According to the ICD 10 classification, abdominal ascites is coded as R18. These symbols hide a pathological secondary state of accumulation in the peritoneal region of liquid secretions - exudate, transudate. The condition is accompanied by an increase in the size of the abdomen. A person suffers from pain, breathing is disturbed, there is a feeling of heaviness. Other unpleasant conditions caused by the accumulation of fluid are possible. Doctors sometimes refer to the pathology as abdominal dropsy.
General information
From medical research it is known that the causes of abdominal ascites in women, men can be a variety of pathological conditions. Sometimes the accumulation of fluid is explained by gynecological disorders, gastroenterological failures. A possible cause is diseases of the urinary and reproductive systems, the heart and related parts of the body. Sometimes ascites is due to dysfunction of the lymphatic system. It can be caused by cancerillness. The condition does not belong to the number of independent ones and is only a symptom of some disease, a violation of the functionality of structures and organs.
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 carries a risk of death.
Relevance of the issue
As specialized studies have shown, the most common cause of abdominal ascites is liver disease. On average, such primary sources account for up to 70% of all identified abdominal dropsies. This is especially true for adult patients. Approximately every tenth patient suffers from ascites due to oncological disease, even twice as rarely the condition is detected against the background of a violation of the heart. Among patients in the minor age group, abdominal dropsy is more common in people suffering from kidney disease.
A study of reported cases has shown that up to 25 liters of liquid secretions can accumulate in the abdominal cavity with dropsy.
What provokes?
Of course, many people are interested in what are the principles of treatment, the causes of abdominal ascites, 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 is very difficult to list everything that can provoke dropsy. In any ofcases of ascites indicates a serious pathology. The cavity is a closed space. The human body is designed in such a way that excess fluid does not accumulate in this part of it - 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.
In the peritoneum, two layers of tissue are isolated. Outside, there is a shell attached to the wall of the abdomen, and the inner one is adjacent to the organs. The leaves are separated from each other by a small volume of fluid formed due to the functioning of the circulatory, lymphatic system. True, at the same time, ascites of the abdominal cavity in women, men, children is not observed - accumulation does not occur, everything released will soon be absorbed through the capillary network. Small volumes of substance located between the sheets ensure the mobility of the intestinal loops and other organs located inside the peritoneum. An excess of secretions is observed if absorption is disturbed or the substance is generated in too large a volume; the barrier function of any zone is violated.
Start pathology
A possible cause of abdominal ascites is hepatic cirrhosis. Among others, it is she who occurs most often. The condition can also be caused by other pathologies of the organ, including the area of growth of atypical cells, Budd-Chiari disease. Often cirrhosis is accompanied by steatosis, hepatitis. The problem is possible against the background of the use of drugs toxic to the liver. Often the pathology accompaniesaddiction to alcohol. Common to all states is the mechanism of development, starting with the death of the cellular structures of the organ. Instead, scar tissue forms. This leads to liver hypertrophy, disruption of the portal vein. The result is ascites.
Against the background of pathological conditions, a drop in oncotic pressure is possible. This creates conditions in which fluid easily seeps into the abdominal cavity in excess quantities. Liver cells cannot generate albumins, plasma proteins, and this worsens the patient's condition. This cause of abdominal ascites is aggravated by reflexes initiated in the body as an attempt to correct the insufficiency of the liver.
Heart hurts
A possible cause of abdominal ascites is cardio problems. The phenomenon can be provoked by insufficiency of the heart, an inflammatory process in the pericardium. Deficiency develops against the background of most serious cardiac pathologies. Ascites is formed due to the growth of the heart muscle. The body cannot pump blood in the volumes necessary for the normal functioning of the body. Fluid accumulates in the vascular system, and the process is especially noticeable in the vena cava. Increased pressure leads to leakage from the bloodstream through the vascular walls.
Pericarditis initiates similar processes, but the focus of inflammation in the outer cardiac membrane will be a feature of the condition. In this case, the site does not pass blood in normal mode. The work of the veins is disrupted, the result is the accumulation of fluid in the peritoneum.
Renal disorders
Can cause abdominal ascites diseases affecting the kidneys. As a rule, this is due to chronic insufficiency of the organ - 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 abdominal ascites, found that the phenomenon may be associated with improper operation and violation of the integrity of the elements of the lymphatic system. Usually the root cause is trauma or a tumor process. Ascites is possible against the background of metastasis in the presence of an oncological disease, as well as with invasion of filariae. The term refers to a special genus of helminths that can secrete eggs in large vessels with lymph.
