Ascites causes and types. Fluid in the abdominal cavity on ultrasound. Causes of fluid in the abdominal cavity

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

Let's look at the types and causes of fluid accumulation in the abdominal cavity and we will analyze the symptoms and typical signs.

What is ascites - characteristics

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

The function of fluids in the abdominal cavity is to ensure the free sliding of the membranes of the peritoneum and internal organs. IN normal conditions located in the abdominal cavity from 10 to 30 milliliters of liquid, and in some cases of severe ascites, over 10 liters can accumulate.

Fluid accumulation happens in two ways:

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

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

Classification and types of ascites

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

Here we can highlight:

Grade 1 or mild ascites . The amount of fluid is small, not obvious to most diagnostic methods, and can only be detected using abdominal ultrasound.
Grade 2 or moderate ascites . It can be identified semiotically, by its characteristic dull sound.
Grade 3 or severe ascites . It can be detected by simple observation, the volume of the abdominal cavity increases significantly and the abdomen is tense.

Symptoms that accompany ascites

The symptoms that manifest ascites, of course, greatly depend on the severity of the condition. If mild ascites, then it does not appear no symptoms, it is difficult to identify even with the help instrumental examinations, only an ultrasound or CT scan of the abdominal cavity helps.

If ascites is serious, accompanied by the following symptoms:

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

Diagnosis of ascites

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

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

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

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

frog belly. It is visible when the patient lies on his side. In this position, the fluid in the abdominal cavity drains to one side and the abdomen takes on a shape similar to a frog or toad.
Dull sound– characteristic of a barrel filled with liquid.
Drum sound– typical for an empty barrel or cavity containing gas.
splash sound- if you hit with your palm and put your palm on the other side.

The formulated hypothesis will be confirmed by a series of clinical trials:

Blood analysis aimed at assessing:

liver functions– enzymes (transaminases) and proteins (albumin, blood clotting factors);
kidney function– creatinine, azotemia;

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

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

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

Puncture examination. It involves inserting a thin needle through the abdominal wall to obtain a sample of fluid and analyze it.

In particular, the following analyzes are performed:

Finding and assessing albumin concentration.
Sowing a crop in order to detect possible infections and their causative agents.
Cytological analysis to identify possible neoplasms.
Finding and counting blood cells, such as leukocytes.
Search for amylase. The presence of amylase, an enzyme that accelerates the breakdown of complex sugars, is a sign of damage to the pancreas and therefore pancreatitis.

Causes of fluid accumulation in the abdominal cavity

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

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

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

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

Disease	Symptoms
Cirrhosis of the liver. Violation of the physiological structure of liver tissue, which is replaced by fibrous tissue, and there is a gradual loss of organ functions. There are several reasons for this process - the most common are: viral hepatitis and chronic alcoholism.	Ascites Portal hypertension Jaundice Low platelet count and blood clotting problems (bruising, petechiae, bleeding) Edema (fluid accumulation) lower limbs Skin problems Abnormal development of mammary glands in men
Budd-Chiari syndrome. Occlusion of the veins that drain oxygen-poor blood from the liver. The causes of the disease are numerous and it is not always possible to identify them (they remain unnoticed in half of the patients).	Ascites Pain in the lower abdomen Liver enlargement Increased levels liver enzymes, especially transaminases Encephalopathy. The syndrome is characterized by disturbances in brain function, such as loss of cognitive abilities, personality changes, drowsiness, etc.
Heart failure. The inability of the heart to provide the range of blood flow necessary for the body to perform its functions normally. The most common cause of heart failure is the condition following a myocardial infarction.	Ascites Chronic cough Difficulty breathing and shortness of breath Fatigue Edema of the lower extremities Effusion in pleural cavity Pulmonary edema
Pericarditis. Chronic inflammation of the pericardium (the lining of the heart), which interferes with the relaxation of the ventricles.	Ascites Chronic cough Difficulty breathing and shortness of breath Fatigue Edema of the lower extremities Pleural effusion Pulmonary edema
Infantile marasmus or Kwashiorkor syndrome: Develops due to lack of protein. It is practically not found in developed countries, but is quite common in Africa.	Ascites Liver enlargement Immune system problems (inability to develop certain types of antibodies) Delayed mental development

