Why does fluid accumulate in the abdominal cavity? Ascites. Causes, symptoms and signs Accumulation of fluid in the abdominal cavity

Ascites or dropsy of the abdomen a pathology in which abdominal cavity free fluid accumulates. It happens that the amount of liquid reaches 20-25 liters, which brings the patient maximum discomfort and suffering. Ascites is not an independent disease, but a complication or symptom of some pathology, for example, malignant neoplasms, cirrhosis of the liver, etc. The accumulation of fluid in the peritoneum often indicates untimely or incorrect therapy of the underlying disease.

The development of ascites is associated with impaired circulation of lymph and blood in the peritoneal cavity, as a result of which there is an accumulation of transudate or non-inflammatory fluid in it. Also, the development of pathology is associated with inflammation, leading to the formation of effusion and exudate. When a high concentration of protein and leukocytes is found in the liquid, we are talking about infection, which often leads to the development of peritonitis.

Ascites classification

Ascites of the peritoneal cavity is classified according to a number of criteria.

According to the volume of fluid accumulated in the cavity, there are:

1. transient - up to 400 ml.
2. moderate - from 500 ml to 5 liters.
3. resistant (tense) - more than 5 liters.

Depending on the presence of pathogenic microflora in the fluid, ascites is divided into:

• sterile, in which the presence of harmful microorganisms is not observed.
• infected, in which microbes multiply in the contents of the abdominal cavity.
• spontaneous peritonitis due to exposure to bacteria.

Ascites is also classified by responsiveness to drug treatment:

• ascites, amenable to conservative methods of treatment.
• refractory ascites - resistant to drug therapy.

Chylous ascites

Chylous astitis is a rare complication of end-stage liver cirrhosis or obstruction of the abdominal lymphatic duct, chronic intestinal inflammation. Ascitic fluid in this type of pathology has a milky hue due to the presence in the transudate a large number fat cells.

The chylous type of ascites can also be a complication of tuberculosis or pancreatitis, injuries of the peritoneal organs.

Causes of fluid in the abdominal cavity

Almost 80% of cases of fluid accumulation in the abdomen are caused by pathological processes in the liver and liver cirrhosis in the final stage of decompensation, which is characterized by depletion of hepatic resources and significant circulatory disorders, both in the organ itself and in the peritoneum.

Other hepatic causes include:

• portal hypertension.
• Hepatitis B chronic course(including alcohol).
• obstruction of the hepatic vein.

9-10% of cases of ascites are associated with oncological pathologies of the abdominal organs, metastases in the stomach. Causes in women often lie in oncopathologies of the pelvic organs. At malignant neoplasms there is a deterioration in lymphatic circulation and blockage of lymphatic outflow tracts, as a result of which the fluid is not able to exit and accumulates.

Interesting: ascites, which developed as a result of oncopathologies, often indicates the approaching death of a person.

5% of cases of dropsy of the abdomen are associated with pathologies of the heart muscle accompanied by circulatory decompensation. Doctors call this condition "cardiac ascites." It is characterized by significant edema lower extremities, and in advanced cases, swelling of the whole body. As a rule, with heart disease, fluid is collected not only in the abdomen, but also in the lungs.

Rarely, dropsy of the abdomen can be caused by the following conditions:

• renal pathologies such as amyloidosis, glomerulonephritis.
• diseases of the pancreas.
• portal vein thrombosis.
• peritoneal tuberculosis.
• acute dilatation of the stomach.
• Lymphogranulomatosis.
• Crohn's disease.
• intestinal lymphangiectasia.
• protein starvation.

The accumulation of fluid in the abdomen and retroperitoneal space is observed not only in adults, but also in newborns.

Among the factors for the development of ascites in this category of patients are:

• congenital nephrotic syndrome.
• hemolytic disease that occurs in a child due to the incompatibility of the group and the Rh factor of the blood in the mother and fetus.
• various diseases of the liver and bile ducts.
• exudative enteropathy acquired hereditarily.
• protein deficiency leading to severe dystrophy.

Symptoms of fluid in the abdomen

The accumulation of fluid in the abdominal cavity is a gradual process, however, in the case of, for example, portal vein thrombosis, ascites develops rapidly.

The manifestation of symptoms of pathology does not appear immediately, only if the volume of the contents of the peritoneal cavity exceeds 1000 ml.

