Abdominal ascites: causes and treatment

Ascites, which is sometimes called abdominal dropsy, is not a separate disease, but a complication of a number of independent diseases. And almost all of them are extremely dangerous for health and life. How is ascites ascites diagnosed, what causes it and is it possible to cure it?

Ascites: a disease or symptom?

A pathological accumulation of fluid in the abdominal cavity is called ascites. A small amount of ascitic fluid is always present in the peritoneal cavity. This fluid is constantly moving into the lymphatic vessels, and a new one takes its place, and this is a completely natural process. But with some disturbances in the body, this fluid either begins to be produced in excess, or ceases to be absorbed. As a result, it gradually accumulates and begins to put pressure on the internal organs, impairing their functioning.

Causes of ascites

The list of diseases and disorders in which ascites can occur is very impressive. Among them:

  • cirrhosis of the liver,
  • some oncological diseases,
  • tuberculosis,
  • pancreatitis
  • heart failure,
  • endometriosis, cysts and ovarian tumors,
  • internal bleeding
  • kidney disease
  • malnutrition and exhaustion,
  • endocrine system diseases.

However, if a person is diagnosed with ascites ascites, the cirrhosis of the liver (the cause of 75% of cases of ascites), oncological diseases (10% of cases) and heart failure (5% of cases) are usually the first to be suspected by doctors. All other diseases taken together account for only 10% of cases of ascites in the abdominal cavity.

Of course, ascites does not occur in all people suffering from the above diseases. However, there are risk factors that increase the chances of developing ascites: alcoholism, drug addiction, hepatitis, obesity and high cholesterol, as well as diabetes.

Signs of pathology

Ascites of the abdominal cavity most often develops gradually over many months, and therefore most patients do not pay attention to it for a very long time. Often people just think that they are gaining weight.

In the early stages, ascites is really difficult to notice: you need to collect at least a liter of fluid. Only after that the typical symptoms of ascites ascites begin to appear: abdominal pain, flatulence, belching and heartburn, shortness of breath, swelling of the legs. As the volume of fluid increases, the stomach also grows, soon it becomes difficult for a person to lean. The abdomen takes the form of a ball, stretch marks and dilated veins may appear.

But in order to make a diagnosis, there are few external signs - you need to consult a doctor.

Diagnostics

It begins with a visual examination and palpation of the abdomen. An experienced doctor can diagnose ascites already on the basis of only these data, but more precise methods are required to clarify. It is not enough to know that the patient has ascites - it is much more important to find out what caused him.

If ascites is suspected, ultrasound of the abdominal cavity and chest is prescribed - it allows you to see both ascites and neoplasms or changes in the structure of the liver. Sometimes Dopplerography is also indicated, showing the state of the veins.

Radiography is another method that is widely used in the diagnosis of ascites. This examination makes it possible to detect tuberculosis or an increase in heart size, which can cause accumulation of fluid in the abdominal cavity.

MRI and CT are very accurate diagnostic methods that allow you to see the presence of fluid even where it is difficult to consider with ultrasound and radiography.

In some cases, the doctor may refer the patient to laparoscopy, in which the abdominal wall is punctured and the accumulated fluid is taken for analysis. A biochemical blood test and urinalysis are also performed.

Principles of therapy

Treatment of ascites always begins with the treatment of the underlying disease that caused the accumulation of fluid.

  • In ascites caused by heart disease, vasodilators, diuretics and glycosides are prescribed.
  • In renal diseases, a low-salt diet and limiting fluid intake are indicated.
  • In cases of protein metabolism disorders, a diet with an optimal protein content and albumin transfusion is prescribed.
  • With cirrhosis, hepatoprotectors are used.

In addition to this, symptomatic therapy is prescribed:

  • low-salt diet (no more than 2 g of salt per day), and in some cases a completely salt-free diet. If cirrhosis is the cause of ascites, you should also limit your fluid intake,
  • potassium preparations and diuretics.

During treatment, the doctor monitors changes in the patient's condition and, in particular, his weight. If the selected therapeutic measures work, weight loss should be about 500 grams per day.

Surgical intervention

If conservative methods for some reason do not give the expected result, surgical intervention is indicated. Often with ascites, fluid is removed by gradual drainage (if its amount is significant). The surgeon makes a small puncture in the peritoneum and inserts a drainage tube (laparocentesis) into it.

An alternative to this painful and high-risk method is the placement of permanent catheters and subcutaneous ports. As a result, ascitic fluid is removed as it accumulates. This approach greatly facilitates the life of patients, eliminates the need for repeated punctures, which means reducing the risk of damage to internal organs and inflammation.

Installation of the system is a simple surgical operation, during which the doctor inserts the end of the catheter (made of hypoallergenic materials) into the abdominal cavity, while the port itself (it is made of titanium) is placed subcutaneously in the region of the costal arch. In order to evacuate the fluid accumulated in the abdominal cavity, it is necessary to pierce the skin and the silicone membrane of the port chamber with a special needle. Through it, ascites fluid is pumped out. In a similar way, you can enter medications.