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

Abdominal cancer: malignant tumors and metastases. In this case, they talk about neoplastic ascites.	Ascites Symptoms of the affected organ
Intestinal tuberculosis: intestinal infection from Koch's mycobacterium.	Ascites Symptoms gastrointestinal tract(abdominal pain, diarrhea, constipation, etc.)
Chronic pancreatitis: chronic inflammation pancreas, which can have various causes.	Ascites Abdominal pain Jaundice Alternating diarrhea and constipation. Excessive levels of nitrogenous substances in feces.
Serositis and, in particular, peritonitis. Serous inflammation of the peritoneal tissue, which can be caused by many autoimmune diseases, such as systemic lupus erythematosus, rheumatoid arthritis, Crohn's disease, etc.	Ascites Abdominal pain Fever Nausea and vomiting Sepsis
Hypothyroidism: poor functioning thyroid gland with a slowdown in metabolism.	Ascites Pleural effusion Fatigue Weight gain Feeling constantly cold (cold hands and feet) Bradycardia. Decreased heart rate Edema of the extremities Hoarseness Problems concentrating and memory loss

Treatment of ascites

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

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

Bed rest.
Diet low in salt and therefore low in sodium. This increases diuresis and, therefore, helps eliminate fluid accumulated in the peritoneum.
Taking diuretics. The most commonly used is spironolactone.
Therapeutic paracentesis. It involves removing ascitic fluid accumulated in the abdominal cavity using a needle. Used in cases of severe tension in the abdomen, large volumes of fluid, or the patient's insensitivity to the effects of diuretics.

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

The development of ascites is associated with disturbances in the circulation of lymph and blood in the peritoneal cavity, resulting in the accumulation of transudate or non-inflammatory fluid. The development of pathology is also associated with inflammation, leading to the formation of effusion and exudate. If a high concentration of protein and leukocytes is detected in the fluid, we are talking about infection, which often leads to the development of peritonitis.

Classification of ascites

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

Based on the volume of liquid accumulated in the cavity, the following are distinguished:

transient - up to 400 ml.
moderate - from 500 ml to 5 l.
resistant (stressed) - more than 5 liters.

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

sterile, in which the presence harmful microorganisms not visible.
infected, in which microbes multiply in the contents of the abdominal cavity.
spontaneous peritonitis caused by exposure to bacteria.

Ascites is also classified according to its responsiveness to drug treatment:

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

Chylous ascites

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

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

Causes of fluid in the abdominal cavity

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

Other hepatic causes include:

portal hypertension.
chronic hepatitis (including alcoholic).
obstruction of the hepatic vein.

9-10% of cases of ascites are associated with oncological pathologies of the abdominal organs, metastases in the stomach. The causes in women often lie in oncological pathologies of the pelvic organs. At malignant neoplasms There is a deterioration in lymph circulation and blockage of lymph drainage pathways, as a result of which the fluid is not able to escape and accumulates.

Interesting: ascites that develops as a result of cancer pathologies often indicates a person’s approaching death.

5% of cases of abdominal dropsy are associated with pathologies of the heart muscle which are accompanied by circulatory decompensation. Doctors call this condition “cardiac ascites.” It is characterized by significant swelling of the lower extremities, and in advanced cases, swelling of the entire body. As a rule, with heart disease, fluid accumulates not only in the stomach, but also in the lungs.

Rarely, abdominal hydrops can be caused by the following conditions:

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

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

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

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

Symptoms of fluid in the abdomen

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

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

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

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

Diagnostics

A specialist can suspect ascites in a patient during an examination, by palpating and “tapping” the abdomen. To confirm the diagnosis, the patient undergoes studies that visualize the peritoneal cavity:

X-ray.