1. The main manifestation of ascites is an increase in the size of the abdomen. When the patient is in a vertical position, the abdomen sags, while in a horizontal position it looks flattened with clearly protruding lateral sections.
2. The patient's navel protrudes strongly.
3. Astitis caused by portal hypertension is accompanied by the appearance of a vascular network on the skin around the umbilical ring, which can be easily seen under the stretched skin.
4. Patients complain of shortness of breath and difficulty breathing. This manifestation of the disease is due to the fact that the contents of the peritoneal cavity shifts the diaphragm upward, which leads to a decrease in the volume of the chest cavity and compression of the lungs, which are difficult to straighten out when trying to inhale.
5. Often the first complaints are a feeling of fullness in the abdomen, bloating, heaviness.

Important: due to the fact that ascites is a complication of other pathological processes in the body, other signs are directly related to the underlying disease and may be different in each case.

Diagnostics

A specialist is able to suspect ascites in a patient already upon examination, by probing and “tapping” the stomach. To confirm the diagnosis, the patient undergoes studies that visualize the peritoneal cavity:

• Radiography.

Important: ultrasound and CT also reveal the main cause of the development of pathology.

For diagnosis, they also resort to puncture of the peritoneal cavity and laboratory research methods:

1. clinical blood and urine tests.
2. biochemical blood test (according to its data, the condition of the patient's liver and kidneys is assessed).
3. study of peritoneal contents obtained by puncture.

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Treatment of ascites

Important: the treatment of ascites should be, first of all, aimed at eliminating the cause of its development.

Therapy of dropsy of the abdomen is carried out by conservative, symptomatic and operative methods.

With transient ascites, they resort to the use of medications (diuretics) and recommend the patient to bed or semi-bed rest to improve the quality of lymphatic drainage.

If dropsy of the abdomen is caused by hypertension of the portal vein, Albumin, hepatoprotectors and plasma transfusion are prescribed.

In the absence of a positive effect from conservative treatment, as well as with a large volume of accumulated fluid, symptomatic therapy is carried out. This method includes laparocentesis - a puncture of the peritoneal wall with pumping out of its contents from the cavity. The procedure is performed in the operating room local anesthesia. In one procedure, no more than 5 liters are pumped out. The frequency of use of procedures is 1 time in 3-4 days.

Important: laparocentesis is a rather dangerous procedure, with each subsequent use of which, the risk of damage to a. Also, the danger lies in the fact that, together with the pumped out fluid, a protein is excreted from the body, the deficiency of which is the cause of repeated ascites.

With rapidly developing dropsy, drainage catheters are used, which are installed for non-stop drainage of fluid.

In case of recurrence of the pathology, surgical intervention is prescribed, in which the inferior vena cava and portal vein are connected and collateral circulation is created. If, before the operation, specialists repeatedly resorted to removing ascitic fluid from the patient's abdomen, plasma transfusion is carried out at the same time, and a protein diet is recommended after the operation.

In the most severe cases, a donor liver transplant is indicated.

Forecasts are determined by the severity of the course of the pathology that caused ascites. Life expectancy has no direct relationship with the accumulation of fluid in the abdomen, however, increasing dropsy contributes to the aggravation of the underlying disease and worsening general condition sick.

Ascites - pathological condition, which requires urgent and mandatory intervention of doctors. Lack of treatment or started, but with a delay, leads to the rapid development of complications. If fluid accumulation in the abdomen is suspected, an urgent examination and adequate treatment is necessary, which will help increase the chances of a favorable prognosis.

Ascites, or abdominal dropsy, is often the result of another, more dangerous and difficult to treat disease. Nevertheless, ascites itself can complicate the life of the patient and lead to sad consequences. modern medicine enough effective methods treatment of ascites at its various stages. What you need to know about the first signs of ascites, the course of its development, and which doctor to contact for help?

Ascites as a frequent companion of dangerous diseases

In medicine, ascites is understood as a secondary pathological condition, which is characterized by the accumulation of fluid in the abdominal cavity. Most often, ascites is caused by a violation of the regulation of fluid exchange in the body as a result of serious pathological conditions.

In a healthy body, there is always a little fluid in the abdominal cavity, while it does not accumulate, but is absorbed by the lymphatic capillaries. For various diseases internal organs and systems, the rate of fluid formation increases and the rate of its absorption decreases. With the development of ascites, the fluid becomes more and more, it begins to compress the vital organs. This contributes to the aggravation of the development of the underlying disease and the progression of ascites. In addition, since the bulk of the fluid accumulates in the abdominal cavity, there is a significant decrease in the volume of circulating blood. This leads to the launch of compensatory mechanisms that retain water in the body. The patient significantly slows down the rate of urine formation and excretion, while the amount of ascitic fluid increases.

