A symptom of fluctuation is an abscess. Determination of the presence of free fluid in the abdominal cavity, differences from obesity Ascites as a frequent companion to dangerous diseases

Clinical picture. With significant accumulations of pus, a general reaction is usually expressed: fever, weakness, loss of appetite, insomnia, changes in blood composition, morning and evening temperature fluctuations.

There is swelling and hyperemia of the skin above the abscess. Only when the abscess is deep, these symptoms are absent.

An important sign of an abscess in the presence of other signs acute inflammation is a symptom of fluctuation, or oscillation (Fig. 24).

Rice. 25. Ultrasound picture of a soft tissue abscess.

It is caused by the presence of fluid (pus) enclosed in a cavity with elastic walls, which transmits a push in the form of a wave from one wall in all directions. This symptom is absent when the wall is very thick and the abscess cavity is small and deep. In this case it is necessary to carry out diagnostic puncture abscess or ultrasound of soft tissues (Fig. 25)

A significant threat is posed by an abscess breaking into any cavity (joint, pleural cavity).

With a chronic abscess, signs of acute inflammation may be almost completely absent. In these cases, swelling, slight pain, fluctuation symptoms and puncture data allow a diagnosis to be made. Ultrasound must be used to diagnose abscesses.

The ultrasound image of an abscess depends on the stage of its development. The formed abscess has clear, uneven contours, a heterogeneous liquid structure with the presence of fine sediment, which at rest settles on the walls of the abscess or moves when the body position changes. There may be an effect of strengthening the posterior wall of the formation. In most cases, a rim is visualized around the formed abscess varying degrees severity with increased echogenicity, with an uneven internal contour (pyogenic capsule). Ultrasound signs of a formed abscess appear 8-12 days after its formation.

A sign of an unformed abscess is a hypoechoic formation, most often irregular shape, with fairly homogeneous content, the absence of a rim (capsule) of increased echogenicity. A hypoechoic zone of varying severity may be detected around the formation (edema zone).

Differential diagnosis. It is necessary to differentiate an ordinary abscess from a cold abscess, i.e., an abscess of tuberculous origin, characterized by the presence of a main focus of tuberculosis, slow development, and the absence of acute inflammatory phenomena. An abscess should also be differentiated from a hematoma, aneurysm, and vascular tumors.

Treatment. The diagnosis of an abscess serves as an indication for surgical intervention, the purpose of which, regardless of the location of the abscess, is to open, empty and drain its cavity.

Puncture of the abscess with aspiration of pus and subsequent injection of antibiotics and enzyme preparations into the abscess cavity can only be used according to strict indications, for certain localizations of the abscess.

The operation - opening a superficial abscess - is performed under local infiltration anesthesia with 0.25% or 0.5% novocaine solution or short-term intravenous anesthesia. (sombrevin, ketamine, etc.). To open the abscess, choose the shortest quick access taking into account the anatomical and topographical features of the organ, above the place of greatest fluctuation. An abscess is often opened using a needle: the abscess is initially punctured, then the tissue is dissected using the needle.

When opening an abscess, if possible, approach its lower pole in order to create good conditions for drainage.

Rice. 26. Abscess of the left leg. Washing the wound with antiseptics after opening the abscess

In order to reduce infection of the surgical field, the area in the center of which the abscess is supposed to be opened is isolated with gauze and, after making a small hole in the wall of the abscess, the pus is removed with an electric suction. After aspirating the pus, the incision is widened, and the remaining pus and necrotic tissue are removed. If the abscess cavity is large, it is examined with a finger, separating the bridges, removing tissue sequestration. The abscess cavity is washed with an antiseptic solution (Fig. 26).

The abscess cavity is drained with one or more rubber or polyethylene tubes and gauze swabs moistened with a solution of proteolytic enzymes, antiseptics, and antibiotics are inserted into it. If there is insufficient emptying, a counter-aperture is made through the main incision.

In case of a chronic abscess, it is excised together with the capsule within healthy tissue, the wound is sutured and drained for active aspiration in order to prevent recurrence of infection.

General treatment includes the use of antibiotics taking into account the sensitivity of the microflora, the use of specific therapy (immunization with staphylococcal toxoid, the use of specific β-globulin).
Cellulitis (phlegmon)- it's spicy purulent inflammation subcutaneous fat and cellular spaces (subcutaneous).

The causative agents of phlegmon are usually staphylococci and streptococci, which penetrate the fiber through damage to the skin, mucous membranes or hematogenously.

Cellulitis is an independent disease, but it can also be a complication of various purulent processes (carbuncle, abscess, etc.). The inflammatory exudate spreads throughout the tissue, passing from one fascial sheath to another through the openings for the neurovascular bundles. By pushing tissue apart, squeezing and destroying blood vessels, pus leads to tissue necrosis.

With phlegmon, two phases are distinguished inflammatory process- serous infiltrate and purulent melting.

Based on the nature of the exudate, purulent, purulent-hemorrhagic and putrefactive forms of phlegmon are distinguished. Depending on the location, epi- and subfascial (intermuscular) forms of diffuse purulent inflammation of the tissue are distinguished.

In some localizations, phlegmon has a special name. Inflammation of the perinephric tissue is called paranephritis, peri-intestinal - paracolitis, peri-rectal - paraproctitis.

Clinical picture. The clinical picture of phlegmon is characterized by the rapid appearance and spread of painful swelling, diffuse redness of the skin over it, high temperature (40 ° C and above), pain, and dysfunction of the affected part of the body. The swelling is a dense infiltrate, which then softens. The disease often begins suddenly, with chills, headache, general malaise, and is accompanied by severe intoxication and an increase in body temperature up to 40 °C. High leukocytosis and severe neutrophilia are noted.

Subcutaneous phlegmon, which develops primarily, can lead to a number of complications (lymphadenitis, lymphangitis, erysipelas, thrombophlebitis, sepsis, etc.).

When phlegmon spreads to surrounding tissues, secondary purulent arthritis, tendovaginitis and other purulent lesions may occur.

Subcutaneous phlegmon can develop secondary to diseases such as osteomyelitis, purulent arthritis, purulent pleurisy.

Phlegmon of the subcutaneous tissue of the face can be complicated by progressive thrombophlebitis of the facial veins and purulent meningitis.

Patients are treated in a hospital setting. In the stage of serous infiltration of phlegmon development, conservative treatment is acceptable. Prescribe bed rest, antibiotic therapy, and create rest. UHF therapy is used locally around the phlegmon. When the process is limited and ulcers form (limited phlegmon), the phlegmon is opened and drained.

With progressive phlegmon, delaying surgical intervention is unacceptable. The operation is performed under general anesthesia. The phlegmon is opened with one or more parallel incisions. The direction of the incisions is determined by the localization of the phlegmon: on the limbs they are made along the length of the limb, in the gluteal regions - parallel to the lower gluteal fold, on the stomach - along the muscles, on the chest - along the fibers of the pectoralis major muscles, on the lateral surface of the chest - along the ribs, on the back - parallel to the spine.

The wounds are washed with antiseptics and drained with drainage tubes.

In specialized medical institutions, active surgical treatment wounds, which consists of excision of all non-viable tissues, evacuation of the purulent contents of phlegmon, drainage with several drainage tubes and application primary seam. Active aspiration is performed through drainage tubes in the postoperative period.

Putrid infection. Usually putrefactive phlegmon is combined with staphylococcal anaerobic infection. Most often the pathogens are Proteus vulgaris, Escherichia coli.

Predisposing factors

Traumatic wounds with a large amount of crushed, non-viable tissue, bite wounds, gunshot wounds.
Urinary phlegmon with fractures of the pelvic bones.
Phlegmon of the anterior abdominal wall after damage to the colon (fecal phlegmon), putrefactive peritonitis.

Clinical manifestations. In terms of clinical manifestations, putrefactive infection often resembles gas gangrene, but differs from it in a number of ways.

General state. Picture of general intoxication, heat body, anxiety, delirium, dry tongue.
Local manifestations. Inflammatory changes, wound hyperemia, fever, necrosis of the wound edges, pain in the wound area. When cut, healthy muscles supplied with blood are revealed.
The nature of the separated. Limited accumulation of gas in the fatty tissue of the wound area. Putrid or fetid purulent melting of tissue, limited only to the wound area.

The clinical picture consists of local and general manifestations.

Local symptoms

Classic signs of inflammation

The local reaction during acute purulent infection is manifested by symptoms characterizing the development of the inflammatory reaction:

ruber(redness),

color(local heat)

tumor(swelling),

dolor(pain),

functio laesa(dysfunction).

Redness easy to determine upon inspection. It reflects the dilation of blood vessels (arterioles, venules and capillaries), while the blood flow slows down until it almost completely stops - stasis. Such changes are associated with the effects of histamine on blood vessels and disorders metabolic processes in cells in the area of inflammation. Otherwise, the described changes are called “hyperemia”.

Local heat associated with increased catabolic reactions releasing energy. A local increase in temperature is determined (usually with the back of the hand, comparing the sensations obtained with the sensations during palpation outside the painful focus).

Tissue swelling is caused by a change in the permeability of the vascular wall for plasma and blood cells, as well as increased hydrostatic pressure in the capillaries. Increased permeability of the vascular wall mainly affects capillaries and small veins. The liquid part of the plasma sweating from the vessels, together with migrating leukocytes, and often erythrocytes released through diapedesis, form an inflammatory exudate. The bulk of it consists of neutrophilic leukocytes. Usually swelling is determined visually. In doubtful cases, measurements are taken (for example, limb circumference).

Pain . The presence of pain and tenderness on palpation in the lesion area - characteristic feature purulent diseases. It should be remembered that palpation must be carried out quite carefully so as not to cause negative sensations in the patient.

Dysfunction related to development pain syndrome, and with edema. It is most pronounced when the inflammatory process is localized on the limb, especially in the joint area.