Sometimes the so-called intrahepatic bypass is required, in which the doctor creates a message between the hepatic and portal veins.

In severe cases, a liver transplant may be required.

Treatment prognosis

The sooner ascites is diagnosed and treatment begins, the higher the chances of success. Getting rid of ascites in the early stages is much easier. But there are some factors that negatively affect the effectiveness of therapy - this is old age, diabetes mellitus, hypotension, cancer (and especially liver cancer), peritonitis, as well as low levels of albumin.

Ascites is deadly. In approximately 50% of cases, if the appointment of diuretics does not help, the development of ascites ends tragically. Especially dangerous is ascites in cancer - a fatal outcome is likely in about 60% of cases.

Possible complications and risk of relapse

It should be remembered that ascites always worsens the course of the underlying disease, causing respiratory failure, hydrothorax, hernias, bowel obstruction and a host of other complications.

Even if ascites can be cured, you should be very careful about your health, as there is always a risk of relapse. Therefore, even after curing ascites, you should adhere to a diet prescribed by your doctor.

The accumulation of fluid in the abdominal cavity can cause severe discomfort, but even before this happens, other symptoms appear. You should not leave them unattended - be sure to consult a doctor.


If the amount of fluid in the abdominal cavity is less than 400 grams, ascites is almost invisible, but at this stage it can be detected using instrumental examinations, so regular examination by a specialist is very important. Especially with diagnosed oncology or cirrhosis.

What is ascites

This is a dangerous diagnosis, which is characterized by an increased accumulation of fluid in the abdominal cavity. Other important organs of the body, such as the lungs and heart, can suffer from ascites. The problem is not inflammatory in nature. The liquid accumulated in the peritoneum in volume can reach 15-20 liters. In people, this disease is called a "frog stomach", prone to a malignant course. For 75% of all clinical pictures, this is a complication of progressive cirrhosis, and the main goal of treatment is to suppress alarming symptoms and extend the period of remission.

Why does abdominal fluid accumulate?

The peritoneum, lining the walls of the abdominal cavity, releases a small amount of fluid, which in chemical composition is similar to blood plasma. It is necessary for the normal functioning of the internal organs, otherwise they would stick together. The fluid is absorbed and excreted throughout the day, but under the influence of pathological factors this natural process may be disrupted. With an imbalance, intra-abdominal pressure rises, the abdomen increases in size. An urgent diagnosis is required followed by complex therapy.

Reasons

This disease is a complication of cirrhosis of the liver and not only. It progresses gradually in the body, at first it does not manifest itself. Abdominal ascites is difficult to treat successfully. However, healing occurs if the main pathogenic factor is eliminated. The causes of ascitic disease are of an unexpected nature, the most common among them are presented below. It:

  • heart failure,
  • malignant neoplasms,
  • impaired portal vein pressure of the liver,
  • abdominal tuberculosis,
  • the development of mesothelioma, pseudomyxoma,
  • endocrine disruption,
  • female diseases (from the field of gynecology).

Why there is dropsy of the abdomen in newborns

Abdominal ascites can progress at any age, and infants with a characteristic ailment are no exception. The pathological process exacerbates in the prenatal period, is characterized by congenital impaired hepatic function. Infections of a pregnant woman cause such a disease at such a young age. Among these, the following diagnoses:

  • rubella of pregnant women,
  • syphilis,
  • toxoplasmosis,
  • listeriosis
  • hepatitis,
  • herpes,
  • measles.

At risk were newborns whose mothers during pregnancy abused drugs, drugs, alcohol, chemicals. In addition, ascites progresses in case of transfusion of pregnant women, with obesity, type 2 diabetes. So that from the first days of life a child does not get ascites in the abdominal cavity, a pregnant woman is not recommended to do permanent makeup, tattoos.

How does the accumulation of fluid in the abdominal cavity

The main symptom of peritoneal ascites is free fluid in the abdominal cavity, which collects and is not excreted naturally. This symptom of the disease provokes an increase in the abdominal cavity in size, and over time, this process only progresses. At first, the patient does not notice the characteristic changes in appearance, but then he cannot strain and relax the stomach. Additional symptoms of ascites are as follows:

  • abdominal pain
  • signs of dyspepsia,
  • weight gain
  • shortness of breath when walking,
  • big belly,
  • heartburn, belching,
  • fluctuation,
  • general discomfort
  • increased swelling of the limbs.

How to treat ascites

Having performed radiography and angiography, the doctor can make a prediction, determine an effective treatment regimen. The approach to the problem is complex, and for advanced clinical pictures it does not exclude an operation to remove oncology, laparocentesis. It all depends on the signs and symptoms of the diagnosis, the recommendations of a specialist. First, doctors seek to remove the focus of pathology conservatively, but if the fluid continues to accumulate in the abdominal cavity, you can’t do without surgery. Otherwise, oncology only progresses.