The accumulation of fluid in the abdominal cavity is usually accompanied by an increase in intra-abdominal pressure, impaired blood circulation and cardiac activity. In some cases, protein loss and electrolyte disturbances occur, causing cardiac and respiratory failure, which significantly worsens the prognosis of the underlying disease.

In medicine, there are three main stages in the development of ascites.

• transient ascites. At this stage, no more than 400 ml of fluid accumulates in the abdominal cavity. It is possible to identify the disease only with the help of special studies. Organ functions are not impaired. Removing the symptoms of ascites is possible with the help of the treatment of the underlying disease.
• moderate ascites. Up to 4 liters of fluid accumulate in the abdominal cavity at this stage. The patient's abdomen is enlarged. In a standing position, you can notice the bulging of the lower part abdominal wall. In the supine position, the patient often complains of shortness of breath. The presence of fluid is determined using percussion (tapping) or a symptom of fluctuation (fluctuations of the opposite wall of the abdomen when tapped).
• Tense ascites. The amount of liquid at this stage can reach, and in some cases even exceed, 10-15 liters. The pressure in the abdominal cavity rises and disrupts the normal functioning of vital organs. The patient's condition is severe, he must be urgently hospitalized.

Separately, refractory ascites, which is practically not treatable, is considered. It is diagnosed if all types of therapy fail and the amount of fluid not only does not decrease, but constantly increases. The prognosis for this type of ascites is unfavorable.

Causes of ascites

According to statistics, the main causes of abdominal ascites are:

• liver disease (70%);
• oncological diseases (10%);
• heart failure (5%).

In addition, ascites may be accompanied by the following diseases:

• kidney disease;
• tuberculosis of the peritoneum;
• gynecological diseases;
• endocrine disorders;
• rheumatism, rheumatoid arthritis;
• lupus erythematosus;
• diabetes second type;
• uremia;
• diseases of the digestive system;
• peritonitis of non-infectious etiology;
• violation of the outflow of lymph from the abdominal cavity.

The following factors can contribute to the occurrence of ascites, in addition to these diseases:

• alcohol abuse leading to cirrhosis of the liver;
• drug injections;
• blood transfusion;
• obesity;
• high cholesterol;
• tattoo;
• living in a region that is characterized by cases of viral hepatitis.

In all cases, ascites is based on a complex combination of violations of the vital functions of the body, leading to the accumulation of fluid in the abdominal cavity.

Signs of pathology

One of the main external signs abdominal ascites is an increase in the size of the abdomen. In the standing position of the patient, it can hang down in the form of an apron, and in the prone position form the so-called frog belly. There may be a protrusion of the navel and the appearance of stretch marks on the skin. With portal hypertension caused by increased pressure in the portal vein of the liver, a venous pattern appears on the anterior abdominal wall. This drawing is called the "head of Medusa" because of the distant resemblance to the mythological Gorgon Medusa, on whose head instead of hair there were writhing snakes.

There are pains in the abdomen and a feeling of fullness from the inside. The person has difficulty bending the torso. External manifestations also include swelling of the legs, arms, face, cyanosis skin. The patient develops respiratory failure, tachycardia. Constipation, nausea, belching and loss of appetite may occur.

With laboratory and instrumental studies, the doctor confirms the diagnosis and establishes the cause that caused ascites. For this, ultrasound, MRI, diagnostic laparocentesis and laboratory tests are performed. With the help of ultrasound, the presence of free fluid in the abdominal cavity and its volume, an increase in the liver and spleen, expansion of the vena cava and portal vein, a violation of the structure of the kidneys, the presence of tumors and metastases are detected.

MRI allows layer-by-layer examination of a particular tissue, revealing even a small amount of ascitic fluid and diagnosing the underlying disease that caused ascites.

In addition, the doctor conducts a study using palpation and percussion. Palpation helps to identify signs that indicate damage to a particular organ (liver or spleen). Percussion is used directly to detect ascites. Its essence lies in tapping the patient's abdominal cavity and analyzing percussion sounds. With severe ascites, for example, a dull percussion sound is determined over the entire surface of the abdomen.

Laboratory blood tests show a decrease in the concentration of erythrocytes, an increase in the number of leukocytes and ESR, an increase in the concentration of bilirubin (with cirrhosis of the liver), proteins of the acute phase of inflammation is possible. Urinalysis for ascites at the initial stage may show more urine of a lower density, since ascites causes abnormalities in the urinary system. In the terminal stage, the density of urine may be normal, but its total amount is significantly reduced.

Principles of therapy

The general principles of the treatment of ascites involve, first of all, the treatment of the underlying disease. Treatment of ascites itself is aimed at removing fluid from the abdominal cavity and preventing recurrence.