Symptoms of the presence of accumulation of pus

To determine the accumulation of pus, use clinical symptoms (symptoms of fluctuation and softening), data additional research methods And diagnostic puncture.

Clinical symptoms

An important method for identifying areas of pus accumulation is the symptom of fluctuation. To determine it on one side of the zone pathological process the doctor places his palm (for small lesions - one or more fingers), and on the opposite side with the other palm (or 1-3 fingers) performs jerking movements (Fig. 12-1).

If there is liquid between the doctor’s palms in the pathological focus (in in this case pus), these shocks will be transmitted from one hand to another. Usually, a positive symptom of fluctuation, indicating the accumulation of purulent exudate in the tissues, becomes decisive in setting the indications for surgery (opening and draining the abscess).

The symptom of softening has a similar meaning: if, against the background of an inflammatory infiltrate, a softening zone appears in the center (a feeling of emptiness, failure on palpation), this also indicates purulent melting of tissues and accumulation of pus.

Rice. 12-1. Scheme for determining the symptom of fluctuation

Additional research methods

Among special research methods that can determine the accumulation of purulent exudate, ultrasound comes first. The method allows you to accurately determine the accumulation of fluid, the size and location of the cavity.

In some cases, X-ray examination helps diagnosis. There are characteristic radiological signs of accumulation of pus under the diaphragm, lung abscess, etc.

To identify an abscess and determine all its parameters in complex cases, you can perform a CT or MRI.

Diagnostic puncture

The procedure is performed when the diagnosis is unclear. Typically, a thin needle is used to anesthetize the skin, and then a puncture is performed with a thick needle (with a diameter of at least 1.5 mm), constantly creating a vacuum in the syringe.

The appearance of at least a minimal amount of pus in it indicates the presence of its accumulation in the corresponding area, purulent fusion of tissue, which most often requires surgical treatment. For deep purulent processes, ultrasound-guided puncture is highly effective.

Local complications of purulent processes

With the development of purulent diseases, it is possible local complications: necrosis, inflammation of lymphatic vessels (lymphangitis) and nodes (lymphadenitis), thrombophlebitis.

The formation of necrosis is associated with the activity of microorganisms, as well as with impaired microcirculation due to the inflammatory process. At the same time, black areas appear in the inflammation zone.

Lymphangitis is a secondary inflammation of the lymphatic vessels, aggravating the course of various inflammatory diseases. With stem lymphangitis, hyperemia is noted in the form of separate stripes running from the source of inflammation to the area of regional lymph nodes - the axillary fossa or inguinal fold. Along with hyperemia, swelling of the skin appears. Upon palpation, painful compactions in the form of strands are revealed along the lymphatic vessels. Lymphadenitis occurs quite early. With inflammation of the intradermal lymphatic vessels, hyperemia in the form of a mesh pattern (multiple bright red intersecting stripes) is observed. The symptoms of lymphangitis can be fleeting and last only for a few hours. At the same time, the development of necrotic lymphangitis with the formation of foci of necrosis along the vessels is also possible.

Lymphadenitis is an inflammation of the lymph nodes that occurs as a complication of various purulent-inflammatory diseases and specific infections (tuberculosis, plague, actinomycosis). Thus, lymphadenitis, as a rule, is a secondary process.

Lymphadenitis begins with pain and enlargement of the lymph nodes. Sometimes, when the main process subsides, lymphadenitis dominates the clinical picture of the disease. With the progression of the disease and the development of periadenitis, these clinical signs are more pronounced, clearly palpable earlier The lymph nodes, merging with each other and with surrounding tissues, they become motionless. The process can turn into a destructive form up to the development of adenophlegmon.

Thrombophlebitis is inflammation of the veins that provide blood flow from the area of inflammation. This type of thrombophlebitis is called ascending. Usually we are talking about superficial veins. Clinically, a painful infiltrate along the vein is determined, having the shape of a tourniquet or roller. The skin above it is hyperemic and may be slightly raised. Thrombophlebitis requires special treatment. Typically, inflammatory changes are leveled out quickly, but a thrombosed vein can be palpated for quite a long time after this. In some cases, thrombophlebitis is complicated by the development of abscesses (abscess thrombophlebitis), which leads to the need for surgical treatment.

It should be noted that lymphangitis, lymphadenitis and thrombophlebitis are the first signs of generalization of the infectious process.

Purulent diseases of soft tissues.

This lecture is devoted to the issues of purulent surgery. Despite the successes of modern medicine, the fight against purulent surgical infection remains an urgent problem, due to the continuing increase in the number of patients with purulent diseases. In this lecture we will look specifically at many purulent diseases of soft tissues. The causative agents of these diseases are most often staphylococcus, streptococcus, Escherichia coli, Proteus, Pseudomonas aeruginosa, as well as anaerobic bacteria.

A furuncle is an acute purulent-necrotic inflammation of the hair follicle, sebaceous gland and surrounding subcutaneous tissue. Most often caused by Staphylococcus aureus. A contributing factor is decreased immunity and diabetes. The infection penetrates into the area of the hair follicle through the broken integrity of the skin (microtrauma) due to scratching, rubbing, etc.

Further, inflammation occurs in this zone, which is characterized by the appearance of inflammatory edema in the tissues. Clinically, this is manifested by the appearance of a dense, painful infiltrate on the surface of the skin. Then, as a result, hyperemia appears above the infiltrate and pain increases. Due to inflammation and swelling deep in the tissues, local circulatory disturbances, tissue necrosis in the hair follicle area, and purulent melting of tissues in this area occur. Then the pus rushes to the surface of the skin in the form of a purulent rod, in the center of which there is dead hair. Locally, this is manifested by the appearance of a small pustule (pustule) in the center of the hyperemic infiltrate. Subsequently, rejection of the purulent core is observed, while the pustule is opened and pus comes out from the depths of the furuncle. In the area of inflammation and necrosis, thrombosis of the skin capillaries and veins is observed, so a premature attempt to mechanically remove the rod may result in the spread of infected blood clots from the source through the veins to big circle blood circulation and the development of sepsis. After the rod is rejected, a small, crater-shaped wound remains, inflammation subsides, the infiltrate disappears, and after 5-6 days the wound scars.

Complications of a boil

sepsis (which we already talked about)

abscess formation, which occurs due to the formation of a pyogenic capsule around the abscess located at the hair folipcule, and which prevents the formation and exit of the purulent core.

Formation of phlegmon, in in that case t when pus does not rush to the surface of the skin in the form of a rod, but spreads into the depths of the subcutaneous tissue.

Thrombophlebitis and phlebitis, in the case when the inflammatory process spreads to the nearby wall of the venous vessel.

Lymphangitis or lymphadenitis if inflammation spreads to the lymphatic vessel or inflammation of the lymph node begins.

Meningitis can be a complication of a boil in the facial area, especially the upper half. In the loose tissue of the facial region there are multiple branches of the anterior and facial vein, which through it has communications with which flows into the sinus of the dura mater (cavernous sinus). Therefore, the inflammatory process in the area of the boil can spread to the venous vessels, thrombophlebitis of the facial veins occurs, and then this thrombophlebitis can lead to purulent thrombosis of the cavernous sinus with the subsequent development of purulent meningitis.

A carbuncle can occur if the boil is not treated correctly.

General clinical symptoms with uncomplicated boils are not expressed. In addition to pain, sometimes there is an increase in temperature, most often up to subfebrile levels.

With the development of complications, the clinical picture will be characteristic of these developed severe diseases.

Treatment of a boil is conservative. In the initial phase of the disease - the phase of serous inflammation, dry heat is applied locally, the area is treated with antiseptic solutions (alcohol, brilliant green, etc.), in some cases, they are injected with a solution of novocaine with antibiotics or antibiotics are taken orally. When a pustule forms. For faster removal of the rod, acid, proteolytic enzymes, and physiotherapy are used locally. The superficial portion of the epidermis above the pustule is removed using surgical tweezers to quickly remove the rod. After rejection of the rod, various antiseptics are used topically to treat the wound, including furacillin, rivonol, levomikol, dioxykol, etc. Local physiotherapy is also recommended. The indication for opening a furuncle (surgical treatment) is its abscess formation.

All patients with facial boils are subject to hospitalization for active therapy.

Furunculosis is the presence of several boils in different areas that have a recurrent course. With furunculosis, patients must be examined to identify metabolic disorders (diabetes mellitus, vitamin deficiency). Treatment is complex, including immunotherapy.

A carbuncle is an acute diffuse purulent-necrotic inflammation of several nearby hair follicles and sebaceous glands with the formation of necrosis of the skin and subcutaneous tissue, accompanied by signs of purulent intoxication. The causative agents and routes of infection are the same as with a boil. Carbuncles are often observed in patients with diabetes mellitus.

The localization of carbuncles is most often observed on the back surface of the neck, interscapular area. Usually the carbuncle is accompanied by lymphadenitis, and when localized on the extremities - lymphangitis.

With carbuncle, the development of the inflammatory process is accompanied by the appearance of a pronounced inflammatory infiltrate, multiple thrombosis of the vessels of the skin and subcutaneous tissue. Due to local circulatory disorders, extensive necrosis of the skin and subcutaneous tissue occurs, followed by purulent melting. With carbuncle, the phenomena of purulent intoxication will quickly join, so, as a rule, they are subject to treatment in a hospital.

Clinical picture: locally there is a very dense, sharply painful infiltrate. The skin over it is tense, shiny, blue-purple in color. On the surface of the infiltrate there are several purulent-necrotic pustules of a whitish color, which in the center of the carbuncle merge with each other to form skin necrosis. The latter becomes thinner, purulent-necrotic rods break through in several places with the formation of holes from which pus comes out (the “sieve” symptom).