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

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

clinical blood and urine tests.
biochemical blood test (based on its data, the condition of the patient’s liver and kidneys is assessed).
study of peritoneal contents obtained by puncture.

Video

Treatment of ascites

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

Treatment of abdominal dropsy is carried out using conservative, symptomatic and surgical methods.

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

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

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

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

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

In case of relapse of the pathology, surgical intervention is prescribed, during which the inferior vena cava and portal vein are connected and collateral circulation is created. If before the operation, specialists have repeatedly resorted to removing ascitic fluid from the patient’s abdomen, a plasma transfusion is simultaneously performed, and a protein diet is recommended after the operation.

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

Prognosis is determined by the severity of the pathology that caused ascites. Life expectancy has no direct connection with the accumulation of fluid in the abdomen, however, increasing dropsy contributes to the aggravation of the underlying disease and deterioration general condition sick.

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

Water in the belly is considered one of the alarming symptoms. Its diagnosis is carried out only using ultrasound examination. This type of examination is required for those who notice even a slight increase in the abdominal cavity. This phenomenon cannot be ignored, as it can develop serious illnesses and it all ends in death.

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

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

Causes of water accumulation in the stomach

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

The liquid is absorbed and released throughout the day. But if unfavorable factors influence, then this phenomenon may be disrupted. During an imbalance, intra-abdominal pressure rises. Against this background, a significant increase in the abdomen occurs.

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

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

Fluid accumulation in the abdomen can also occur in newborns. The pathological phenomenon begins to form even at the intrauterine stage. In this case, a violation of liver functionality is observed. Most often, the decisive factor is an infectious disease at the gestation stage.

If a newborn has fluid in the abdominal cavity, the reasons may be hidden in:

transferred rubella in expectant mothers;
syphilis;
toxoplasmosis;
listeriosis;
hepatitis;
herpes infection;
measles

The risk group includes children whose parents abused drugs, alcohol, chemicals and medications.

In addition to all this, ascites can progress with blood transfusions in pregnant women, obesity, diabetes mellitus second type. To prevent your baby from getting this disease from the first days of life, to the expectant mother You should not do permanent makeup and tattoos.

Symptoms of fluid in the abdomen

Main symptom pathological process is the presence of free fluid in the abdominal area. It begins to accumulate in the stomach, but is not excreted naturally.

Excess water leads to the appearance of unpleasant symptoms in the form of:

significant enlargement of the abdomen;
painful sensations in the abdomen;
symptoms of dyspepsia;
weight gain;
shortness of breath while walking;
big belly;
heartburn and belching;
fluctuations;
deterioration of general condition;
severe swelling of the limbs.

In addition to all this, there may be an increase in the veins in the abdomen in men and women. The patient may complain of lack of appetite. With thrombosis, excess fluid can accumulate for weeks, and with cirrhosis - for several months.

Diagnosis of water in the stomach

Why in the liquid, only a doctor can say. The diagnosis is made not only on the existing symptoms, but also with the help of an examination.

It consists of the following steps:

general blood test;
general urine examination;
biochemical analysis blood. This will identify changes in kidney function;
performing a puncture of the ventral cavity of water. The water is clear, but in some cases there may be blood present;
performing the Rivolta test. Allows you to distinguish transudate from exudate;
cytological analysis of evacuated fluid from the abdominal area. It will help determine the cause and exclude the presence of a malignant formation;
carrying out bacteriological analysis of liquid. Helps to recognize peritonitis and the cause of its development.