Patients with grade 1 ascites do not require drug treatment and following a salt-free diet.

Patients with the second degree of ascites are prescribed a diet with reduced content sodium and diuretic therapy. It should be carried out with constant monitoring of the patient's condition, including the content of electrolytes in the blood serum.

Patients with the third degree of the disease carry out the removal of fluid from the abdominal cavity, and further diuretic therapy in combination with a salt-free diet.

Treatment prognosis

Ascites usually indicates a serious malfunction of the affected organs, but nevertheless, it is not a fatal complication. At timely diagnosis and proper treatment it is possible to completely eliminate ascitic fluid from the abdominal cavity and restore the functions of the affected organ. In some cases, for example, in cancer, ascites can progress rapidly, causing complications and even death of the patient. This is explained by the fact that the course of ascites is greatly influenced by the underlying disease, which can cause serious damage to the liver, kidneys, heart and other organs.

Other factors also affect the prognosis:

• Grade of ascites. Transient ascites (first degree) is not an immediate threat to the patient's life. In this case, all attention should be paid to the treatment of the underlying disease.
• Start time of treatment. If ascites is detected at a stage when the vital organs are not yet destroyed or their functions are slightly affected, the elimination of the underlying disease can also lead to a complete recovery of the patient.

The type and severity of the underlying disease also affects the survival statistics for ascites. With compensated liver cirrhosis, 50% of patients are able to live from 7 to 10 years, and with decompensated - a five-year survival rate does not exceed 20%.

In oncological diseases, ascites, as a rule, appears in the later stages, and the five-year survival rate is no more than 50% with timely treatment. The average life expectancy for these patients is 1–2 years.

If not properly treated, ascites can cause serious complications worsening prognosis:

• bleeding;
• peritonitis;
• swelling of the brain;
• dysfunction of cardiac activity;
• severe respiratory failure.

Ascites recurrences can also occur as side effects with the wrong treatment. Recurrence is very dangerous, since in most cases, incurable ascites is fatal.

Conservative treatment of abdominal ascites

Conservative or symptomatic treatment of ascites is used in cases where abdominal ascites is at an early stage of development or as a palliative therapy for oncology and the inappropriate use of other methods.

In all cases, the main task of treatment is to remove ascitic fluid and maintain the patient's condition at a certain level. To do this, it is necessary to reduce the amount of sodium entering the body and increase its excretion in the urine.

Reach positive results It is possible only with an integrated approach, following a diet, controlling weight changes and taking diuretic drugs.

Main diet principles with ascites:

• Salt minimum. Its excess consumption leads to the development of edema, and consequently, ascites. Patients are advised to limit the intake of salty foods as much as possible.
• Fluid Minimum. With moderate or intense ascites, the norm should be no more than 500–1000 ml of pure liquid per day.
• Minimum fat. Consumption of food with a lot of fat leads to the development of pancreatitis.
• Enough protein in the diet. It is protein deficiency that can lead to edema.

Prohibited fatty meat and fish, fried foods, smoked meats, salt, alcohol, tea, coffee, spices.

In the treatment of ascites, it is necessary to control the dynamics of weight. At the beginning of a salt-free diet, daily weighing is performed for a week. If the patient has lost more than 2 kg, then diuretic drugs are not prescribed to him. With a weight loss of less than 2 kg, drug therapy is started over the next week.

Diuretic drugs help to remove excess fluid from the body and promote the transition of part of the fluid from the abdominal cavity into the bloodstream. Clinical manifestations ascites is significantly reduced. The main drugs used in therapy are furosemide, mannitol and spironolactone. On an outpatient basis, furosemide is administered intravenously no more than 20 mg once every two days. It removes fluid from the vascular bed through the kidneys. The main disadvantage of furosemide is excessive excretion of potassium from the body.

Mannitol is used in conjunction with furosemide, since their action is combined. Mannitol removes fluid from the intercellular space into the vascular bed. It is prescribed 200 mg intravenously. However, it is not recommended for use on an outpatient basis.

Spironolactone is also a diuretic, but it can prevent excessive potassium excretion.

Additionally, drugs are prescribed that strengthen vascular walls(vitamins, diosmin), drugs that affect the blood system (Gelatinol, Reopoliglyukin), albumin, antibiotics.

Surgical manipulations

Surgery for ascites is indicated in cases where the accumulation of fluid cannot be eliminated with conservative treatment.

