Tense ascites (ICD-10 code: R18) is a secondary condition in which a collection of a 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 types indicates 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% are due to heart pathologies and other diseases. At the same time, ascites in a child indicates kidney disease.
It has been proven that the largest amount of water accumulating in the abdominal cavity with intense ascites (ICD-10 code: R18) in a patient can reach25 liters.
Reasons
Ascites factors are diverse and always associated with some significant pathology. The abdomen is considered to be a closed area where no unnecessary fluid should be generated.
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 blood and lymphatic vessels located 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 do not touch each other.
When the barrier, excretory and resorptive functions are violated, the exudate ceases to be absorbed normally and accumulates in the abdomen, as a result of which intense ascites is formed.
Liver disorders
In the first place is to put a disease called cirrhosis, as well as a tumor of the organ and Budd-Chiari syndrome. Cirrhosis can progress against the background of hepatitis, steatosis, the use of toxic pharmaceuticals, alcoholism 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, it helps to releaseunnecessary water, a decrease in oncotic pressure, due to the fact that the liver itself is no longer able to produce plasma proteins and albumins. Enhances the pathological process in tense ascites in liver cirrhosis, a number of reflex interactions triggered by the body in response to liver failure.
Heart disease
Tense ascites can progress due to heart failure, or due to constrictive pericarditis. Able to be the result of almost all cardiac diseases. The mechanism of ascites formation in this case will be due to the fact that the hypertrophied cardiac 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, fluid will begin to leave the vascular bed, creating ascites. The system of formation of ascites in pericarditis is approximately the same, however, in this case, the outer layer of the heart becomes inflamed, which leads to the impossibility of its normal filling with blood. Subsequently, this affects the functioning of the venous system.
Kidney disease
Due to dropsy of chronic renal failure, which appears as a result of various diseases (pyelonephritis, glomerulonephritis, urolithiasis, etc.). Kidney diseases lead to the fact that blood pressure increases, sodium, together with the liquid, is retained in the body, as a resultascites is created. A reduction in plasma oncotic pressure, which leads to ascites, can also occur against the background of nephrotic syndrome.
Other factors
Ascites can 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 filariae (worms that lay their eggs in large lymphatic vessels).
Various lesions of the peritoneum often cause ascites. Among them - diffuse, tuberculous and fungal peritonitis, peritoneal carcinosis, tumors of the large intestine, stomach, breast, ovaries, endometrium. This also includes pseudomyxoma and peritoneal mesothelioma.
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. These are rheumatism, rheumatoid arthritis, lupus erythematosus and more.
Ascites in newly born babies also occurs and is most often considered the result of hemolytic disease of the fetus. It, in turn, is formed during an intrauterine immunological conflict, if the blood of the fetus and mother do not match in the order of antigens.
Diseases of the digestive system can cause excessive concentration of water in the abdominal cavity. It can be pancreatitis, prolonged diarrhea, Crohn's disease. It is also possible to include here all the processes that take place in the peritoneum and interfere with the lymphatic output.
Statuslocalis of tense ascites (symptoms)
The initial sign of ascites is the rapid growth of the abdomen, and more specifically, its swelling. The main factor is that a very large amount of water accumulates further, which almost does not come out. A person detects ascites in himself, as a rule, when he is not able to fit into ordinary clothes, which not so long ago suited him in terms of volume.
If ascites appears, then in the body, of course, there are at least two significant multifunctional pathologies that need to be cured. Most of all, it is the pathological work of the intestinal tract, indigestion or liver abnormalities.
The rate of increase in signs is directly related to what actually became the ascites factor. The procedure can progress rapidly, or it can take a couple of months.
Local status of tense ascites:
- A state of heaviness in the abdominal cavity.
- Occurrence of discomfort and pain in the abdomen and pelvis.
- Bloating, signs of flatulence.
- Burning in the esophagus.
- Difficulty going to the toilet and eating.
- Bouts of nausea.
- Increased belly size. If the sick person is in a horizontal state, then the stomach swells around the edges and resembles the appearance of the belly of a frog. If a person is in an upright position, the stomach hangs down.
- Protrusion of the navel.
- Symptom of tummy swaying or fluctuation. Constantly appears when filled with liquid.
- The more water accumulates in the abdominal cavity, the more shortness of breath becomes,swelling of the lower extremities worsens, movements become slower. It is especially difficult for the patient to lean forward.
- Due to increased intra-abdominal pressure, a femoral or umbilical hernia is likely to bulge. Against the same background, hemorrhoids and varicocele can form. Prolapse of the rectum is not ruled out.
Symptoms depending on the factor
Highlight the status of localis of intense ascites and such:
Tuberculosis peritonitis. In this case, dropsy is considered the result of a tuberculous lesion of the reproductive system or intestinal tract. The sick person begins to rapidly lose weight, his body temperature rises, signs of intoxication of the body increase. Lymph nodes grow, which pass through the mesentery of the intestinal tract. In addition to lymphocytes and erythrocytes, mycobacterium tuberculosis will be isolated in the sediment of the exudate taken by puncture.
Peritoneal carcinosis. In the event that dropsy develops due to the presence of a tumor in the peritoneum, then the signs of the disease will primarily be located where it affected the organ. However, constantly with ascites of oncological etiology, an increase in lymph nodes occurs, which can be felt through the wall. The effusion sediment will contain atypical cells.