General symptoms- strong pain, high temperature, chills, weakness, malaise, headache, loss of appetite, dry mouth, tachycardia, i.e. symptoms of purulent intoxication.

The corbuncle should be differentiated from the anthrax corbuncle, which is characterized by the presence of pustules with hemorrhagic contents and the presence of anthrax bacilli in this fluid. The infiltrate is painless, there is no purulent discharge.

Complications of a corbuncle are the same as those of a furuncle, only they are more common.

Treatment of carbuncle. The main method of treating carbuncle is surgical. Conservative treatment is carried out only in initial stages development of a carbuncle in the presence of a serous infiltrate and a relatively mild clinical course. This is the use of parenteral antibiotics, injection of novocaine with antibiotics, physiotherapy, x-ray therapy. If there is no effect from treatment within 2-3 days, surgery is indicated. The carbuncle is opened with a cross-shaped incision through the entire thickness of the infiltrate to the fascia with excision of all necrotic tissue, followed by local application of proteolytic enzymes, antiseptics, physiotherapy, as well as antibacterial and detoxification therapy. After cleansing the wound and the formation of granulations, ointment dressings are applied topically, and in the event of extensive granulating wound surfaces formed as a result of skin necrosis, plastic surgery is performed to eliminate the defect.

Phlegmon

Phlegmon is an acute purulent diffuse inflammation of cellular spaces that does not tend to be demarcated. This disease is most often caused by staphylococcus, as well as any other pyogenic microflora. The infection can penetrate into tissues through damage to the skin and mucous membranes, after various injections (so-called post-injection phlegmon), by lymphogenous and hematogenous routes, when inflammation passes from lymph nodes, carbuncles, boils, etc. on the surrounding tissue.

Cellulitis spreads through cellular spaces, vascular beds, and fascial sheaths.

Some types of phlegmon have special names: paraproctitis, paracolitis, paranephritis, mediastenitis, adenophlegmon, paraarticular phlegmon. According to the nature of the exudate, phlegmons are divided into serous, purulent, purulent-hemorrhagic, putrefactive forms.

By localization - subcutaneous, epifascial, subfascial, intermuscular, paroosseous, retroperitoneal. The development of phlegmon begins with serous infiltration of fatty tissue, then the exudate quickly becomes purulent, tissue necrosis and melting are formed, and abscess formation is possible.

General symptoms correspond to the symptoms of purulent intoxication, the severity of which depends on the location, prevalence and type of microbial pathogen. The temperature reaches up to 4°C and is constant.

Local symptoms:

Painful swelling and hyperemia without clear boundaries if the phlegmon is not located deep. When localized in the depths of tissues, there may not be hyperemia. Local hyperthermia is noted. Fluctuation is not typical for phlegmon and appears only when it becomes abscessed. There is a dysfunction of the affected part of the body.

Treatment of phlegmon is surgical.

Under anesthesia, the phlegmon is opened, pus and necrotic tissue are removed, and purulent streaks and pockets are widely opened with additional incisions. The wound is thoroughly washed with H O and drained with drainage and gauze swabs soaked in hypertonic salt solution or with antiseptics. Treatment of the wound after surgery is carried out according to the principle of treating purulent wounds. In addition, patients undergo antibacterial, detoxification and corrective therapy. The most difficult treatment for phlegmon caused by anaerobic microflora.

An abscess is a limited accumulation of pus in various tissues or organs, surrounded by a pyogenic capsule. The pathogens and routes of infection into tissues are the same as with phlegmon, although the percentage of anaerobic pathogens is much higher. Based on location, abscesses are divided into superficial and deep (in organs or tissues). Metastatic abscesses occur.

When an infection enters the tissue, necrosis occurs, and then purulent melting occurs. A cavity is formed containing pus and remains of necrotic tissue. A pronounced inflammatory infiltrate appears around the abscess cavity, from which a pyogenic capsule is then gradually formed, consisting of an outer connective tissue barrier, and its inner layer is represented by granulations with fibrin overlays. The longer the abscess exists, the thicker the pyogenic capsule. The poigenic membrane usually prevents the spread of pus in the tissues, but sometimes it is possible for the abscess to break out or into various cavities.

Clinic – the general symptoms correspond to the symptoms of purulent intoxication, but there is a characteristic curve with fluctuations of up to 2.5 degrees or more per day. In chronic abscesses, intoxication is not pronounced, the temperature is low-grade, and signs of renal failure appear.

Local symptoms for superficial abscesses are severe swelling, fluctuation (very important symptom) soreness, hyperemia may or may not be present, hyperthermia. The symptom of fluctuation indicates a limited accumulation of fluid in the tissues (blood, exudate, pus, etc.). To clarify, a diagnostic puncture is indicated.

With deep abscesses, local symptoms may be absent. To diagnose these abscesses, the entire modern complex of diagnostic measures is used - X-ray, ultrasound, computed tomography, radioisotope research, thermal imaging, etc. If there are abscesses in any organ, a clinical picture of dysfunction of this organ appears.

Identifying deep abscesses presents certain difficulties for the clinician.

It is necessary to differentiate an ordinary abscess from a cold abscess with tuberculosis of bones and joints. Cold abscesses are characterized by a long course, absence of purulent intoxication, subfebrile temperature, absence of local hyperemia and hyperthermia, although fluctuation does occur. A diagnostic puncture is performed by displacing the skin fold over the abscess. The resulting pus is odorless and sometimes contains caseous masses.

The main method of treating an abscess is surgical - opening and draining the abscess cavity. Sometimes excision of the abscess is used along with the pyogenic capsule without opening its lumen, within healthy tissue (usually for small superficial abscesses). Resection of the organ with an abscess is performed. Currently, the puncture method of treatment under X-ray or ultrasound guidance is widely used. After opening the abscesses and excision of non-erotized tissues, a closed method of treating the abscess is used using a drainage system with active aspiration, which speeds up wound healing by 2-3 times.

In addition, after surgery, patients undergo complex conservative therapy, including antibiotics and detoxification. Treatment of metastatic abscesses, for example in sepsis, is conservative. They are small in size, their pyogenic capsule is thin, and there are usually several of them.

Hidradenitis

This is purulent inflammation sweat glands.

If hygiene rules are not followed and excessive sweating occurs, the infection penetrates through the ducts of the apocrine glands or through the lymphatic tract. The most common pathogen is Staphylococcus aureus. Most often, several sweat glands are affected at once. First, an inflammatory infiltrate appears containing a large number of leukocytes, then the infiltrate undergoes purulent melting, the sweat gland is destroyed, then the abscess can open on its own. The disease may recur.

The most common location of hidradenitis is the armpit. Less commonly, this occurs in the perianal area, groin area, and nipple areola in women.

Local symptoms: first, a dense painful nodule appears, which increases in size to 1-2 cm. Often there are several of them and they merge with each other like a bunch of grapes, forming a large painful infiltrate. These nodules are fused to the skin. At first there is no hyperemia, then redness is observed. After 1-2 weeks, a fluctuation appears in the center of the nodule, then the abscess can open on its own and thick, creamy pus comes out of it. After cleansing of pus, scarring of the wound occurs. General symptoms: pain, dysfunction, fever, weakness, sweating.

Hidradenitis must be differentiated from the following diseases: boil, lymphadenitis, cancer metastases to the lymph nodes, actinomycosis, tuberculous lesions of the lymph nodes, lymphogranulomatosis, paraproctitis, mastitis.

In the phase of serous infiltration, treatment is conservative: shaving the hair in this area, treating the skin with antiseptics, injecting novocaine with antibiotics, dry heat, physiotherapy, radiotherapy, creating functional rest, antibacterial therapy. Abscessation i.e. when fluctuation appears - opening and draining the abscess.

This is an acute inflammation of the mammary gland. Mastitis mainly develops in the postpartum period during lactation (lactation mastitis).

The infection (most often staphylococcus) penetrates the gland tissue through microcracks in the nipple, as well as through the milk ducts during lactostasis. Most often, primigravidas suffer from the disease, which is facilitated by the narrowness of the mammary ducts, a sedentary nipple, and the thin, delicate skin of the nipple is easily subject to microtrauma.

According to the course of inflammation, acute mastitis is divided into serous, acute infiltrative, phlegmonous, abscessing, and gangrenous.

Mastitis must be differentiated from lactostasis. With lactostasis, there is usually an enlargement of the mammary glands on both sides, but practically no increase. After pumping, relief is observed. The pain is moderate. However, against the background of unresolved lactostasis, if an infection occurs, after 2-4 days a serous phase of mastitis occurs, which is characterized by an increase in temperature to 38-39 degrees, increased pain, enlarged mammary glands, without clear hyperemia and infiltration. Expressing milk is painful and does not bring relief. In the infiltrative form, a sharply painful infiltrate is determined, without clear boundaries, hyperemia, weakness, headache, temperature up to 40 degrees, the patient’s condition is regarded as serious. However, if the correct treatment is taken, regression of the disease will follow. Mandatory pumping of milk and an immobilizing bandage on the mammary gland are necessary to prevent venous stagnation. Restriction of fluid intake, physiotherapy, blockade with novocaine with antibiotics, antibacterial and infusion detoxification therapy. In some cases, suppression of lactation with hormonal drugs.

The phlegmonous phase of mastitis is characterized by the severe condition of patients and severe intoxication. The mammary gland is enlarged, pasty, sharply painful, severe hyperemia with a cyanotic tint, dilatation of the saphenous veins, lymphingitis, lymphadenitis, there may be areas of softening, anemia develops. Treatment is only surgical. Opening mastitis with excision of necrotic purulent tissue.