Therapeutic laparocentesis with ascites (puncture of the anterior abdominal wall) it is able to remove large volumes of fluid - from 6 to 10 liters at a time. The procedure is performed under local anesthesia with preliminary emptying Bladder. The patient takes a semi-sitting or lying position. The puncture is made along the midline of the abdomen between the navel and the pubic bone. A skin incision is made with a scalpel, through which a special instrument, a trocar, is inserted into the abdominal cavity. Through it, the liquid is removed in the right volume. After the procedure, the wound is sutured. Laparocentesis with ascites can only be performed in a hospital, since it is necessary to comply with antiseptic standards and master the technique of the operation. To simplify the procedure for those patients who require periodic laparocentesis, it is performed through a permanent peritoneal port.

Another effective surgical procedure is omentohepatophrenopexy . It consists in suturing the omentum to the pre-treated areas of the surface of the diaphragm and liver. Due to the appearance of contact between the liver and the omentum, it becomes possible for the absorption of ascitic fluid by neighboring tissues. Additionally, the pressure in the venous system and the exit of fluid into the abdominal cavity through the walls of the vessels are reduced.

TIPS - transjugular intrahepatic portosystemic shunting - allows decompression of the portal system and elimination of ascitic syndrome. In general, TIPS is performed for refractory ascites that is not amenable to drug therapy. In the TIPS procedure, a guidewire is inserted into the jugular vein before entering the hepatic vein. Then a special catheter is passed through the conductor into the liver itself. Using a long, curved needle, a stent is placed in the portal vein, creating a channel between the portal vein and the hepatic vein. The blood is directed to the hepatic vein with reduced pressure, which leads to the elimination of portal hypertension. After TIPS in patients with refractory ascites, there is a decrease in fluid volume in 58% of cases.

Despite the fact that ascites and the diseases that cause it are quite serious and difficult to treat, timely complex therapy can significantly increase the chances of recovery or improve the quality of life of terminally ill patients. It is necessary to treat ascites only under the supervision of a doctor, since the complexity of the underlying disease rarely allows home or folk methods. This is especially true of ascites caused by oncology.

Ascites is the accumulation of fluid in the abdominal cavity, usually caused by cirrhosis of the liver, but can also be a symptom of other diseases.

Consider the types and causes of fluid accumulation in the abdominal cavity and we will analyze the symptoms and typical signs.

What is ascites - characteristics

Ascites is medical term used in gastroenterology to refer to pathological accumulation of fluid in the abdominal cavity.

The function of the fluids in the abdominal cavity is to ensure the free sliding of the membranes of the peritoneum and internal organs. Under normal conditions, the abdominal cavity contains 10 to 30 milliliters of liquid, and in some cases of severe ascites, more than 10 liters may accumulate.

Fluid accumulation happens in two ways:

• Exudation, that is, the formation of exudate - a fluid that comes from blood vessels, due to an increase in their permeability during a local inflammatory process. Inflammation is known to be associated with the formation of a number of chemical mediators, including histamine. Their task is to increase the permeability of tissues in order for cells to immune system it was easier to reach the site of inflammation. An increase in permeability leads to the fact that the walls of blood vessels begin to pass blood serum. From here appears ascitic fluid, which in such conditions is rich in proteins, as well as blood cells (in particular, albumin and leukocytes).
• extravasation, that is, the formation of a transudate, which also has a vascular origin, but is released without inflammation, but due to an increase in hydrostatic pressure inside the vessel. The ascitic fluid thus formed is poor in proteins and blood cells, and therefore has a lower specific gravity.

The difference between the concentration of albumin in ascitic fluid used to evaluate the form of origin. This parameter is referred to as SAAG. If the SAAG value is below 1 mg/dL, then it is an exudate, and, conversely, if the SAAG is greater than 1 mg/dL, it is a transudate.

Classification and types of ascites

It is generally accepted to classify ascites according to its severity, i.e. depending on the volume of fluid accumulated in the abdominal cavity.

Here you can highlight:

• Ascites grade 1 or mild . The amount of fluid is negligible, not obvious to most diagnostic methods, and can only be detected with an abdominal ultrasound.
• Ascites grade 2 or moderate . It can be identified semiotically, by a characteristic dull sound.
• Ascites grade 3 or severe . It can be detected by simple observation, the volume of the abdominal cavity is greatly increased, and the abdomen is tense.

Symptoms that accompany ascites

The symptoms that ascites manifests, of course, are highly dependent on the severity of the condition. If a mild ascites, then it does not appear no symptoms, it is difficult to detect even with the help of instrumental examinations, only ultrasound or CT of the abdominal cavity helps.