How is abdominal dropsy treated therapeutically

The main goal of drug therapy for ascites is to remove the accumulation of fluid in the abdominal cavity by a non-invasive method. Treatment is appropriate at an early stage when the peritoneum is not yet completely filled with transudate. With ascites, the doctor prescribes diuretics, calcium preparations. In the first case, we are talking about such medicines as Veroshpiron, Diakarb, Lasiks, Torasemide, after which water in the abdominal cavity disappears. In the second - calcium tablets, Panangin and Asparkam. In addition, it is recommended to use multivitamin complexes.

Causes of fluid accumulation in the abdomen, ascites

The causes of ascites can be varied, but the most common cause of fluid buildup in the abdomen is cirrhosis of the liver.

Ascites cannot be called liver disease, but fluid accumulation in the abdominal cavity is often the result of severe liver diseases, such as cirrhosis. According to statistics, 50% of people suffering from cirrhosis of the liver for more than 10 years have liver ascites.

It is worth noting that liver ascites indicates a severe course of cirrhosis and a possible fatal outcome. About half of the patients die 2 years after the detection of ascites developed in the presence of cirrhosis.

Severe heart failure can also cause accumulation of fluid in the abdomen - the development of ascites.

In some cases, when stomach cancer in the peritoneum, fluid begins to accumulate, as a result, the so-called ascites of the stomach is formed. Tumors spread to the inner lining of the stomach, which leads to an increase in the abdomen in volume.

So, causes of ascites or fluid accumulation in the abdomen are associated with the following diseases and pathologies:

Liver disease
Problems with heart,
Diseases of the peritoneum,
Kidney disease
Gastrointestinal diseases
Tuberculosis infection

The main symptoms of ascites

Symptoms of ascites vary depending on the stage and nature of the course of the disease.

Moderate ascites is often accompanied by edema of the lower extremities, an enlarged chest, an inguinal and umbilical hernia can be observed. The patient is concerned about heaviness in the abdomen, shortness of breath, heartburn, problems with stool. These symptoms of ascites are observed if the pathology develops gradually over the course of weeks and months.

A characteristic sign of fluid accumulation in the abdominal cavity is an enlarged abdomen. The size and shape of the abdomen depends on the stage of the disease.

With moderate ascites, the abdomen sags, and the veins of the abdominal cavity expand. If the patient takes a horizontal position, then the stomach is flat on the sides, while it is soft, the so-called "frog stomach". If you slightly push the stomach from the side, a response wave forms in the other side.

Tense ascites of the abdominal cavity is characterized by the appearance of a round abdomen, with tense, shiny, smooth skin. In this case, the skin of the hernial sac may become thinner, which leads to its rupture and the outflow of a certain amount of ascitic fluid. The patient may develop severe heart and respiratory failure.

Ascitic fluid can spontaneously become infected, and peritonitis develops. Peritonitis can lead to the death of the patient, so if you find signs of ascites, you should not delay a visit to the doctor.

Stages of the onset and development of ascites

There are 3 stages of ascites:

Transient ascites characterized by the accumulation in the peritoneum of a fluid with a volume of 400 milliliters, visually the fluid is not detected. At this stage, the treatment of ascites is quite effective, while dieting and a water-salt regimen are sufficient,

Moderate ascites characterized by a soft stomach. Abdominal ascites at this stage responds well to treatment, while albumin infusions and diuretics are prescribed. Laparocentesis may be needed - puncture and removal of fluid from the peritoneum. But abuse of this procedure can lead to kidney failure and the development of the next stage of the disease,

Tense or resistant ascites characterized by a large accumulation of fluid - up to 20 liters. In this case, the volume of fluid increases very quickly, the volume of the abdomen and the patient's weight increases. Treatment of ascites at this stage almost always requires a laparocentesis procedure, as one of the methods of complex therapy.

What kind of diet is needed for ascites (fluid buildup in the stomach)?

During the treatment of ascites, a special diet should be followed. The patient is limited in taking salt, fried and starchy foods.

There should be a reduced or moderate amount of fat in the diet, preference should be given to vegetable fats. Carbohydrates should be limited.

Also, fluid intake is limited to 0.75-1 liters per day.

Diet for ascites involves the use of the following products:

Lean meat
Fish,
Cereals
Fruits and vegetables,
Cottage cheese,
Greens

Dishes are boiled or steamed, while salt is not added. Fruits are consumed in the form of compotes and jelly. Vegetables can be cooked, baked and stewed.

With the accumulation of fluid in the stomach, it is strictly forbidden to drink alcohol, spices, marinades, seasonings, coffee and strong tea.

How to get rid of fluid in the stomach with folk remedies

Treatment of ascites with folk remedies only helps to get rid of excess fluid, but you can completely get rid of the accumulation of water in the stomach only when the disease that caused it is eliminated. Therefore, the treatment of ascites with folk remedies can only be an addition to medical treatment.