The abscess form often develops after the infiltrative form, when purulent melting of the infiltrate occurs. The clinical picture is characteristic of abscesses; fluctuations and swings between morning and evening temperatures are observed. Treatment for this form is only surgical. The most severe is the gangrenous form. It usually develops in patients who seek medical help late, in patients with diabetes mellitus. The causative agents of the disease in this form most often develop sepsis with purulent forms and the disease ends in death. Surgical treatment of the gangrenous form consists of removing the entire mammary gland and then treating it as a patient with sepsis. Depending on the location of the purulent focus, mastitis is divided into subareolar, intramammary, retromammary, and intracanacular. Retromammary mastitis is the most difficult to diagnose due to its location. Sometimes this form is complicated by subpectoral phlegmon. Various incisions are made to open mastitis, depending on the location of the purulent focus.

Paraproctitis

This is a purulent inflammation of the peri-rectal tissue. Caused by mixed microflora with a predominance of Escherichia coli, as well as anaerobic microflora. The infection penetrates into the tissue through the anal glands, which in the amount of 6-8 pieces open into the anal crypt. The infection can also penetrate through microtraumas of the mucous membrane, fissures in the anal canal, with hemorrhoids, hematogenous and lymphogenous routes (but rarely), from neighboring organs affected by the inflammatory process. Classification of paraproctitis depending on location:

1 - subcutaneous

2 – submucosal

3 – ischiorectal

4 – pelviorectal

5 – retrorectal

The mildest forms of the disease are subcutaneous and submucosal. General clinical symptoms of purulent intoxication depend on the form of paraproctitis, its prevalence and the type of pathogen.

With subcutaneous paraproctitis, there is painful swelling and hyperemia in the anus.

In the submucosal form, pain is particularly disturbing during bowel movements. Rectal examination can determine the presence of a rarely painful infiltrate from the mucous membrane.

Ischio-rectal paraproctitis is characterized by severe intoxication, high temperature, swelling and hyperemia of the skin in the perineal area, and upon rectal examination, pain in one of the lateral walls of the rectum.

The most difficult to diagnose is the pelvic-rectal form of paraproctitis. In this case, the process is localized high near the pelvic peritoneum. In this case, the disease initially occurs without visible inflammatory manifestations from the perineum.

In rare cases, the abscess breaks through the pelvic peritoneum into the abdominal cavity. Treatment of paraproctitis is surgical under general anesthesia or sacral-epidural anesthesia. The usual opening of an abscess with an incision in the paraanal area often leads to relapse of the disease or the formation of a pararectal fistula. Currently, radical operations have been proposed, the meaning of which is not only to open the abscess, but also to excise the affected crypt from the mucous side, eliminating the purulent-necrotic tract in the tissues near the rectum. After the operation, local treatment of the purulent wound, antibacterial and detoxification therapy are carried out.

This is a purulent inflammation of the parotid salivary gland. Mumps most often develops when microbes penetrate through the salivary duct from the mouth, as well as through the lymphogenous and hematogenous route. Factors contributing to the development of mumps are severe purulent intoxication, dehydration of patients, in patients with postoperative period those operated on the digestive tract, in cancer patients, and in malnourished patients. The causative agents are mixed pyogenic microflora. According to the nature of the inflammation, it can be abscessive, phlegmonous, or gangrenous.

Local symptoms: a painful swelling appears in the area of the parotid gland, increasing in size, intense edema, then hyperemia, in the abscess form - fluctuation, difficulty opening the mouth. General symptoms are symptoms of purulent intoxication, which often worsen the course of the underlying disease.

In the initial phase of inflammation in the absence of purulent tissue melting, treatment is conservative. Local dry heat, warming compresses, antibacterial therapy, detoxication and corrective infusion therapy, cannulation and rinsing of the excretory duct of the salivary gland with antiseptic solutions and proteolytic enzymes, oral care.

In the presence of purulent inflammation - surgical treatment, opening the abscess with an incision in the area of the angle of the lower jaw, being careful not to damage the main branches facial nerve. Complications of paratitis: arrosive bleeding from the vessels of the parotid gland or carotid artery. The occurrence of phlegmon of the neck, peripharyngeal space, purulent mediastinitis.

Prevention of paratitis

Fighting intoxication and dehydration.

Oral care.

Antibacterial therapy.

Prescription of acidic food irritants (lemon) to induce solivation.

Chewing gum or crackers to train the chewing muscles.

Erysipelas is an acute serous-exudative inflammation of the skin or mucous membrane. The causative agent of erysipelas is pathogenic streptococcus. Local and general predisposition of the body plays a significant role in the occurrence of erysipelas.

The infection penetrates through microtraumas of the skin contaminated with streptococcus, less often - lymphogenously.

Classification of erysipelas

According to the nature of inflammation:

Erythematous

Bullous

Phlegmonous

Necrotic

According to clinical features:

recurrent
migratory

Erythematous form - in the first days of the disease, general phenomena prevail over local ones. The temperature rises to 4O. Headache, chills, vomiting, increased heart rate, and weakness occur.

Local symptoms are bright red hyperemia with clear, uneven boundaries (like a geographical map), severe pain, local hyperthermia, swelling due to damage to the lymphatic vessels. Where the subcutaneous tissue is loose (scrotum, labia, eyelids) there is pronounced swelling.

Treatment of erythematous erysipelas: conservative. Penicillin antibiotics, including semisynthetic ones, and sulfonamides, including streptocide, are prescribed. Local treatment: use of UV-suberythematous doses, you can apply bandages with synthomycin emulsion, streptocidal or tetracycline ointment. Of the wet antiseptics, those that have a drying effect are used - rivanol, furacillin along with dimexide. X-ray therapy is practically not used.

Bullous form - symptoms of general intoxication are more pronounced than with erythematous. Constipation and vomiting appear, and diuresis decreases. Protein, red blood cells, and casts appear in the urine. Locally, due to swelling of the cells of the Malpighian layer with subsequent detachment of the epidermis, blisters appear filled with serous exudate, or hemorrhagic (in more severe cases. All this against the background of severe hyperemia and edema. The blisters contain a large number of streptococci, which is dangerous in terms of contact infection.

Treatment of bullous form of erysipelas. General treatment – parateral administration of semisynthetic penicillins, antibiotics wide range actions both intramuscularly and intravenously. Sulfonamides are prescribed in large doses. Infusion detoxication and corrective therapy, immunotherapy are carried out. Local treatment - the blisters must be opened and the exfoliated epidermis excised. Apply bandages with furacillin, rivenol, levosin or diaxikol. UFO is used. In some cases, this form is complicated by the spread of infection to the subcutaneous tissue and the development of a phlegmonous form of erysipelas.

Clinic of phlegmonous erysipelas. The general symptoms of purulent intoxication are more pronounced than with previous forms of erysipelas. The condition of the patients is serious. Local symptoms: changes on the surface of the skin may be minor, hyperemia is not so pronounced. And in the subcutaneous tissue there is serous-purulent impregnation and accumulation of pus. The swelling is widespread, intense, in some cases softening of the tissues is observed. Treatment of the phlegmonous form of erysipelas is surgical. Opening phlegmonosis and draining it with gauze swabs with hypertonic solution or liquid antiseptics. Daily dressings, local physiotherapy. In the postoperative period, antibacterial, detoxification and corrective therapy is carried out. In weakened and exhausted patients, bullous and phlegmonous forms of erysipelas can become necrotic.

Bohn's symptom (H. Bohn, b. 1896, German doctor) - decreased systolic blood pressure in a standing position after physical activity, observed with patent ductus arteriosus and associated with an increase in pathological arteriovenous blood discharge....

Blood ejection pressure is the pressure in the cavities of the ventricles of the heart at the moment of opening of the semilunar valves of the aortic valves and pulmonary trunk....

News about Fluctuation

Anatoly Nikolaevich Rogoza Dr. biol. Sciences, Ved. scientific co-workers Institute of Cardiology named after. A.L. Myasnikov RKNPK Ministry of Health of the Russian Federation. IN clinical practice non-invasive methods of measuring blood pressure (BP), which are classified depending on the
MM. Krasnov Moscow, State University Research Institute of Eye Diseases of the Russian Academy of Medical Sciences About intraocular pressure M.M. Krasnov The author gives new views on intraocular pressure, and investigates related conditions. In modern ophthalmological practice (including in our country)

Discussion Fluctuation

Hello! I am 20 years old, I am concerned about the question: my blood pressure in the evening is almost always 140/80, sometimes 150/90, but it decreases. I am a very emotional person, I study at 2 degrees, I underwent examination: ultrasound of the heart, etc. The doctor diagnosed neurocircular dystonia. Is this pressure normal in mine?

Thank you

The site provides background information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

Diagnosis of ascites

Liquid accumulation in abdominal cavity is a sign of severe dysfunction of various organs and systems, which can pose a threat to the health and life of the patient. That's why when the first signs appear ascites It is necessary to consult a doctor as soon as possible, since only after a full and comprehensive examination and identification of the cause of ascites can adequate, effective treatment be prescribed, which will slow down the progression of the disease and prolong the patient’s life.

You can confirm the diagnosis and establish the cause of ascites using:

abdominal percussion;
palpation of the abdomen;
laboratory tests;
ultrasound examination (ultrasound);
diagnostic laparocentesis (puncture).

Percussion of the abdomen for ascites

Percussion of the abdomen can help in diagnosing ascites (when the doctor presses 1 finger to the anterior abdominal wall and taps it with the second). If ascites is moderate, when the patient lies on his back, fluid will shift downward, and intestinal loops (containing gases) will be pushed upward. As a result, when percussing the upper abdomen, a tympanic percussion sound will be detected (as when tapping on an empty box), while in the lateral sections a dull percussion sound will be heard. When the patient is standing, the fluid will shift downward, resulting in upper sections There will be a tympanic percussion sound in the abdomen, and a dull sound below. With severe ascites, a dull percussion sound will be detected over the entire surface of the abdomen.