If a ascites is severe, accompanied by the following symptoms:

• Bloating and heaviness of the abdomen.
• Bloating, swelling and increase in the volume of the abdomen.
• Breathing problems due to the pressure of the contents of the abdominal cavity on the diaphragm. Squeezing leads to dyspnea (shortness of breath, short and rapid breathing).
• pain in a stomach.
• flat navel.
• Lack of appetite and an instant feeling of satiety.
• Swollen ankles (edema) due to excess fluid.
• Other typical symptoms of the disease such as portal hypertension (resistance to blood flow) in the absence of cirrhosis.

Diagnosis of ascites

If the accumulation of fluid in the abdominal cavity does not exceed the minimum threshold, which is about half a liter, then they speak of mild ascites, which can only be detected using abdominal ultrasound. In the case of volumes exceeding the specified, diagnosis is possible without additional studies.

The specialist you should contact is gastroenterologist. He will formulate a diagnosis and look for the disease that led to the accumulation of fluid in the abdominal cavity, using:

Anamnesis – medical history of the patient and family, information about previous diseases, therapy used, lifestyle, for example, alcohol abuse, etc.

Symptom analysis : ascites is characterized by a number of "unmistakable" signs:

• frog belly. It can be seen when the patient lies on his side. In this position, the fluid in the abdominal cavity drains to one side and the abdomen takes on a shape similar to a frog or toad.
• dull sound- characteristic of a barrel filled with liquid.
• drum sound- typical of an empty barrel or cavity containing gas.
• splash sound- if you hit with the palm of your hand, and on the other hand, attach your palm.

The formulated hypothesis will be confirmed by a series clinical research:

Blood analysis aimed at evaluating:

• liver function- enzymes (transaminases) and proteins (albumin, blood coagulation factors);
• kidney function- creatinine, azotemia;

General blood analysis- the number of corpuscular cells in the blood.

Electrolyte concentration- sodium, potassium, chlorine, which affect fluid retention.

Ultrasound or CT scan of the abdomen allow you to assess the amount of fluid accumulated in the abdominal cavity, and the condition of organs, such as the liver and spleen (its increase is an accurate sign of portal hypertension).

Puncture study. It consists in introducing a thin needle through the abdominal wall to obtain a sample of fluid and analyze it.

In particular, the following analyzes are performed:

• Search and evaluation of albumin concentration.
• Seeding culture in order to discover possible infections and their pathogens.
• Cytological analysis to identify possible neoplasms.
• Finding and counting blood cells such as leukocytes.
• Amylase Search. The presence of amylase, an enzyme that speeds up the breakdown reactions of complex sugars, is a sign of damage to the pancreas and hence pancreatitis.

Causes of accumulation of fluid in the abdominal cavity

The disease that most often leads to ascites is cirrhosis of the liver In fact, more than 70% of patients with abdominal fluid problems suffer from complications of cirrhosis, and half of patients with cirrhosis experience ascites.

However, ascites can also have many other causes, all very serious, such as: abdominal tumors, heart failure, etc..

In the following table, we have collected the main causes (pathologies that cause the problem), given short description and the main symptoms that accompany ascites.

Causes that determine the accumulation of fluid in the abdominal cavity due to extravasation:

The reasons that determine the accumulation of fluid in the abdominal cavity due to exudation:

Treatment of ascites

Since ascites is a symptom, treatment involves therapy in the direction of the underlying disease. So, for example, if ascites is a consequence of cirrhosis, then a liver transplant is required, but if there is tumor ascites, surgical removal of the tumor and restorative treatment are necessary.

However, it is often necessary treat a symptom, then proceed as follows:

• Bed rest.
• Diet low in salt and therefore low in sodium. This increases diuresis and therefore promotes the elimination of fluid accumulated in the peritoneum.
• Taking diuretics. The most commonly used is spironolactone.
• Therapeutic paracentesis. It consists in removing with a needle ascitic fluid accumulated in the abdominal cavity. Used in case of severe tension in the abdomen, large volumes of fluid or insensitivity of the patient to the action of diuretics.

Ascites is the presence of free fluid in the abdominal cavity, which accumulates outside the organs and tissues.

Ascites can develop as a result of a large number of diseases of organs and systems (not only structures of the abdominal cavity). But in 75% this condition is a complication of liver cirrhosis.

This pathology is also called dropsy of the abdomen.