For one of the types of abdominal ascites, the cause is lesions in the abdominal region. Sometimes this is observed against the background of peritonitis of various forms: due to infection with fungi, mycobacteria, and also with a spilled form. Abdominal dropsy is possible with malignant processes in the large intestine, gastric regions, and the reproductive system. The phenomenon can be caused by peritoneal carcinosis. Sometimes dropsy is formed in people with mesothelioma, pseudomyxoma.
Diagnosisand consequences
Certain types of abdominal ascites may develop due to polyserositis. The term refers to a pathological condition in which a person is simultaneously sick with pericarditis, inflammation of the pleural pulmonary membranes and dropsy localized in the abdominal cavity. Accumulation of liquid secretions is possible with a variety of systemic pathologies. For example, considerable risks are associated with lupus erythematosus. Sometimes ascites provoke arthritis, rheumatism.
There are known cases of development for various reasons of 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 during the gestation period. This is usually due to an immunological conflict: maternal, child blood differ in antigens. Protein deficiency can provoke ascites. Sometimes the cause is pathologies covering the gastrointestinal tract. Abdominal dropsy can appear with Crohn's disease, chronic diarrhea, inflammation of the pancreas. Certain risks are associated with pathological processes in the organs located in the peritoneum, if they interfere with the flow of lymph.
Aspects and diseases
Myxedema is a possible cause of abdominal ascites in humans. The pathological condition causes swelling of soft tissues, mucous membranes. The disease is clearly manifested if the processes of generating thyroxine, triiodothyronine, which are normally produced by the pancreas, go astray in the body.
Another reason for the occurrenceascites of the abdominal cavity in humans - improper, unbalanced nutrition. True, only very serious violations of the diet can lead to such negative consequences - a complete refusal to eat or an extreme form of food restriction. The body is deprived of protein reserves, the content of protein structures in the circulatory system decreases. The result is a drop in oncotic pressure, and liquid blood fractions seep through the vascular walls.
In children, ascites is possible with certain types of enteropathy. The risks are associated with nephrotic syndrome, which the baby suffers from birth, as well as malnutrition.
How to notice?
Knowing the main manifestations of the pathological condition, it is possible to suspect in time the symptoms of abdominal ascites. Photos in specialized sources can do little to help - 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 abdominal distension associated with fluid accumulation. The phenomenon is the stronger, the larger volumes seep into the cavity and remain in it. Usually, the symptom comes to attention when the person notices that the usual clothes have become too small in the waist.
The formation of abdominal dropsy indicates the presence of a serious imbalance, a violation of the functionality of the internal organs. Often there is ascites of the abdominal cavity with oncology. Regardless of what caused the symptoms, bloating due to accumulation of fluid inside indicatesthe need for urgent treatment. The rate of progression is determined by the cause and what kind of care the patient receives. For some, progress takes months, for others the deterioration is almost instantaneous - it takes only a few hours.
State Clinic
Abdominal ascites in oncology, gastric diseases, heart pathologies and other he alth disorders is indicated by a feeling that the peritoneum is bursting. This area responds with soreness extending to the pelvis. Simultaneously with bloating, increased gas formation in the intestinal tract is observed. A person is worried about belching, heartburn, nausea. The stomach feels heavy, the digestive process brings discomfort, urination becomes more difficult.
It is quite easy to notice ascites if you look at the patient lying strictly horizontally from the side. The area of the peritoneum is bursting on the sides, the stomach swells. To some extent, this is similar to the appearance of a frog lying on its back. If the patient stands up, the abdomen will sag. The navel sticks out, fluctuation is observed, which intensifies as the cavity is filled with secretions. The more fluid in the peritoneum, the more significant breathing problems, swelling of the legs. The person slowly and sluggishly, awkwardly moves, bends over with difficulty. Some people have a hernia. There is a risk of formation of hemorrhoids, varicocele. Ascites can cause bowel prolapse.
Provoking factors and nuances of manifestations
If dropsy has developed against the background of peritonitis due to infection with mycobacterium, the patient loses weight, temperature check shows fever, manifestations increasegeneral poisoning of the body. At the same time, the lymph nodes become larger, especially in the intestinal mesentery. If you take exudate for examination, you can see erythrocytes, lymphocytes, mycobacteria in the liquid.
Abdominal carcinosis, which causes ascites, from time to time provokes different symptoms: it depends on which organ the tumor is localized in. The common thing is an increase in lymph nodes - the areas become large enough to be felt through the anterior wall of the peritoneum. The exudate contains abnormal cellular structures.
The insufficiency of the 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 certainly 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 abdominal ascites, the prognosis of life largely depends on at what stage in the development of the pathological condition it was possible to make a diagnosis, how well the patient's treatment was chosen. It is customary to distinguish three successive stages, and the first is a transistor one. At this stage of development, no more than 0.4 liters of fluid accumulate in the abdominal zone. Ascites practically does not manifest itself as a symptom and it is possible to identify it if MRI and ultrasound are performed in time. Since the fluid has accumulated in rather small volumes, the functionality of the peritoneal organs remains normal. If the patient notices he alth disorders, then due to their blurring and weak severity, he does not give the manifestations a specialvalue.