Palpation of the abdomen with ascites

Palpation (palpation) of the abdomen can give important information about the state internal organs and help the doctor suspect a particular pathology. Availability cannot be determined large quantity liquids (less than 1 liter) by palpation is quite difficult. However, at this stage of the development of the disease, a number of other signs can be identified that indicate damage to certain organs.

By palpation you can detect:

Enlarged liver. May be a sign of cirrhosis or liver cancer. The liver is dense, its surface is lumpy and uneven.
Enlarged spleen. U healthy people the spleen is not palpable. Its increase may be a sign of progressive portal hypertension (with cirrhosis or cancer), tumor metastasis, or hemolytic anemia (in which blood cells are destroyed in the spleen).
Signs of inflammation of the peritoneum (peritonitis). The main symptom indicating the presence of an inflammatory process in the abdominal cavity is the Shchetkin-Blumberg symptom. To identify it, the patient lies on his back and bends his knees, and the doctor slowly presses his fingers on the anterior abdominal wall, after which he sharply removes his hand. The strongest that appear sharp pains indicate in favor of peritonitis.

With severe ascites, the anterior abdominal wall will be tense, hard, and painful, so it will be impossible to identify the above symptoms.

Symptom of fluctuation in ascites

The symptom of fluctuation (oscillation) is an important sign of the presence of fluid in the abdominal cavity. To identify it, the patient lies on his back, the doctor presses his left hand to the patient’s abdominal wall on one side, and right hand lightly taps the opposite wall of the abdomen. If there is a sufficient amount of free fluid in the abdominal cavity, when tapping, characteristic wave-like shocks will form, which will be felt on the opposite side.

A symptom of fluctuation can be detected if there is more than 1 liter of fluid in the abdominal cavity. At the same time, with severe ascites it may be uninformative, since it is excessively high pressure in the abdominal cavity will not allow you to correctly conduct the study and evaluate its results.

Tests for ascites

Laboratory tests are prescribed after a thorough clinical examination of the patient, when the doctor suspects a pathology of a particular organ. The purpose of laboratory tests is to confirm the diagnosis, as well as exclude others. possible diseases and pathological conditions.

For ascites, the doctor may prescribe:

general blood analysis ;
biochemical analysis blood;
general urine analysis ;
bacteriological examination;
liver biopsy.

Complete blood count (CBC)
It is prescribed to assess the general condition of the patient and identify various abnormalities that occur in certain diseases. For example, in patients with cirrhosis of the liver and splenomegaly (enlarged spleen), there may be a decrease in the concentration of red blood cells (red blood cells), hemoglobin (the respiratory pigment that transports oxygen in the body), leukocytes (cells of the immune system) and platelets (blood platelets that provide stopping bleeding). This is explained by the fact that blood cells are retained and destroyed in the enlarged spleen.

In case of infectious inflammatory diseases abdominal organs (in particular with peritonitis and pancreatitis), there may be a marked increase in the concentration of leukocytes (as a response of the immune system in response to the introduction of a foreign infection) and an increase in the erythrocyte sedimentation rate (ESR), which also indicates the presence of an inflammatory process in the body.

Biochemical blood test (BAC)
This study estimates the number various substances in the blood, which allows one to judge the functional activity of certain organs.

With cirrhosis of the liver, there will be an increase in the concentration of bilirubin (due to a decrease in the neutralizing function of the organ). Cirrhosis is also characterized by a decrease in the concentration of proteins in the blood, since they are all formed in the liver.

In case of inflammation of the peritoneum or pancreatitis, BAK allows to detect an increase in protein concentration acute phase inflammation ( C-reactive protein, fibrinogen, ceruloplasmin and others), and their concentration in the blood directly depends on the severity and activity of the inflammatory process. This allows you to recognize peritonitis in a timely manner, as well as monitor the patient’s condition over time during treatment and identify possible complications in a timely manner.

With renal ascites (developing as a result of kidney failure), the concentrations of substances in the blood that are usually excreted by the kidneys will increase. Of particular importance are substances such as urea (normal 2.5 – 8.3 mmol/liter), uric acid (normal 120 – 350 µmol/liter) and creatinine (normal 44 – 100 µmol/liter).

LBC is also important in diagnosing pancreatitis (inflammation of the pancreas). The fact is that as the disease progresses, the gland tissue is destroyed, as a result of which digestive enzymes (pancreatic amylase) enter the blood. An increase in pancreatic amylase concentration of more than 50 Action Units/liter (U/L) confirms the diagnosis.

General urinalysis (UCA)
A urine test can reveal abnormalities in the functioning of the urinary system. IN normal conditions More than 180 liters of fluid are filtered through the kidneys daily, but about 99% of this volume is absorbed back into the bloodstream. At the initial stage renal failure the concentration and absorption function of the kidneys may be impaired, as a result of which a larger amount of less dense urine will be released (normally, the specific gravity of urine ranges from 1010 to 1022). At terminal stage disease, the specific gravity of urine may be normal or even slightly increased, but the total amount of urine excreted per day is significantly reduced.

With nephrotic syndrome, there will be a discharge of urine of increased density, in which an increased concentration of proteins will be determined (more than 3.5 grams per day). OAM is also valuable in diagnosing pancreatitis, since with this disease the concentration of amylase increases not only in the blood, but also in the urine (more than 1000 U/l).

Bacteriological research
This study is of particular value for bacterial and tuberculous peritonitis. Its essence is to collect various biological material (blood, ascitic fluid, saliva) and isolate pathogenic microorganisms from it that could cause the development of an infectious-inflammatory process. This allows not only to confirm the diagnosis, but also to determine those antibiotics that are best suited to treat the infection in a given patient (the sensitivity of various bacteria to antibacterial drugs different, which can be determined in laboratory conditions).

Liver biopsy
During a biopsy, a small fragment of the patient's liver tissue is removed intravitally for the purpose of examining it in the laboratory under a microscope. This study allows you to confirm the diagnosis of cirrhosis in more than 90% of cases. For liver cancer, a biopsy may not be informative, since no one can guarantee that cancer cells will be in the exact area of liver tissue that will be examined.

Ultrasound for ascites

The principle of ultrasound is based on the ability of sound waves to be reflected from objects of different densities (they easily pass through air, but are refracted and reflected at the boundary of air and liquid or dense organ tissue). The reflected waves are recorded by special receivers and, after computer processing, are presented on the monitor as an image of the area under study.

This study is absolutely harmless and safe; it can be performed many times during the entire treatment period to monitor the patient’s condition and timely identify possible complications.

Ultrasound can reveal:

Free fluid in the abdominal cavity– even a small amount of it (several hundred milliliters) is determined.
Liquid in pleural cavity and in the pericardial cavity– for systemic inflammatory diseases and tumors.
Liver enlargement– for cirrhosis, cancer, hepatic vein thrombosis.
Enlarged spleen– with increased pressure in the portal vein system (portal hypertension) and with hemolytic anemia (accompanied by the destruction of blood cells).
Dilatation of the portal vein– with portal hypertension.
Dilatation of the inferior vena cava– with heart failure and stagnation of blood in the veins of the lower body.
Kidney structure disorder– in case of renal failure.
Violation of the structure of the pancreas- with pancreatitis.
Anomalies of fetal development.
Tumor and its metastases.

MRI for ascites

Magnetic resonance imaging is a modern, high-precision study that allows layer-by-layer examination of a selected area, organ or tissue. The principle of the method is based on the phenomenon of nuclear resonance - when living tissue is placed in a strong electromagnetic field, the nuclei of atoms emit a certain energy, which is recorded by special sensors. Different fabrics are characterized different character radiation, which allows you to examine muscles, parenchyma of the liver and spleen, blood vessels, and so on.

This study allows us to detect even small amounts of ascitic fluid located in hard-to-reach areas of the abdominal cavity that cannot be examined using other methods. MRI is also useful in diagnosing liver cirrhosis, benign and malignant tumors any localization, with peritonitis, pancreatitis and other diseases that could cause ascites.

Other instrumental studies for ascites

In addition to ultrasound and MRI, the doctor can prescribe a number of additional instrumental studies necessary to establish a diagnosis and assess the condition of various organs and systems.

To identify the cause of ascites, your doctor may prescribe:

Electrocardiography (ECG). This study allows you to evaluate the electrical activity of the heart, identify signs of enlarged heart muscle, heart rhythm disturbances and other pathologies.
Echocardiography (EchoCG). This study evaluates the nature of heart contractions during each systole and diastole, and also evaluates structural disorders of the heart muscle.
X-ray examination. A chest x-ray is prescribed to all patients if ascites is suspected. This simple study allows us to exclude infectious diseases of the lungs and pleurisy. X-ray of the abdominal cavity can reveal an enlarged liver, the presence of intestinal obstruction or perforation (perforation) of the intestine and the release of some gases into the abdominal cavity.
Dopplerography. This study is based on the principle of ultrasound using the Doppler effect. Its essence lies in the fact that during ultrasound examination, approaching and separating objects (in particular blood in blood vessels) will reflect sound waves differently. According to the results this study the pattern of blood flow through the portal vein and other blood vessels can be assessed, the presence of blood clots in the hepatic veins can be detected, and other possible disorders can be determined.

Laparocentesis (puncture) for ascites

Diagnostic puncture (that is, puncture of the anterior abdominal wall and pumping out a small amount of ascitic fluid) is prescribed for patients who could not make a diagnosis based on other research methods. This method allows you to examine the composition of the liquid and its properties, which in some cases is useful for making a diagnosis.

Diagnostic laparocentesis is contraindicated:

If there is a violation of the blood coagulation system, since this increases the risk of bleeding during the study.
If the skin in the area of the anterolateral wall of the abdomen is infected, since during a puncture it is possible to introduce infection into the abdominal cavity.
At intestinal obstruction(there is a high risk of the needle perforating the swollen intestinal loops, which will lead to feces into the abdominal cavity and the development of fecal peritonitis).
If you suspect a tumor near the puncture site (damage to the tumor with a needle can trigger metastasis and spread of tumor cells throughout the body).