Here are some folk recipes to reduce the accumulation of fluid in the abdomen:

Bean pods are used as a diuretic to remove excess fluid. To prepare the broth use the husk of 20-30 bean pods, which is poured with 1 liter of water and boiled for 10 minutes. Then the broth is insisted for 20 minutes and filtered. Take the infusion in portions of 200 milliliters: the first portion - at 5 a.m., the second - 30 minutes before breakfast, the third - 30 minutes before lunch, the remaining volume - no later than 20 pm

Apricot decoction helps to replace potassium lost with the use of diuretics. The broth is prepared from fresh or dried apricots, for this 1 glass of fruit is poured with 1 liter of water and boiled for 40 minutes. 250-400 milliliters of decoction should be consumed per day,

Parsley decoction helps remove excess fluid from tissues. To prepare a decoction, 300 grams of parsley is boiled for 30 minutes in 1 liter of water. The broth is filtered and taken in 0.5 cups every hour in the morning.

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Where does the fluid come from in the abdominal cavity?

The abdominal cavity is the space in which the abdominal organs are located. From above it is delimited from the chest by the respiratory muscle - aperture, below - by the muscles that form the diaphragm of the pelvis. The front wall of the abdominal cavity is formed by the abdominal muscles, the back - the lumbar spine and lumbar muscles.

The inside of the abdominal cavity is lined with a thin film of connective tissue - parietal sheet of peritoneum. The latter goes to the internal organs and covers them from the outside - this is already visceral sheet of peritoneum. Thus, the abdominal cavity is the space between the parietal and visceral sheets of the peritoneum. In fact, it is a narrow gap.

In the abdominal cavity is constantly produced and absorbed serous fluid. Its main function is that it plays the role of a lubricant that facilitates the sliding of internal organs relative to each other. Normally, about 1.5 liters of serous fluid is formed and absorbed in the abdominal cavity per day in an adult. Constantly it is present only in small quantities.

The production and absorption of serous fluid are two processes that are normally constantly in dynamic equilibrium. If the latter is disturbed, then fluid accumulates in the stomach, this leads to some symptoms.

What diseases does fluid begin to accumulate in the abdominal cavity?

One of the main causes of ascites is portal hypertension, a condition in which pressure rises in portal vein - it collects blood from the intestines and spleen and flows into the liver. Substances that are absorbed in the intestine first enter the vessel. Hepatic cells - hepatocytes - process some useful substances and neutralize toxins. It is because of this that many drugs when taken in the form of tablets act worse than when they are administered intravenously: absorbed in the intestine, they enter the portal vein into the liver and are destroyed there.

Causes of Portal Hypertension

If blood flow in the portal vein is impaired, portal hypertension occurs. Blood pressure rises, and it seeps through the wall of the vessel into the abdominal cavity. This occurs under the following conditions:

  • cirrhosis of the liver, which, in turn, is caused by viral hepatitis B and C, damage to the liver tissue by alcohol, non-alcoholic fatty liver disease,
  • heart failure, in which stagnation and blood pressure increase in inferior vena cavacollecting blood from the lower body, and after it - in the portal vein,
  • obstruction and compression of the portal vein with a tumor,
  • Budd-Chiari syndrome - hepatic vein thrombosis in the place where they flow into the portal vein.

Decreased blood protein levels

The second important mechanism for the development of ascites is a decrease in blood levels. albumin proteinswhich provide oncotic pressure and help retain fluid in the vessels. When the level of protein in the plasma falls, the fluid rushes into the tissue, body cavity. Swelling, ascites, hydrothorax (fluid accumulation in the pleural cavity inside the chest). This condition develops with liver pathologies (since liver cells synthesize albumin), impaired renal function (nephrotic syndromewhen a lot of protein is lost in the urine), protein deficiency during fasting.

Accumulation of fluid in the abdomen with malignant tumors

The accumulation of fluid in the abdominal cavity can lead to malignant tumors, most often cancer of the ovaries, breast, stomach and intestines, pancreas, peritoneum, uterus, lung, liver.

Causes of ascites in cancer:

  • Cancer cells that spread along the surface of the peritoneum irritate it and cause it to produce excess fluid.
  • When a tumor affects the lymph nodes, the latter cannot provide a normal outflow of lymph from the abdominal cavity.
  • A tumor or metastasis can be in the liver and disrupt the outflow of blood through the portal vein.
  • With liver damage, hepatocytes cease to produce proteins normally.

Causes of fluid accumulation in the abdominal cavity

Often there is ascites of the abdominal cavity in oncology and many other diseases, when the barrier and secretory function of the peritoneal sheets is disrupted. This leads to the filling of the entire free space of the abdomen with fluid. Constantly increasing exudate can reach up to 25 liters. As already mentioned, the main cause of damage to the abdominal cavity is its close contact with the organs in which the malignant tumor forms. The tight fit of the folds of the peritoneum to each other provides a quick capture of nearby tissues by cancer cells.