Causes of ascites

There are about a hundred conditions and diseases that can cause the accumulation of free fluid in the abdominal cavity. The main ones are:

• cirrhotic degeneration of the liver;
• malignant tumors of various organs;

These three causes of ascites account for 90% of cases of this pathology. Other reasons for the accumulation of free fluid in the abdominal cavity are as follows:

Also, ascites can occur due to the progression of a number of chronic specific diseases - first of all, these are:

• tuberculous inflammation of the peritoneum;
• inflammation of the serous membranes (those that produce a biological fluid that lubricates the membranes);
• some diseases of the gastrointestinal tract - first of all, it is (a disease with the formation of multiple seals), chronic, sarcoidosis (a disease of many organs with the formation of nodules similar to granulomas).

Inflammation of the serous membranes, provoking ascites, can occur with diseases such as:

Newborns and children infancy are also at risk for ascites. Often this happens due to congenital pathologies- primarily such as:

• congenital edema that occurs due to incompatibility in blood type or Rh factor between mother and child. Such children die almost immediately after birth;
• congenital swelling of tissues that arose due to latent blood loss during fetal development;
• failure in the development or functioning of the liver and biliary tract due to their congenital disorders;
• loss of plasma protein due to its excessive release into the lumen of the small intestine;
• Kwashiorkor is a disease of starving children, which is based on a lack of protein in the diet.

A number of factors have been identified that do not lead directly to the accumulation of fluid in the abdomen, but contribute to the development of ascites. First of all it is:

• chronic alcohol abuse, even with a low degree - for example, with the so-called beer alcoholism, when a person consumes a portion of beer daily for years;
• chronic (not only);
• the use of injectable (introduced into tissues or bloodstream) drugs;
• blood transfusion, which is carried out with violations;
• type 2 (a type of diabetes mellitus that develops due to the disruption of the interaction of insulin, which breaks down blood sugar, with tissues);
• increased amount .

Development of pathology

The peritoneum, which lines the inside of the abdominal cavity and envelops a number of its organs, normally secretes a small amount of serous fluid, similar in composition to blood plasma. This fluid is necessary so that the internal organs, which are quite compactly located in the abdominal cavity, do not stick together, and so that there is no friction between them. During the day, serous fluid is secreted and absorbed by the peritoneum many times. Its increased production and deterioration of absorption lead to the accumulation of free fluid in the abdomen.

This is a general mechanism for the occurrence of ascites, with a number of pathologies it may differ. How excess fluid accumulates in the abdomen can be vividly illustrated by the example of cirrhosis of the liver:

Ascites is dangerous because it forms a so-called vicious circle - the process of excessive fluid formation and poor absorption starts, but it is difficult to get out of this state, because the breakdown of some mechanisms provokes the breakdown of others, which further contribute to the growth of ascites:

• if the veins are compressed, the body tries to unload them, and the excess fluid is sent to the lymphatic system, but it can also cope with the extra load to a certain level - then the lymph pressure rises, the fluid from the lymphatic vessels seeps into the abdominal cavity;
• as fluid from the blood vessels rushes into the abdominal cavity, this leads to a decrease in blood volume and its pressure. To compensate for this condition, the body produces more hormones. But due to the increased production of hormones, increases arterial pressure. The fluid does not retain well in the vessels and rushes into the abdominal cavity - ascites grows.

In case of tumor or inflammatory process some membrane begins to produce more fluid than it can suck back - this causes ascites. In addition, swelling and edematous tissues due to inflammation put pressure on lymphatic vessels, not allowing the lymph to move freely along them, the liquid part of the lymph rushes into the tissues and cavities - including the abdominal cavity.

If heart failure has developed, then the blood flow is disturbed not only in the heart, but also in the veins of the liver and peritoneum. The plasma from the vessels passes into the abdominal cavity. The peritoneum is not ready to absorb an additional amount of fluid - ascites occurs.

Symptoms of ascites

Depending on the provoking disease, signs of ascites can develop both suddenly and gradually, over several months. So, when the portal vein is clogged with a thrombus, the amount of free fluid in the abdominal cavity increases very quickly, with protein starvation - gradually. Symptoms appear if more than 1 liter of fluid has accumulated in the stomach.

The main signs of ascites are:

• feeling of bursting;
• an increase in the abdomen;
• weight gain;
• difficulty with physical activity - in particular, when trying to lean forward;

If the abdomen increases in size very quickly, this means that the lymphatic vessels are compressed.

Dyspeptic shifts that appear with ascites are explained by the fact that an increasing amount of free fluid presses on the digestive organs, which prevents them from performing their functions. There are signs such as:

Shortness of breath in the initial stages of ascites occurs when physical activity. As the amount of free fluid in the abdomen builds up, it presses on the lungs and heart, causing shortness of breath even at rest.