It is also worth noting that in the third trimester of pregnancy, laparocentesis is carried out only according to strict indications and under the control of an ultrasound machine, which helps control the depth of needle insertion and its location in relation to other organs and the fetus.

Preparing the patient
Preparation for the procedure consists of emptying the bladder (if necessary, a special catheter can be installed in it), stomach (up to rinsing through a probe) and intestines. The procedure itself is performed under local anesthesia(that is, the patient is conscious), so particularly sensitive and emotional patients can be prescribed mild sedatives.

Lidocaine and novocaine (local anesthetics injected into soft fabrics and suppressing pain and other types of sensitivity for a while) quite often cause allergic reactions (up to anaphylactic shock and death of the patient). That is why an allergy test is required before starting pain relief. On the skin of the patient’s forearm, 2 scratches are made with a sterile needle, anesthetic is applied to one of them, and regular anesthetic is applied to the other. saline. If after 5 - 10 minutes the color skin above them is the same, the reaction is considered negative (no allergy). If there is redness, swelling and swelling of the skin above the scratch with an anesthetic, this indicates that the patient is allergic to this anesthetic, so its use is strictly contraindicated.

Technique of the procedure
The patient takes a semi-sitting or lying (on his back) position. Immediately before the puncture begins, it is covered with sterile sheets so that only the area of the anterior abdominal wall through which the puncture will be performed remains free. This reduces the risk of developing infectious complications in the postoperative period.

The puncture is usually made along the midline of the abdomen, between the navel and the pubic bone (this area contains the least blood vessels, therefore the risk of injury is minimal). First, the doctor treats the site of the intended puncture with an antiseptic solution (iodine solution, hydrogen peroxide), after which he injects the skin, subcutaneous tissue and muscles of the anterior abdominal wall with an anesthetic solution. After this, a small skin incision is made with a scalpel, through which a trocar (a special instrument that is a tube with a stylet inside) is inserted. The trocar is slowly moved deeper with the help of rotational movements until the doctor decides that it is in the abdominal cavity. After this, the stylet is removed. The leakage of ascitic fluid through the trocar indicates a correctly performed puncture. The required amount of fluid is taken, after which the trocar is removed and the wound is sutured. The test tube with the resulting liquid is sent to the laboratory for further research.

Interpretation of research results
Depending on the nature and composition, two types of ascitic fluid are distinguished - transudate and exudate. This is extremely important for further diagnosis, since the mechanisms of formation of these liquids are different.

Transudate is an ultrafiltrate of plasma formed when fluid sweats through blood or lymphatic vessels. The cause of the accumulation of transudate in the abdominal cavity may be heart failure, nephrotic syndrome and other pathologies accompanied by an increase in hydrostatic pressure and a decrease in oncotic blood pressure. At laboratory research transudate is defined as a clear liquid of low density (specific gravity ranges from 1.006 to 1.012). The protein concentration in the transudate does not exceed 25 g/l, which is confirmed by special tests.

Exudate, in contrast to transudate, is a cloudy, shiny liquid rich in proteins (more than 25 g/l) and other micromolecular substances. The density of the exudate usually ranges from 1.018 to 1.020, and the concentration of leukocytes can exceed 1000 in one microliter of the test fluid. Also, impurities of other biological fluids (blood, lymph, bile, pus) may be found in the exudate, which will indicate damage to one or another organ.

Stages of ascites

In clinical practice, there are three stages of ascites development, which are determined depending on the amount of free fluid in the abdominal cavity.

Ascites can be:

Transitional. In this case, no more than 400 ml of fluid accumulates in the abdominal cavity, which can only be detected using special research(ultrasound, MRI). Transient ascites does not impair the function of the abdominal organs or lungs, therefore all existing symptoms are caused by the underlying disease, adequate therapy of which can lead to fluid resorption.
Moderate. With moderate ascites, up to 4 liters of ascitic fluid can accumulate in the abdominal cavity. The abdomen in such patients will be slightly enlarged, in a standing position there will be a bulging of the lower abdominal wall, and in a lying position shortness of breath (a feeling of lack of air) may appear. The presence of ascitic fluid can be determined by percussion or fluctuation symptom.
Tense. In this case, the amount of ascitic fluid may exceed 10–15 liters. The pressure in the abdominal cavity increases so much that it can disrupt the functions of vital organs (lungs, heart, intestines). The condition of such patients is assessed as extremely serious, so they must be immediately hospitalized in the intensive care unit for diagnosis and treatment.

Also in clinical practice, it is customary to distinguish refractory (not treatable) ascites. This diagnosis is made if, during treatment, the amount of fluid in the abdominal cavity continues to increase. The prognosis in this case is extremely unfavorable.

Treatment of ascites

Treatment of ascites should begin as early as possible and be carried out only by an experienced doctor, since otherwise the disease may progress and serious complications may develop. First of all, it is necessary to determine the stage of ascites and assess the general condition of the patient. If, against the background of intense ascites, the patient develops signs of respiratory failure or heart failure, the primary goal will be to reduce the amount of ascitic fluid and reduce the pressure in the abdominal cavity. If the ascites is transient or moderate, and the existing complications do not pose an immediate threat to the patient’s life, treatment of the underlying disease comes to the fore, but the level of fluid in the abdominal cavity is regularly monitored.

In the treatment of ascites the following are used:

diet therapy;
physical exercise;
therapeutic laparocentesis;
traditional methods of treatment.

Diuretics (diuretics) for ascites

Diuretics have the ability to remove fluid from the body through various mechanisms. A decrease in the volume of circulating blood can facilitate the transition of some fluid from the abdominal cavity into the bloodstream, which will reduce the severity of clinical manifestations ascites.

Diuretics for ascites

Drug name	Mechanism of therapeutic action	Directions for use and doses
*Furosemide*	Promotes the excretion of sodium and fluid through the kidneys.	Intravenously, 20–40 mg 2 times a day. If ineffective, the dose may be increased.
*Mannitol*	Osmotic diuretic. Increases the osmotic pressure of blood plasma, promoting the transition of fluid from the intercellular space into the vascular bed.	Prescribed 200 mg intravenously. The drug should be used simultaneously with furosemide, since their action is combined - mannitol removes fluid from the intercellular space into the vascular bed, and furosemide - from the vascular bed through the kidneys.
*Spironolactone*	A diuretic that prevents excessive loss of potassium from the body ( what is observed when using furosemide).	Take orally 100–400 mg per day ( depending on the level of potassium in the blood).

It is important to remember that the rate of excretion of ascitic fluid should not exceed 400 ml per day (this is exactly how much the peritoneum can absorb into the vascular bed). With more intense fluid excretion (which can occur with improper and uncontrolled use of diuretics), dehydration may develop.

Other medications used for ascites

In addition to diuretics, a number of other medications can be used that affect the development of ascites.

Drug treatment for ascites may include:

Agents that strengthen the vascular wall(diosmin, vitamins C, P). Vasodilation and increased permeability of the vascular wall are one of the main elements in the development of ascites. The use of drugs that can reduce vascular permeability and increase their resistance in the face of various pathogenic factors(increased intravascular pressure, inflammatory mediators, and so on) can significantly slow down the progression of ascites.
Drugs affecting the blood system(>polyglucin, rheopolyglucin, gelatinol). The introduction of these drugs into the systemic circulation helps to retain fluid in the vascular bed, preventing its passage into the intercellular space and into the abdominal cavity.
Albumin (protein). Albumin is the main protein that provides oncotic pressure in the blood (which holds fluid in the vascular bed and prevents it from moving into the intercellular space). With cirrhosis or liver cancer, as well as with nephrotic syndrome, the amount of protein in the blood can be significantly reduced, which must be compensated for by intravenous administration of albumin.
Antibiotics. Prescribed for bacterial or tuberculous peritonitis.

Diet for ascites

Nutrition for ascites should be high-calorie, complete and balanced in order to provide the body with everything necessary nutrients, vitamins and microelements. Patients should also limit the consumption of a number of foods that could aggravate the disease.

The main principles of the diet for ascites are:

Limiting salt intake. Excessive salt consumption promotes the transition of fluid from the vascular bed into the intercellular space, that is, leads to the development of edema and ascites. This is why such patients are advised to exclude salt from their diet. pure form, and take salty foods in limited quantities.
Limiting fluid intake. Patients with moderate or severe ascites are not recommended to take more than 500–1000 ml of liquid (pure) per day, as this may contribute to the progression of the disease and deterioration of general well-being.
Adequate protein intake. As already mentioned, protein deficiency can cause the development of edema. That's why in daily diet A patient with ascites should include proteins of animal origin (contained in meat, eggs). However, it is worth remembering that in case of liver cirrhosis, excessive consumption of protein foods can cause intoxication of the body (as the neutralizing function of the liver is impaired), so in this case it is better to coordinate the diet with your doctor.
Limiting fat intake. This rule is especially important for ascites caused by pancreatitis. The point is that consumption fatty foods stimulates the formation of digestive enzymes in the pancreas, which can lead to exacerbation of pancreatitis.

Diet for ascites

Exercise for ascites

When planning physical activity with ascites, it is important to remember that this condition itself indicates a pronounced dysfunction of one or several internal organs at once, therefore it is recommended to select the load together with the attending physician. In general, the type and nature of permissible physical exercise depends on the general condition of the patient and the cause of ascites.

The main “limiter” of physical activity during ascites is the state of the heart and respiratory systems. So, for example, with severe heart failure (when shortness of breath occurs at rest), any physical activity contraindicated. At the same time, with a milder course of the disease and transient or moderate ascites, the patient is recommended to take a daily walk. fresh air(with a light, slow step), do morning exercises and other light sports. Special attention Swimming should be given attention, since while in the water, blood circulation improves and, at the same time, the load on the heart decreases, which slows down the progression of ascites.