The main causes of ascites in the abdominal cavity:

  • peritonitis,
  • peritoneal mesothelioma,
  • peritoneal carcinosis,
  • cancer of the internal organs
  • polyserositis
  • portal hypertension
  • cirrhosis of the liver,
  • sarcoidosis
  • hepatosis
  • hepatic vein thrombosis,
  • venous congestion with right ventricular failure,
  • heart failure,
  • myxedema,
  • gastrointestinal diseases
  • introduction of atypical cells into the peritoneum.

Classification

Excess fluid can enter the abdominal cavity in many ways, depending on this, two types of ascites are classically distinguished:

  • Transudative occurs due to an increase in pressure in the portal vein and a decrease in oncotic blood pressure. Moreover, in ascites fluid there is usually little protein.
  • Exudative - result of inflammation. It is characterized by a high protein content in ascitic fluid.

This classification has some drawbacks, therefore, at present, another one based on serum ascitic albumin gradient (abbreviated as SAAG). This indicator indicates the difference between the levels of albumin proteins in serum and ascitic fluid:

  • LowSAAG characteristic of fluid accumulation in the abdomen during inflammatory processes (pancreatitis, peritonitis), impaired renal function.
  • At highSAAG ascites is most likely caused by portal hypertension or impaired heart function.

How much fluid can accumulate in the stomach?

In severe cases, up to 35 liters of fluid can accumulate in the abdominal cavity. Depending on its volume and clinical manifestations, three degrees of ascites are distinguished:

  1. Mild: external manifestations are absent, fluid can be detected only during ultrasound examination.
  2. Moderate degree: ascites leads to a moderate increase in the abdomen. This usually happens if more than 400–1000 ml of fluid accumulates in the stomach.
  3. Severe degree: severe symptoms occur.

How dangerous is fluid buildup in the stomach?

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The price includes:

  • Inspection and consultation of the oncologist surgeon.
  • General blood test, biochemical blood test, ECG.
  • Ultrasound of the abdominal cavity with determination of the level of free fluid
  • Carrying out laparocentesis with ultrasound navigation.
  • Comprehensive drug therapy aimed at restoring water-electrolyte balance.

Removal of fluid from the abdominal cavity is carried out using the most modern techniques, best practices of Russian and foreign doctors. We specialize in cancer treatment and know what can be done.

Among women

The fluid inside the abdominal cavity in the female population is not always a pathological process. It can be collected during ejaculation, which occurs monthly in women of reproductive age. Such a liquid dissolves on its own, without posing a health hazard. In addition, the cause of water often becomes purely female diseases that require immediate treatment - inflammation of the reproductive system or ectopic pregnancy.

Ascites provokes the development of intraperitoneal tumors or internal bleeding, for example, after surgery, due to trauma or cesarean section. When the endometrium lining the uterine cavity grows uncontrollably, due to which it extends beyond the female organ, water also collects in the peritoneum. Endometriosis often develops after a viral or fungal infection of the reproductive system.

In men

In all cases of dropsy in the stronger sex, the combination of violations of important body functions that lead to the accumulation of exudate is the basis. Men often abuse alcohol, which leads to cirrhosis of the liver, and this disease provokes ascites. Also, factors such as blood transfusion, injection of narcotic drugs, high cholesterol due to obesity, multiple tattooing on the body contribute to the onset of the disease. In addition, the following pathologies become the cause of dropsy in men:

  • tuberculous lesion of the peritoneum,
  • endocrine disorders,
  • rheumatoid arthritis, rheumatism,
  • lupus erythematosus,
  • uremia.

In newborns

Fluid in the stomach is collected not only in adults, but also in children. More often, ascites in newborns arises from infectious processes occurring in the mother's body. As a rule, the disease develops in the womb. The fetus may experience defects in the liver and / or biliary tract. Because of this, bile stagnates, which leads to dropsy. After birth in an infant, ascites may develop against the background of:

  • cardiovascular disorders
  • nephrotic syndrome,
  • chromosomal abnormalities (Down's disease, Patau, Edwards or Turner syndrome),
  • viral infections
  • hematological problems
  • congenital tumors,
  • serious metabolic disorders.

Symptoms

Signs of ascites ascites depend on how quickly ascites fluid collects. Symptoms may appear in one day or for several months. The most obvious sign of dropsy is an increase in the abdominal cavity. This causes an increase in body weight and the need for larger clothing. In a patient with a vertical position, the abdomen hangs down like an apron, and with a horizontal position, it is spread out on two sides. With a large volume of exudate, the navel protrudes.

If portal hypertension became the cause of the dropsy, then a venous pattern forms on the anterior peritoneum. It occurs due to varicose veins of the umbilical veins and varicose veins of the esophagus. With a large accumulation of water in the abdomen, internal pressure rises, as a result of which the diaphragm moves into the abdominal cavity, and this provokes respiratory failure. The patient has pronounced shortness of breath, tachycardia, cyanosis of the skin. There are general symptoms of ascites:

  • pain or a feeling of fullness in the lower abdomen,
  • dyspepsia,
  • fluctuation,
  • peripheral edema on the face and limbs,
  • constipation
  • nausea,
  • heartburn,
  • loss of appetite,
  • slow motion.