Puffiness is explained by mechanical compression of the veins and a violation of blood flow in them, followed by the release of fluid into the tissues. With ascites, in general, in men, the scrotum can sometimes swell.

If ascites arose due to, then appear characteristics intoxication (poisoning of the body with the waste products of a tubercle bacillus). It:

• general weakness;
• unexplained fatigue that occurs even at rest;
• weight loss. The patient in this case looks very characteristic: thin arms and legs and a large belly.

If ascites arose due to protein deficiency, then it is not very pronounced, a significant increase in the abdomen is not observed. But for given state characteristic:

• swelling of the upper and lower extremities;
• - it occurs because the fluid, in addition to the abdominal cavity, accumulates in the pleural cavity, squeezing the heart and lungs and thereby worsening their work.

Diagnosis of ascites

Complaints of the patient with ascites are quite typical. Even more characteristic are the data of a physical examination of the patient - examination, palpation of the abdominal wall, tapping and listening to the abdomen with a phonendoscope. Based on their combination, it is not difficult to make a diagnosis of ascites.

The inspection details are as follows:

The following sign is indicative - if one palm is placed on the side of the patient, and the fingers of the other hand push the other side, then fluctuations ("waves") of the fluid inside the abdomen will be felt.

If you tap the abdomen, the sound will be dull, as, for example, on a tree - in the lower abdomen, if the patient is standing, and in the lateral sections, if he is lying.

With a significant accumulation of fluid in the abdominal cavity, when listening to the abdomen, it is possible to ascertain the subsidence of intestinal noises.

Complaints of the patient, studying the history of his illness (for example, the presence of hepatic or cardiovascular diseases) and physical examination findings are often sufficient to make a diagnosis of ascites. Instrumental and laboratory methods studies are used additionally to confirm the diagnosis and determine the cause of ascites.

Of the instrumental methods for the diagnosis of ascites, the following are used:

In the diagnosis of ascites, laboratory research methods such as:

In addition, if treatment is started, the daily dynamics (changes) in the patient's weight should be monitored, for this patient they are periodically weighed. In 24 hours, he should lose approximately 500 grams. It should also be borne in mind that the amount of liquid taken (in the form of tea, juices, soups, and so on) should be slightly larger than the amount allocated (at normal body and air temperature).

Complications

Being a complication of other pathologies, ascites, in turn, can also lead to complications. The most common are:

• (in case of suppuration of fluid in the abdominal cavity);
• transition to refractory ascites - one that does not respond to treatment with diuretics. It can develop with severe cirrhosis of the liver, liver cancer, kidney disease, and so on;
• discharge of fluid through the umbilical hernia.

Treatment of ascites

Free fluid is easy to remove from the abdominal cavity - but the causes of ascites will remain. That's why a full-fledged treatment of ascites is the treatment of diseases that provoked its occurrence.

Regardless of what triggered the ascites, the general uses are as follows:

• bed or semi-bed (with getting out of bed only in case of physiological need) mode;
• restriction, and in advanced cases - the complete exclusion of sodium from food. It is achieved by limiting (or eliminating) the use of .

If ascites is due to, then with a decrease in the amount of sodium in the blood, fluid intake is also limited. different form(tea, juices, soups) - up to 1 liter.

Drug therapy depends on the disease that provoked ascites. A common use, regardless of the cause of ascites, is diuretics. This may be either their combination with potassium preparations, or potassium-sparing diuretics. Also appointed:

• with - hepatoprotectors (drugs that protect liver cells);
• with a low amount of protein in the blood - protein preparations that are administered intravenously . As an example - albumin, fresh frozen plasma (it is administered if there are violations of the blood coagulation system during ascites);
• with - drugs that support the work of the heart (they are selected depending on what is the cause of the failure)

Surgical treatments for ascites are used for:

• significant accumulation of free fluid in the abdominal cavity;
• if conservative methods show low performance or do not show it at all.

Main surgical methods that are used for ascites are:

Prevention of ascites

In order to prevent the development of ascites, it is necessary to identify and treat diseases and conditions that can provoke it in advance.

Prognosis for ascites

The prognosis for both health and life depends on the disease that provoked ascites. It worsens with:

• over 60 years of age;
• lowering blood pressure;
• loss of protein (in particular, if the amount of albumin in the blood is below 30 grams per liter);
• diabetes mellitus;
• ascites resistant to diuretics.

In most cases, the presence of ascites means that the disease that provoked it is running. 50% of patients with ascites die within 2 years of onset. If a form insensitive to diuretics has developed, half of the patients die within six months.

Kovtonyuk Oksana Vladimirovna, medical commentator, surgeon, medical consultant