Stressed ascites, in which compression of the lungs and abdominal organs is observed, can also limit the patient’s physical activity. Performing normal physical exercises in this case is impossible, since any load can lead to decompensation of the patient’s condition and the development of acute respiratory failure.

Therapeutic laparocentesis (therapeutic puncture) for ascites

As mentioned earlier, puncture (puncture) of the anterior abdominal wall and removal of part of the ascitic fluid from the abdominal cavity is important in the diagnosis of ascites. At the same time, this procedure can also be performed in medicinal purposes. This is indicated for tense and/or refractory ascites, when the fluid pressure in the abdominal cavity is so high that it leads to disruption of vital organs (primarily the heart and lungs). In this case, the only effective method treatment is a puncture of the abdominal cavity, during which part of the ascitic fluid is removed.

The technique and rules for preparing the patient are the same as for diagnostic laparocentesis. After puncture of the anterior abdominal wall, a special drainage tube is installed into the abdominal cavity, through which ascitic fluid will flow. A container with a graduated volume must be attached to the other end of the tube (to control the amount of liquid removed).

It is important to remember that ascitic fluid may contain large amounts of proteins (albumin). Simultaneous removal of a large volume of fluid (more than 5 liters) can not only lead to a drop in blood pressure (due to the expansion of previously compressed blood vessels), but also to severe protein deficiency. That is why the amount of fluid removed should be determined depending on the nature of the ascitic fluid (transudate or exudate) and the general condition of the patient.

Treatment of ascites with traditional methods

Traditional methods of treatment are widely used to treat ascites with various diseases. The main task medicinal herbs and plants is to remove ascitic fluid from the body, so they all have a diuretic effect.

In the treatment of ascites you can use:

Parsley infusion. 40 grams of chopped green grass and parsley roots should be poured into 1 liter of boiling water and left at room temperature for 12 hours. Take 1 tablespoon orally 3-4 times a day (before meals).
Decoction of bean pods. Pour 2 tablespoons of chopped bean pods into a liter of water, bring to a boil and boil in a water bath for 20 - 30 minutes. After this, cool and take 2 tablespoons orally 4 to 5 times a day before meals.
A decoction of coltsfoot leaves. Coltsfoot pour 1 cup (200 ml) water, bring to a boil and simmer for 10 minutes. Cool, strain and take 1 tablespoon orally 3 times a day.
Motherwort tincture. 1 tablespoon of crushed motherwort leaves should be placed in glass jar and pour 100 ml of 70% alcohol, then leave in a dark place at room temperature for 3 to 5 days. The tincture should be taken three times a day before meals, 30 drops diluted in a small amount of boiled water.
Apricot compote. It has not only a diuretic, but also a potassium-sparing effect, which is extremely important for long-term use of diuretic herbs and drugs. It is better to prepare compote from dried apricots, 300–400 grams of which are poured with 2–3 liters of water and boiled for 15–20 minutes. It is important to remember that with intense ascites, the amount of fluid consumed should be limited, so it is not recommended to take more than 200 - 300 ml of compote per day.

When is surgery needed for ascites?

Surgery for ascites is indicated if the cause of its occurrence can be eliminated surgically. At the same time, the possibility of surgical treatment is limited by the amount of ascitic fluid and the general condition of the patient, which can be extremely severe.

Surgical treatment can be used:

For liver cancer. Removing the part of the liver affected by the tumor can stop the progression of the pathological process (in the absence of metastases in distant organs).
For heart defects. Correction of valvular heart disease (replacement of a damaged valve with an artificial one) can lead to complete recovery of the patient, normalization of heart function and resorption of ascitic fluid.
For abdominal cancer. Timely removal of a tumor compressing the blood vessels of the portal vein system can lead to complete cure patient.
With peritonitis. Bacterial peritonitis is an indication for surgical treatment. The abdominal cavity is opened, cleared of purulent masses and washed with antiseptic solutions.
With chylous ascites. If the penetration of lymph into the abdominal cavity is due to damage to a large lymphatic vessel in this area, its suturing during surgery can lead to complete recovery of the patient.

Surgical treatment of ascites is not performed in cases of decompensated cardiac and respiratory failure. In this case, the patient simply will not survive the anesthesia and the surgical intervention itself, so before the operation a course of diuretics is usually prescribed, and, if necessary, a therapeutic puncture and removal of part of the ascitic fluid. Also, certain difficulties may arise when operating on a patient with tense ascites, since the simultaneous removal of a large volume of fluid can lead to complications and death.

Today, the method of returning ascitic fluid (more precisely, the proteins and other microelements it contains) into the systemic circulation through intravenous infusions is widely used, which reduces the risk of death in such patients.

Treatment of ascites in liver cirrhosis

One of the main stages in the treatment of ascites in liver cirrhosis is to stop the progression of the pathological process in it and stimulate the restoration of normal liver tissue. Without complying with these conditions symptomatic treatment ascites (use of diuretics and repeated medical punctures) will give a temporary effect, but ultimately it will end in the death of the patient.

Treatment for liver cirrhosis includes:

Hepatoprotectors(allochol, ursodeoxycholic acid) - drugs that improve metabolism in liver cells and protect them from damage by various toxins.
Essential phospholipids(phosphogliv, essentiale) – restore damaged cells and increase their resistance to toxic factors.
Flavonoids(gepabene, karsil) – neutralize free oxygen radicals and other toxic substances formed in the liver during the progression of cirrhosis.
Amino acid preparations(heptral, hepasol A) - cover the need of the liver and the whole body for amino acids necessary for normal growth and renewal of all tissues and organs.
Antiviral agents(Pegasys, ribavirin) – prescribed for viral hepatitis B or C.
Vitamins (A, B12, D, K)– these vitamins are formed or deposited (stored) in the liver, and with the development of cirrhosis, their concentration in the blood can significantly decrease, which will lead to the development of a number of complications.
Diet therapy– it is recommended to exclude from the diet foods that increase the load on the liver (in particular, fatty and fried foods, any types of alcoholic beverages, tea, coffee).
Liver transplant– the only method that allows you to radically solve the problem of cirrhosis. However, it is worth remembering that even after a successful transplant, the cause of the disease must be identified and eliminated, since otherwise cirrhosis can affect the new (transplanted) liver.

Treatment of ascites in oncology

The reason for the formation of ascitic fluid in a tumor can be compression of the blood and lymphatic vessels of the abdominal cavity, as well as damage to the peritoneum by tumor cells. In any case for effective treatment To treat the disease, it is necessary to completely remove the malignant neoplasm from the body.

In treatment oncological diseases can be used:

Chemotherapy. Chemotherapy is the main treatment for peritoneal carcinomatosis, in which tumor cells affect both layers of the serosa of the abdominal cavity. Chemical drugs (methotrexate, azathioprine, cisplatin) are prescribed that disrupt the processes of tumor cell division, thereby leading to the destruction of the tumor. The main problem with this is the fact that these drugs also disrupt the division of normal cells throughout the body. As a result, during the treatment period, the patient may experience hair loss, stomach and intestinal ulcers may appear, and aplastic anemia may develop (lack of red blood cells due to a disruption in the process of their formation in the red bone marrow).
Radiation therapy. The essence of this method is the high-precision impact of radiation on tumor tissue, which leads to the death of tumor cells and a decrease in the size of the tumor.
Surgery. It involves removing the tumor through surgery. This method especially effective for benign tumors or in the case when the cause of ascites is compression of blood or lymphatic vessels by a growing tumor (its removal can lead to a complete recovery of the patient).

Treatment of ascites in heart failure

Heart failure is characterized by the inability of the heart muscle to pump blood throughout the body. Treatment of this disease is to reduce the pressure in circulatory system, eliminating blood stagnation in the veins and improving the functioning of the heart muscle.

Treatment for heart failure includes:

Diuretics. They reduce the volume of circulating blood, reducing the load on the heart and the pressure in the veins of the lower body, thereby preventing further development ascites. They should be prescribed carefully, under the control of blood pressure, so as not to provoke dehydration.
Drugs that lower blood pressure(ramipril, losartan). When blood pressure (BP) is high, the heart muscle has to do more work, pumping blood into the aorta during contraction. Normalizing pressure reduces the load on the heart, thereby helping to eliminate venous stagnation and edema.
Cardiac glycosides(digoxin, digitoxin). These drugs increase the force of heart contractions, which helps eliminate congestion in the veins of the lower body. They should be taken with caution, as in case of overdose, death can occur.
Salt-free diet. Consuming large amounts of salt leads to fluid retention in the body, which further increases the load on the heart. This is why patients with heart failure are not recommended to take more than 3 to 5 grams of salt per day (including salt used in preparing various dishes).
Limiting fluid intake(no more than 1 - 1.5 liters per day).
Maintaining a daily routine. If condition allows of cardio-vascular system, patients are recommended to have moderate physical activity (walking, morning exercises, swimming, yoga).

Treatment of ascites in renal failure

In renal failure, the excretory function of the kidneys is impaired, resulting in fluid and metabolic byproducts (urea, uric acid) are retained in the body in large quantities. Treatment of renal failure consists of normalizing kidney function and removing toxic substances from the body.