Complications

The disease itself is a stage of decompensation (complication) of other pathologies. The consequences of dropsy include the formation of inguinal or umbilical hernias, prolapse of the rectum or hemorrhoids. These conditions contribute to an increase in intra-abdominal pressure. When the diaphragm presses on the lungs, this leads to respiratory failure. Joining a secondary infection leads to peritonitis. Other complications of ascites include:

  • massive bleeding
  • hepatic encephalopathy,
  • thrombosis of the splenic or portal vein,
  • hepatorenal syndrome
  • intestinal obstruction,
  • diaphragmatic hernia
  • hydrothorax,
  • inflammation of the peritoneum (peritonitis),
  • fatal outcome.

Treatment of abdominal ascites

Regardless of the cause of ascites, the pathology should be treated together with the underlying disease. There are three main therapeutic methods:

  1. Conservative treatment. At the initial stage of ascites, medication is prescribed to normalize the liver. If the patient is diagnosed with an organ parenchyma of an inflammatory nature, then additional drugs are prescribed that relieve inflammation and other types of medications, depending on the symptoms and the disease that caused the accumulation of fluid.
  2. Symptomatic If conservative treatment does not give results or doctors are unable to prolong remission for a long time, then a puncture is prescribed to the patient.Laparocentesis of the abdominal cavity with ascites is carried out infrequently, since there is a risk of damage to the intestinal walls of the patient. If the liquid fills the abdomen too quickly, a peritoneal catheter is placed in the patient to prevent the development of adhesions.
  3. Surgical If the two previous treatment regimens do not help, then a special diet and blood transfusion are prescribed to the patient. The method consists in combining the collar and inferior vena cava, in which collateral circulation is created. If the patient needs a liver transplant, then he will undergo surgery after a course of diuretics.

Preparations

The main treatment for ascites is medication. It includes long-term use of diuretic drugs with the introduction of potassium salts. The dose and duration of treatment is individual and depends on the rate of fluid loss, which is determined by the daily decrease in body weight and visually. The right dosage is an important nuance, as improper administration can lead the patient to heart failure, poisoning, death. Commonly prescribed drugs:

  • Diacarb. Systemic carbonic anhydrase inhibitor having weak diuretic activity. As a result of the application, the release of water increases. The drug causes the excretion of magnesium, phosphates, calcium from the body, which can lead to metabolic disorders. The dosage is individual, it is used strictly as prescribed by the doctor. Undesirable effects are observed from the hemopoiesis, immune and nervous system, metabolism. Contraindication for taking the drug is acute renal and hepatic insufficiency, uremia, hypokalemia.
  • Furosemide. A loop diuretic that causes strong but short-term diuresis. It has a pronounced natriuretic, diuretic, chloruric effect. The regimen and duration of the appointment are prescribed by the doctor, depending on the indications. Among the side effects: a pronounced decrease in blood pressure, headache, lethargy, drowsiness, decreased potency. Furosemide is not prescribed for acute renal / liver failure, hyperuricemia, pregnancy, lactation, children under 3 years of age.
  • Veroshpiron. Long-acting potassium-sparing diuretic. It inhibits the potassium-excreting effect, prevents the retention of water and sodium, reduces the acidity of urine. The diuretic effect appears on the 2nd-5th day of treatment. For edema with cirrhosis, the daily dosage is 100 mg. The duration of treatment is selected individually. Adverse reactions: lethargy, ataxia, gastritis, constipation, thrombocytopenia, menstrual irregularities. Contraindications: Addison's disease, anuria, lactose intolerance, hyperkalemia, hyponatremia.
  • Panangin. A drug that affects metabolic processes, which is a source of magnesium and potassium ions. It is used as part of complex therapy for ascites in order to make up for the deficiency of magnesium and potassium that are excreted while taking diuretics. Assign 1-2 tablets / day for the entire course of diuretic drugs. Side effects are possible from the water-electrolyte balance, the digestive system. Do not prescribe Panangin in the presence of Addison's disease, hyperkalemia, hypermagnesemia, severe myasthenia gravis.
  • Asparkam. Source of magnesium and potassium ions. It reduces the conductivity and excitability of the myocardium, eliminates the imbalance of electrolytes. While taking diuretics, 1-2 tablets are prescribed 3 times / day for 3-4 weeks. Perhaps the development of vomiting, diarrhea, redness of the skin, respiratory depression, seizures. Do not prescribe Asparkam in violation of amino acid metabolism, adrenal insufficiency, hyperkalemia, hypermagnesemia.

Chylous ascites

Chronic astitis is a rare complication of cirrhosis of the liver in the last stage or obstruction of the abdominal lymph flow, chronic intestinal inflammation. Ascitic fluid in this type of pathology has a milky tint due to the presence of a large number of fat cells in the transudate.

The chylous form 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 cirrhosis in the final stage of decompensation , which is characterized by depletion of liver resources and significant circulatory disorders, both in the organ itself and in the peritoneum.