Heart failure. The patient has a blue-violet color of the dermatological integuments. The lower limbs, especially the feet and lower legs, will become very swollen. At the same time, the liver increases in volume, pains appear, 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 high risk of severe bleeding. In addition to an increase in the liver, there is a fascination with the volume of the spleen.
Diagnosis of ascites
Diagnosis of tense ascites (in ICD-10: R18) begins with the exclusion of other causes that cause an increase in the volume of the abdomen. 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 abdominal examination.
- Ascitic fluid analysis.
During percussion, a muffled sound is characteristic, during palpation of the lateral part, symptoms of fluctuation are recognized. Radiography makes it possible to diagnose ascites if more than 0.5 liters of free fluid accumulate in the abdominal cavity. As for ultrasound, during this examination, attention is paid to the tissues of the liver and spleen, they study their condition, check the peritoneum for tumors and mechanical lesions.
Laboratory studies
An important stage of manipulation after complaints with intense ascites is the sampling of tests:
- Coagulogram.
- Liver biochemistry.
- Checking antibody levels.
- Complete urinalysis.
If a patient has ascites for the first time, the doctorappoints a laparocentesis to study the fluid itself. In laboratory conditions, the composition, density, protein content are checked, bacteriological culture is done.
Medicated treatment
Drug treatment of ascites is performed both with diuretics and potassium preparations, albumin solution, asparkam. This is done for a reason, but for plasma pressure, thereby increasing blood volume. If the patient has a severe form of ascites, along with medication, he is sent for a laparocentesis procedure using ultrasound navigation. Piercing with a trocar removes fluid from the abdominal cavity. Sometimes doctors put in drains for long-term removal of exudate or transudate.
To remove ascitic fluid you need:
- reduce sodium intake;
- remove sodium in the 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, you need to eat up to 3 grams of s alt per day. After all, it has been proven that the lack of s alt has a very bad effect on the protein metabolism of the body. Now many have begun to take drugs such as Captopril, Fosinopril, Enalapril for the treatment of ascites. They are known to speed up the excretion 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 various tissues.
Surgical treatment
Laparocentesis is a surgical treatment for ascites. To extract excess fluid, a puncture is made and a special instrument, a trocar, is placed. On an empty stomach and with an empty bladder, the patient is seated or laid on his side, local anesthesia is prescribed. Away from the midline 1-2 cm between the navel and the pubis - 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 sudden drop in blood pressure, fluid is withdrawn gradually, with interruptions of 1-2 minutes.
To extract the fluid, wrap the torso with a towel and evenly squeeze the patient's stomach with it. The fluid is either removed at one time or a permanent catheter is placed. This is decided by the doctor. It is not recommended to extract more than 5-6 liters of fluid at a time, as complications may occur, such as cardiac arrest. After removing the trocar, sutures are applied. When a catheter is installed, there is a possibility of developing an ascitic fistula. The fistula is formed at the puncture site or between the seams. If leakage of ascitic fluid lasts more than a day, it is necessary to close the hole with interrupted sutures
Folk treatment
Ascites is, as you know, dropsy of the abdominal cavity, which primarily affects people suffering from cardiovascular diseases, kidney 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 severe clinical cases, doctors also recommend the additional use of alternative medicine for a comprehensive impact on the problem.
What means of combating ascites does the practice of he althy lifestyle suggest:
Using birch leaves and buds to make 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 rotten, 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 condition after dry birch baths is characterized by a slight tingling of the skin.
- Baths with decoction of birch. 50 grams of dry or fresh birch leaves are poured into the bath and filled with 10 buckets of warm boiled water. After that, the patient with ascites is placed in a decoction for 30-40 minutes. If, upon exiting the bath, there is a slight numbness of the limbs and bright pink stripes and spots are visible on the body, the effect of the decoction is considered positive.
- Wraps with birch broth. A decoction for body wraps is prepared in the same way as for taking baths. The patient is wrapped in a sheet soaked in a medicinal drug from the armpits to the knees. Then they lay on the bed and cover with several layers of woolen blankets. Allow to lie down in this state for 45-50 minutes. Then they wash with warm boiled water.
Diuretic herbal infusions:
- Diuretic collection, which is rich in vitamins. You will need dried rose hips, raspberry leaves, lingonberries and black currants in similar proportions. Pour a quarter of a glass of these herbs with a glass of very hot water. Boil half an hour afterwhat to cool and take twice a day.
- Drinking liquid from bean pods. Take the husk of 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 into four times and drink half an hour before meals.
What is the ascites diet?
This diet has its own rules that must be observed very clearly, and if this is not done, the disease will quickly move to the next stage. One of the important rules is to eat small portions of food every three hours, and the dishes must be 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 must be subjected to minimal heat treatment, and it is advisable to steam all food, bake without using oil or stew. The diet of people who suffer from dropsy should consist of he althy and varied products, and emphasis should also be placed on spicy plants that have a mild diuretic effect. If dropsy appeared on the background of cirrhosis of the liver, then it is imperative to include foods rich in easily digestible proteins in the menu.
Allowed foods for dropsy
In the diet of people who suffer from ascites, sea fish of low-fat varieties must be included, which should be cooked without s alt in the oven or steamed. The menu must include the lungsliquid dishes that should be cooked with ingredients such as fennel, parsley or ginger. As for meat, preference should be given to turkey, rabbit or skinless chicken, and it is advisable to steam dishes from these types of meat. It is desirable to prepare drinks from components that have a mild diuretic effect, for example, from currant leaves or figs.