The patient may also be prescribed:

ultrasound diagnostics. This technique helps to assess systemic blood flow in the portal vein, determine cirrhosis or tumor;
X-ray examination. This diagnostic method sees where ascites appears. You can also determine the volume of fluid and the boundaries of the abdominal zone. The picture shows cirrhosis, tuberculosis and heart failure;
laparocentesis. This technique is invasive and involves taking blood for testing;
computed and magnetic tomography. These techniques make it possible to determine fluid effusion. Moreover, it is possible to diagnose pathology even in the most inaccessible places;
angiography. This type of examination is a type of radiography. A contrast agent is injected into the choroid plexus. Using this, you can determine the presence of cirrhosis in the early stages.

One of the main diagnostic methods is a puncture in the anterior wall of the abdominal cavity. The piercing is performed below the navel. The taken liquid is poisoned for diagnosis and checked for the presence of albumin, glucose and protein.

Treatment of ascites is prescribed only after an accurate diagnosis has been made.

Treatment of ascites - accumulation of fluid in the abdomen

If there is water in the stomach, what should you do? After performing radiography and angiography, the doctor can make an accurate diagnosis and prescribe effective treatment. The existing problem is approached in a comprehensive manner. If an advanced stage or complications are observed, then surgical intervention is performed.

The entire treatment process depends on the symptoms and diagnostics performed. At first, doctors try to eliminate the problem conservatively, but if the fluid continues to accumulate, then a surgical procedure cannot be avoided.

Therapeutic treatment

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

Diuretics and calcium may also be prescribed for this disease. This method helps remove all the water from the peritoneum. As an additional method, it is recommended to take vitamin complexes.

Surgery

If the disease is diagnosed in advanced stages, then surgical intervention is simply indispensable. This method will only help eliminate excess water, but it will definitely not get rid of the cause.

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

Laparocentesis. The abdominal cavity is pierced to remove all excess liquid from the peritoneum. These manipulations may take several days, so the patient will need to be hospitalized.
Transjugular intrahepatic shunting. The doctor creates an artificial duct between the hepatic and portal veins. This process makes it possible to improve water exchange and stabilize intra-abdominal pressure.
Liver transplantation. This type of surgery is performed when it degenerates into a malignant formation.

What type of operation to resort to is up to the doctor to decide based on the indications.

Diet

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

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

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

The following products must be removed from the menu:

smoked and salted dishes;
bread products;
sorrel;
chocolate;
turnip;
garlic;
cabbage;
mushrooms;
radish;
coffee drinks;

It is worth limiting your consumption of eggs and dairy products.

Traditional methods of treating ascites

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

First way. Making a tea drink from cherry stems.
To make it you will need a spoonful of raw materials and half a liter hot water. The broth is infused for two hours and then filtered. You should take the medicine up to three to four times a day, one glass.
Second way. Application of flaxseeds.
To make a decoction, take a spoonful of raw materials and pour it into a mug boiled water. After thirty to forty minutes it is filtered. Taken in the morning on an empty stomach and in the evening before bed. The result can be seen in a few weeks.
Third way. Starvation.
According to traditional healers. Patients with dropsy are advised to fast for seven days. This technique should be followed for two months. You can drink several mugs of tea with glucose per day.
During fasting, you can cleanse your intestines with mineral water. Treatment in this way should be carried out gradually. A few days before this, the amount of food consumed is reduced.
This technique is best used after consultation with a specialist. Improper fasting can lead to adverse consequences. At the same time, do not forget about maintaining a drinking regime. But the amount of fluid consumed should not exceed one liter per day.

Possible Adverse Effects

If ascites is not treated for a long time, serious complications may develop. Free liquid in the abdominal area can lead to respiratory failure or cardiac congestion. The reason for this phenomenon is a raised diaphragm. It puts significant pressure on the lungs and large vessels.

When infection occurs, peritonitis may occur. In such cases, urgent surgical intervention is required, otherwise everything can end in death.

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

Ascites is a condition in which fluid accumulates in the abdominal cavity in an amount exceeding 25 mg.

Characteristic symptoms diseases are an enlarged belly, breathing problems, abdominal pain, a feeling of fullness or heaviness. In more than 80 percent of cases, ascites is caused by late-stage liver cirrhosis.