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 the symptoms, it is visually seen how the stomach has increased, hanging down. The ability to breathe worsens, shortness of breath is especially strong when a person lies down. For diagnosis, it is enough to examine the patient and feel the abdominal area.
Progress
Pathological conditions can be caused by various factors - pathologies of the heart, blood flow, tumors, cirrhosis of the liver. The prognosis for abdominal ascites depends on both the cause and the level of progress, and the worst chances are in patients who have a tense form. In this case, the abdominal cavity becomes an area of localization of fluid accumulations up to 10 liters in volume. This is accompanied by an increase in pressure and a violation of the performance of organic structures. The patient needs urgent qualified assistance.
Another developmental step is refractory. In this case, the removal of abdominal ascites is almost impossible. Even if you prescribe treatment, the fluid will constantly arrive. With the formation of pathology in this form, with the development of this scenario, the prognosis is the most unfavorable of all possible.
How to help the sick?
Therapeutic course gives good results if started at an early stage of the pathological condition. Before choosing a therapy, it is necessary to examine the patient, to identify the features of the pathology, its causes. Then the doctor selects a medication course. They mainly resort todiuretic. Furosemide is often prescribed for abdominal ascites - this substance is found in a wide variety of pharmaceutical products with a diuretic effect. Excess fluid moves into the circulatory system, the symptoms subside.
Drugs are prescribed at a minimum dosage at first 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 microelements. Among the popular names, it is worth noting "Veroshpiron" and "Amiloride". Aldakton and Triamteren have a good reputation. In order to minimize the risk of potassium deficiency, it is recommended to simultaneously take preparations and supplements containing this microelement. Patients are shown a course of drugs to protect the liver from the negative effects of drugs.
Nuances of treatment
To prevent the treatment from becoming 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, either increase the dosage, or change the selected medications to more powerful ones. The means of choice are usually Dichlothiazide, Triampur.
Diuretics are usually combined with drugs that strengthen the vascular wall. These include vitamin P, ascorbic acid and Diosmin. Equally useful are compounds that inhibit the ability of vessel walls to pass liquid into the external environment. Reopoliglyukin possesses such qualities. Proteinsubstrates prescribed to the main percentage of patients help to normalize metabolic processes localized in liver cells. Concentrated plasma, 20% albumin solution may be recommended.
Sometimes the fight against ascites requires the use of antimicrobials. This is indicated if the root cause of dropsy is a bacterial disease, an infectious, inflammatory focus.
Comprehensive approach
In order for the symptoms to subside faster, the patient is on the mend sooner, the diet should be changed. Shown high-calorie food, a balanced diet that provides the body with essential trace elements. S alt in its pure form is excluded from the menu, and in dishes it is used in minimal quantities. Adjust the amount of fluid consumed per day: no more than a liter. Soups are allowed in addition.
Shows protein-rich foods in reasonable amounts. Reduce dietary intake of fats. This is especially important in cases of ascites due to pancreatitis.
Need surgery
Laparocentesis is one of the treatment options for ascites. Such an event is indicated if the drug course does not give the desired result. A shunt may be placed to ensure fluid is removed. Surgical interventions that can lower portal pressure are an indirect way to get rid of ascites. This category includes protocaval, portosystemic shunting, reduction of the circulatory system that feeds the spleen. Rarely, 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 herimplementation – successful donor search.
Laparocentesis involves the removal of fluid accumulated in the abdominal region by punctures. One procedure allows the removal of up to 4 liters of the substance. If more is pumped out at a time, the danger 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 placed. Laparocentesis is recommended to do with a tense form of ascites and a pathological condition that develops according to the refractory scenario.
Features of pathology
As studies have shown, ascites develops the slowest if dropsy is caused by heart disease. The most aggressive variant of the course of the process is characteristic of malignant diseases, the chylous form. Doctors pay attention: ascites does not change the duration of a person's life, but the survival prognosis for the underlying disease is significantly worse. 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 the pathological condition, lives for a year. The probability of twice as long is estimated at 50%.
Possible consequences of abdominal ascites include bleeding in the upper parts of the 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 swell, the liver, the work of the heart goes astray,vessels. Against the background of ascites, a hernia may appear. Surgical intervention can cause a fistula in the area of \u200b\u200bthe seam, puncture. There is a danger of infection, as a result - peritonitis of a bacterial nature. A complication with a high degree of probability can be fatal.