Treatment for kidney failure includes:

Diuretics. In the initial stages of the disease they can have a positive effect, but in end-stage renal failure they are ineffective. This is explained by the fact that the mechanism of action of diuretics is to regulate (that is, enhance) the excretory function of renal tissue. At the last stage of the disease, the amount of functional renal tissue is extremely small, which causes the lack of effect when prescribing diuretics.
Medicines that lower blood pressure. In renal failure, the blood supply to the remaining functional renal tissue is disrupted, as a result of which a number of compensatory mechanisms are activated aimed at maintaining renal blood flow at an adequate level. One of these mechanisms is an increase in blood pressure. However, an increase in blood pressure does not improve the condition of the kidneys, but, on the contrary, contributes to the progression of the pathological process, the development of edema and ascites. That is why normalization of blood pressure is an important stage of treatment, allowing to slow down the rate of formation of ascitic fluid.
Hemodialysis. During this procedure, the patient's blood is passed through a special apparatus in which it is purified from by-products metabolism and other toxins, after which it returns back to the bloodstream. Hemodialysis and other methods of blood purification (plasmapheresis, peritoneal dialysis, hemosorption) are the latest effective way prolonging the life of patients with chronic renal failure.
Kidney transplant. A radical treatment method in which the patient is transplanted with a donor kidney. If the operation is successful and the graft takes root in the host’s body, new kidney can fully perform the excretory function, ensuring the normal quality and life expectancy of the patient.

Consequences and complications of ascites

With prolonged progression of the disease and the accumulation of a large amount of fluid in the abdominal cavity, a number of complications can develop, which without timely and complete correction can lead to the death of the patient.

Ascites can be complicated by:

inflammation of the peritoneum (ascites-peritonitis);
heart failure;
respiratory failure;
umbilical hernia;
intestinal obstruction.

Ascites-peritonitis
This condition occurs as a result of the penetration of foreign bacteria into the abdominal cavity, which leads to inflammation of the peritoneum. The development of this complication is facilitated by stagnation of ascitic fluid, impaired motility of compressed intestinal loops, as well as dilation and increased vascular permeability in the portal vein system. Also, an important role in the development of infectious complications is played by a decrease in the overall defenses of the body as a result of the progression of the underlying pathology that caused ascites (renal, heart or liver failure, tumor, and so on).

It is important that there is no visible defect of the peritoneum or internal organs that could become a source of infection. It is believed that bacteria leak into the abdominal cavity through the dilated and overstretched walls of the intestinal loops.

Regardless of the mechanism of development, the presence of peritonitis requires hospitalization of the patient and urgent surgical treatment.

Heart failure
The accumulation of a large amount of fluid in the abdominal cavity leads to compression of the organs and blood vessels located there (arteries and veins), disrupting the flow of blood through them. As a result, the heart has to do a lot of work to pump blood through the vessels.

If ascites develops slowly, compensatory mechanisms are activated in the heart, consisting of the proliferation of muscle fibers and an increase in the size of the heart muscle. This allows you to compensate for the increase in load up to a certain point. With further progression of ascites, the reserves of the heart muscle may be depleted, which will cause the development of heart failure.

If ascites develops quickly (over several days), the heart does not have time to adapt to the increasing load, as a result of which acute heart failure may develop, requiring emergency medical care.

Hydrothorax
This term refers to the accumulation of fluid in the chest. The development of hydrothorax with ascites is facilitated by an increase in the pressure of ascitic fluid, as a result of which fluid from the blood and lymphatic vessels of the abdominal cavity can pass into the vessels of the diaphragm and chest. As the disease progresses, the amount of free fluid in the chest will increase, which will lead to compression of the lung on the affected side (or both lungs in case of bilateral hydrothorax) and respiratory impairment.

Respiratory failure
The development of this condition can be facilitated by the rise and limitation of excursion of the diaphragm as a result of increased pressure in the abdominal cavity, as well as the progression of hydrothorax. In the absence of timely treatment, respiratory failure will lead to a pronounced decrease in the concentration of oxygen in the blood, which can be manifested by shortness of breath, cyanosis of the skin and impaired consciousness, even loss of consciousness.

Diaphragmatic hernia
A diaphragmatic hernia is a protrusion of an organ or tissue through a defect in the diaphragm or through its esophageal opening. The reason for this is a pronounced increase in intra-abdominal pressure.

The stomach, intestinal loops, or serous membrane filled with ascitic fluid may protrude through the hernial opening. This condition manifests itself as pain in the chest and in the heart area, in the upper abdomen. If a sufficiently large section of an organ emerges into the hernial opening, it can compress the lungs and heart, leading to impaired breathing and heartbeat.

Treatment of the disease is mainly surgical, consisting of repositioning the hernial sac and suturing the defect in the diaphragm.

Umbilical hernia
The cause of the formation of an umbilical hernia is also high blood pressure in the abdominal cavity. The anterior abdominal wall is covered with muscles along almost its entire length. The exception is the umbilical region and the midline of the abdomen, where these muscles come together and form the so-called aponeurosis of the anterior abdominal wall. This aponeurosis consists of tendon tissue, which is the “weak spot” of the abdominal wall (this is where protrusion of the hernial sac is most often observed). Treatment of the disease is also surgical (the hernia is reduced and the hernia orifice is sutured).

Intestinal obstruction
It develops as a result of compression of intestinal loops by ascitic fluid, which usually occurs with tense, refractory ascites. Impaired intestinal patency leads to the accumulation of feces above the site of compression and increased peristalsis (motor activity) of the intestine in this area, which is accompanied by severe paroxysmal abdominal pain. If intestinal obstruction does not resolve within a few hours, intestinal paralysis occurs, dilation and increased permeability of the intestinal wall. As a result, numerous bacteria (which are permanent inhabitants of the large intestine) penetrate the blood, causing the development of serious, life-threatening complications for the patient.

Treatment consists of opening the abdominal cavity and eliminating intestinal obstruction. If the damaged intestinal loops are not viable, they are removed, and the resulting ends of the digestive canal are connected to each other.

Prognosis for ascites

Ascites itself is an unfavorable prognostic sign, indicating a long course of the disease and severe dysfunction of the affected organ (or organs). However, ascites is not a fatal diagnosis. With timely initiation and proper treatment, ascitic fluid can be completely resorbed, and the function of the affected organ can be restored. However, in some cases, ascites rapidly progresses, leading to the development of complications and death of the patient, even against the background of adequate and complete treatment. This is explained by severe damage to vital organs, primarily the liver, heart, kidneys and lungs.

Based on the above, it follows that the prognosis for ascites is determined not only by the amount of fluid in the abdominal cavity and the quality of treatment, but also by the underlying disease that caused the accumulation of fluid in the abdominal cavity.

How long do people with ascites live?

The lifespan of people diagnosed with ascites varies widely, depending on a number of factors.

The life expectancy of a patient with ascites is determined by:

The severity of ascites. Transient (mild) ascites does not pose an immediate threat to the patient's life, while intense ascites, accompanied by the accumulation of tens of liters of fluid in the abdominal cavity, can lead to the development of acute cardiac or respiratory failure and death of the patient within hours or days.
Time to start treatment. If ascites is detected in the early stages of development, when the functions of vital organs are not impaired (or slightly impaired), elimination of the underlying disease can lead to a complete cure of the patient. At the same time, with long-term progressive ascites, damage to many organs and systems (respiratory, cardiovascular, excretory) can occur, which will lead to the death of the patient.
The main disease. This is perhaps the main factor determining the survival of patients with ascites. The fact is that even when carrying out the most modern treatment a favorable outcome is unlikely if the patient has multiple organ failure. For example, with decompensated cirrhosis of the liver (when the function of the organ is almost completely impaired), the patient’s chances of survival for 5 years after diagnosis are less than 20%, and with decompensated heart failure - less than 10%. The prognosis for chronic renal failure is more favorable, since patients on hemodialysis who follow all doctor’s instructions can live for decades or more.

Prevention of ascites

Prevention of ascites consists in complete and timely treatment chronic diseases of internal organs, which, if progressed, can cause fluid accumulation in the abdominal cavity.

Prevention of ascites includes:

Timely treatment of liver diseases. The development of liver cirrhosis is always preceded by prolonged inflammation of the liver tissue (hepatitis). It is extremely important to establish the cause of this disease in time and eliminate it (carry out antiviral treatment, stop drinking alcohol, start eating healthy, and so on). This will stop the progression of the pathological process and maintain vitality. most liver tissue, which will ensure the patient a full life for many years.

Timely treatment birth defects hearts. On modern stage development of an operation to replace damaged heart valve or closing a defect in the walls of the heart muscle can be carried out in early childhood, which will allow the child to grow and develop normally and save him from heart failure in the future.
Timely treatment of kidney diseases. Although hemodialysis can compensate for the excretory function of the kidney, it is not able to provide a number of other functions of this organ. That is why it is much easier to promptly and fully treat various infectious diseases of the urinary system, such as cystitis (inflammation Bladder), glomerulonephritis (inflammation of the kidney tissue), pyelonephritis (inflammation of the renal pelvis), than then spend on hemodialysis for 2 - 3 hours twice a week for the rest of your life.
Diet for pancreatitis. In chronic pancreatitis, ingestion of large amounts of alcohol, sweets, spicy, smoked or fried foods can provoke an exacerbation of the disease and destruction of pancreatic tissue. However, it should be understood that such patients should not completely exclude the above foods from their diet. 1 candy or 1 piece of smoked sausage eaten per day will not provoke an exacerbation of pancreatitis, so it is extremely important for patients to eat moderately and not overeat (especially before bedtime).
Performing routine ultrasounds during pregnancy. Pregnant women are recommended to undergo at least three ultrasound scans during pregnancy. The first of them is carried out between 10 and 14 weeks of pregnancy. By this time, all the organs and tissues of the fetus are formed, which makes it possible to identify gross developmental anomalies. The second ultrasound is performed at 18–22 weeks of pregnancy. It also makes it possible to identify various developmental anomalies and, if necessary, raise the issue of termination of pregnancy. The third study is performed at 30–34 weeks to identify abnormalities in the development or position of the fetus. Terminating a pregnancy at this stage is impossible, but doctors can identify this or that pathology and begin treating it immediately after the birth of the child, which will significantly increase his chances of survival.

Before use, you should consult a specialist.