Other hepatic causes include:

  • portal hypertension.
  • chronic hepatitis (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 . The causes in women often lie in the oncopathology of the pelvic organs.

With malignant neoplasms, there is a deterioration in lymph circulation and a blockage of the lymphatic outflow paths, as a result of which the fluid does not have the ability to exit and accumulate.

Interesting: ascites, which developed as a result of cancer pathologies, often indicates the impending death of a person.

5% of cases of abdominal dropsy are associated with pathologies of the heart muscle accompanied by decompensation of blood circulation. Doctors call this condition "cardiac ascites."

It is characterized by significant edema of the lower extremities, and in advanced cases, edema of the whole body. As a rule, with heart diseases, fluid is accumulated not only in the stomach, but also in the lungs.

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

  • renal pathologies, such as amyloidosis, glomerulonephritis.
  • pancreatic disease.
  • portal vein thrombosis.
  • tuberculosis of the peritoneum.
  • acute expansion of the stomach.
  • Lymphogranulomatosis.
  • Crohn's disease.
  • intestinal lymphangiectasia.
  • protein starvation.

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, there are:

  • congenital nephrotic syndrome.
  • hemolytic disease that occurs in a child due to 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.

The concept of ascites

Fluid in the abdomen is considered a dangerous diagnosis, which is accompanied by a strong accumulation of water in the abdominal cavity. Other organs can also suffer from this phenomenon: lungs, heart and stomach. Ascites is not an inflammatory disease.

The collected liquid in volume can reach up to 20 liters. In practice, this type of disease is usually called a frog stomach. In this case, the ailment often acquires a malignant course.

Causes of abdominal water buildup


Why is fluid gathering in the stomach? The peritoneum is a coating that lines over all organs located in the abdominal region. It releases a small amount of liquid, the composition of which is similar to plasma. This process is required for the normal functioning of internal organs. If there were no peritoneum and fluid, they would stick together.

The liquid is absorbed and excreted during the day. But if adverse factors are affected, then this phenomenon may be disturbed. During imbalance, an increase in intra-abdominal pressure occurs. Against this background, there is a significant increase in the abdomen.

So why does fluid accumulate in the stomach? If there is excess water in the abdomen, the reasons may lie in the following:

  • heart failure,
  • the appearance of malignant tumors,
  • violation of the pressure of the portal zone of the liver,
  • abdominal tuberculosis,
  • the occurrence of mesothelioma or pseudomyxoma,
  • violation of the functionality of the endocrine system,
  • the presence of gynecological diseases.

Fluid buildup in the abdomen can also occur in newborns. A pathological phenomenon begins to form at the prenatal stage. In this case, a violation of hepatic functionality is observed. Most often, a disease of an infectious nature at the stage of gestation becomes a decisive factor.

If the newborn has fluid in the abdomen, the causes may be hidden in:

  • rubella in expectant mothers,
  • syphilis
  • toxoplasmosis,
  • listeriosis
  • hepatitis
  • herpes infection
  • measles.

Children at risk are parents whose parents abused drugs, alcohol, chemicals and drugs during pregnancy.

To all this, ascites can progress with a blood transfusion in pregnant women, obesity, and type 2 diabetes. So that the baby does not get this disease from the first days of life, the expectant mother should not do permanent makeup and tattoos.

Treatment of ascites - fluid buildup in the abdomen


If there is water in the stomach, what should I do? Having performed radiography and angiography, the doctor can already make an accurate diagnosis and prescribe an effective treatment. The approach to the existing problem is comprehensive. If an advanced stage or complications are observed, then an surgical intervention is performed.

The entire treatment process depends on the signs and the diagnosis. At first, doctors are trying to fix the problem conservatively, but if the fluid continues to accumulate, then you can not do without a surgical procedure.

Therapeutic treatment

You do not need to do anything yourself. The main goal of drug therapy is to eliminate accumulated fluid in the abdominal cavity. Such treatment will be effective only in the initial stages, when the abdominal cavity is not yet completely filled with transudate.

Also, with this disease, diuretics and calcium can be prescribed. This method helps to remove all the water from the peritoneum. As an additional method, it is advised to take fortified complexes.

Surgery

If the disease is diagnosed in advanced stages, then just can not do without surgery. Such a method will only help eliminate excess water, but it certainly will not relieve the cause.

If the process has acquired an oncological form, then manipulations are carried out in several stages:

  1. Laparocentesis. The abdominal cavity is punctured to remove all excess fluid from the peritoneum. These manipulations can drag on for several days, so hospitalization of the patient will be required.
  2. Transjugular intrahepatic bypass surgery. The doctor creates an artificial duct between the hepatic and portal veins. This process makes it possible to improve water metabolism and stabilize intra-abdominal pressure.
  3. Liver transplantation. This type of surgical intervention is carried out during degeneration into a malignant formation.

What type of surgery to resort to, only a doctor should decide on the basis of evidence.

Dieting

To avoid the development of serious complications in terms of health, you must adhere to a special therapeutic diet. A properly selected diet will reduce the accumulation of fluid in the abdominal zone and extend the period of remission.

