a donor for her transplant.
Laparocentesis of the peritoneal cavity in ascites is a surgical operation in which fluid is removed from the abdominal cavity by puncture. It is impossible to pump out more than four liters of exudate at a time, as this is fraught with the appearance of collapse.
The frequency of puncture increases the likelihood of developing abdominal inflammation. In addition, the likelihood of formation of adhesions and the formation of complications as a result of the procedure increases. It is for this reason that it is desirable to install a catheter in massive ascites.
Refractory and intense ascites are indications for laparocentesis. You can pump out the fluid through a catheter, or it flows freely after inserting the trocar into the abdominal cavity into a pre-prepared container.
Omentohepatophrenopexy is an effective operativemanipulation
Omentohepatophrenopexy is becoming another effective surgical manipulation. Its essence lies in the suturing of the omentum to the areas of the surface of the liver and diaphragm, pre-treated.
Due to the appearance of contact between the omentum and the liver, it is possible for the neighboring tissues to absorb ascitic fluid. Additionally, the pressure in the venous system decreases, 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 ascitic syndrome. TIPS is mainly done for refractory ascites that does not respond to medication.
In this procedure, a conductor is inserted into the jugular vein before entering the liver vein. Then, through the conductor, a special catheter is inserted directly into the liver itself. A stent is placed in the portal vein using a curved long needle, which creates a channel between the hepatic and portal veins. Blood is sent to the liver vein with reduced pressure, due to which portal hypertension is eliminated.
What are the first signs that ascites is going away?
After TIPS in patients with refractory ascites, there is a decrease in the amount of fluid by 58%. Despite the fact that ascites and the diseases that cause it are very serious and difficult to correct, timely complex treatment can significantly increase the likelihood of recovery or improvement in the quality of life of incurable patients. Ascites can be treated only undermedical supervision, since the complexity of the disease in rare cases allows you to get by with folk or home methods. This is especially true for 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. With diet, adequate treatment and laparocentesis, a favorable prognosis is given for ten years. However, this option is very rare. In addition, there are types of dropsy that cannot be treated with medication.
The consequences of peritoneal ascites in this case become irreversible, patients die within the first year.
But don't be disheartened. Now medicine is developing, new equipment produces drainage and minimizes the risk of pathologies. It is very important to try to improve your prognosis by preventing complications, gradually eliminating all negative consequences. Knowing the danger of ascites, you need to act correctly in the treatment of primary diseases.
And one more important note: 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 looked at the signs of abdominal ascites in humans.