Particular emphasis should be placed on foods that are rich in potassium, these are:

  • spinach,
  • grapefruit,
  • dried apricots,
  • baked potato,
  • asparagus,
  • raisins
  • carrot,
  • green pea.

The following products must be removed from the menu:

  • smoked and salty dishes,
  • bread products
  • sorrel,
  • chocolate,
  • turnip,
  • garlic,
  • cabbage,
  • mushrooms
  • radish,
  • coffee drinks
  • bow.

It is worth limiting in the consumption of eggs and dairy products.

Traditional methods of treatment of ascites

Treatment of dropsy in the early stages can be carried out using folk methods. There are several recipes.

    The first way. Making a tea drink from cherry stalks.

For the manufacture you will need a spoon of raw materials and half a liter of hot water. The broth is infused for two hours, and then filtered. Take the medicine up to three to four times a day in one glass. The second way. The use of flaxseed.

To make a decoction, a spoonful of raw materials is taken and poured into a mug of boiled water. After thirty to forty minutes it is filtered. It is taken in the morning on an empty stomach and in the evening before bedtime. The result can be seen in a few weeks. The third way. Starvation.

According to traditional healers. Dropsy patients are advised to refrain from eating food for seven days. This technique should be followed for two months. You can drink several cups of tea with glucose per day.

During fasting, you can cleanse the intestines with mineral water. Treatment in this way should be done gradually. A few days before this, the amount of food consumed is reduced.

This technique is best used after consultation with a specialist. Improper fasting can lead to adverse effects. In this case, do not forget about compliance with the drinking regime. But the amount of fluid consumed should not exceed one liter per day.

Possible adverse effects

If ascites is not treated for a long time, serious complications can develop. Free fluid in the abdominal area can lead to respiratory failure or heart congestion. The cause of this phenomenon is an elevated diaphragm. It exerts significant pressure on the lungs and large vessels.

When an infection is attached, peritonitis can be observed. In such cases, urgent surgical intervention is required, otherwise everything can be fatal.

It is believed that ascites develops only in the last stages of the disease. Such a process is considered incurable, but there are different ways that help maintain the patient’s condition at the level and even lead to improvements. The danger of the disease is the development of terrible diseases in the form of cirrhosis or a tumor. Therefore, do not ignore the symptoms of the disease and consult a doctor in a timely manner at the first suspicion.

How to remove fluid in the abdomen by surgical methods

If ascites is diagnosed in an advanced stage, transudate can not be dispensed with. In this way, you can temporarily remove the big belly, but if the cause of the disease is not eliminated, its symptoms will soon remind of themselves again. It is important to understand that we are talking about oncology, and you can not do without surgery. Surgery for ascites involves the following:

  1. Laparocentesis An abdominal puncture is performed to further discharge ascites fluid. The procedure can take several days, it requires hospitalization of the patient.
  2. Transjugular intrahepatic bypass surgery. The surgeon forms an artificial duct between the hepatic and portal veins to ensure water exchange and stabilize intra-abdominal pressure.
  3. Liver transplantation. The operation is appropriate for oncology, advanced degree of cirrhosis.

Diet

To exclude serious health complications, medical nutrition is necessary. In addition, a properly selected diet for ascites reduces the accumulation of fluid in the abdominal cavity, prolongs the period of remission, and eliminates alarming symptoms. The main emphasis is required on food ingredients, which contain a large amount of potassium. It:

  • spinach,
  • grapefruits
  • dried apricots,
  • baked potato,
  • asparagus,
  • raisins,
  • carrot,
  • green pea.

Surgical methods

When ascites progresses and treatment does not help, in especially advanced cases, surgical treatment is prescribed.Unfortunately, it is far from always possible even with the help of the operation to save the patient’s life, but today there are no other methods. The most common surgical treatment:

  1. Laparocentesis Exudate is removed through a puncture of the abdomen under ultrasound guidance. After the operation, drainage is established. In one procedure, no more than 10 liters of water are removed. At the same time, saline and albumin are drip. Complications are very rare. Sometimes infectious processes occur at the puncture site. A procedure is not performed for bleeding disorders, severe bloating, intestinal injuries, a hernia and pregnancy.
  2. Transjugular intrahepatic bypass surgery. During the operation, the hepatic and portal veins are artificially reported. The patient may experience complications in the form of intra-abdominal bleeding, sepsis, arteriovenous shunting, and liver infarction. An operation is not prescribed if the patient has intrahepatic tumors or cysts, vascular occlusion, obstruction of the bile ducts, and cardiopulmonary pathologies.
  3. Liver transplantation. If ascites develops against cirrhosis, then an organ transplant can be prescribed. The chance for such an operation falls to a few patients, since it is difficult to find a donor. Absolute contraindications to transplantation are chronic infectious pathologies, severe disorders of other organs, and oncological diseases. Among the most serious complications is transplant rejection.

Watch the video: ASCITES Symptoms, Causes & Treatments (February 2020).