This is due to organ degeneration and improper blood circulation, which contributes to the accumulation of water. Fluid with ascites is of two types: exudate (inflammatory in nature) and transudate (non-inflammatory in nature).

Ascites: what is it?

Ascites– this is the accumulation of water or fluid in the abdominal cavity, which leads to a visual increase in the volume of the abdomen and an increase in the patient’s body weight. In most cases, the liquid (from 100 mg to 20 l) is a transudate, that is, it is not inflammatory in nature.

Abdominal ascites does not manifest itself in any way at the beginning; it is characterized by gradual progression. As a rule, ascites is a consequence of another, already existing disease, so its treatment is quite difficult.

Diseases that provoke ascites include:

liver cirrhosis, increased pressure in the portal system;
thrombosis in the inferior vena cava and portal veins of the liver;
renal failure;
other acute or chronic kidney diseases;
nephrosis;
infectious and inflammatory diseases intestines;
pancreatic diseases;
heart failure;
inflammation of the serous membrane of the heart;
oncology;
tuberculosis;
dropsy of cellular tissue (anasarca);
accumulation of mucus in cavities (pseudomyxoma).

Symptoms of the disease

The manifestation of clinical ascites is possible only when a large amount of water has accumulated in the peritoneum.

Characteristic symptoms of abdominal ascites are:

feeling of fullness in the peritoneum;
prolonged pain in the abdominal area;
heartburn;
belching;
nausea;
enlarged belly (hangs in a standing position, while sitting - spreads to the sides);
visible network of blood vessels at the site of stretching;
bulging navel;
dyspnea;
disruption of the heart muscle.

In the presence of oncological diseases ascites develops slowly (from several weeks to several months). In this regard, its detection is extremely difficult.

Stages of abdominal ascites

The development of abdominal dropsy goes through 3 stages:

transient(about 400 ml of fluid in the peritoneum; slight bloating);
moderate(about 5 liters of fluid in the abdominal cavity; malfunction of the digestive organs, shortness of breath; peritonitis, as well as cardiac and respiratory failure in the absence of treatment for ascites);
tense(up to 20 liters of water in the abdominal cavity; the patient’s serious condition, characterized by unstable functioning of vital organs).

Diagnostics

The diagnosis of “abdominal ascites” is established by performing normal palpation, if during the process the doctor feels tightness in the abdomen or if a slight sound is heard tympanic percussion sound.

For further diagnosis, the patient will need to undergo blood and urine tests, as well as undergo a series of examinations. Usually prescribed ultrasonography abdominal organs and paracentesis (sampling of fluid from the abdomen). Sometimes immunological studies may be indicated.

These methods allow us to identify the stage of the disease and also help determine the general course of treatment.

Treatment of abdominal ascites in the presence of oncology should be carried out comprehensively. The primary thing is to remove excess water, since delaying this procedure will only lead to the development of various complications.

Excess fluid is removed through a puncture and subsequent pumping out (laparocentesis). This procedure is best performed 14 days after the onset of ascites. The elimination process is also facilitated by taking diuretics, and following a diet will lower intra-abdominal pressure.

You should know that chemotherapy is effective method for intestinal cancer. And oncology of the female reproductive system and stomach is difficult to influence by chemotherapy.

Medications

Excess water is pumped out of the body by taking diuretics. Drugs in this group promote the passage of fluid into the bloodstream, which automatically reduces its level in the peritoneum.

At the beginning, the patient is prescribed a small dose in order to reduce the likelihood of complications. Usually prescribed Amiloride, Aldactone, Veroshpiron or Triamterene.

The basic principle of using diuretics is to gradually increase the dosage. This avoids leaching significant amounts of potassium from the body. In parallel, the course of treatment includes taking it through vitamins. The use of hepatoprotectors to protect the liver is also indicated.

The intake of diuretics is constantly monitored by a doctor. If necessary, the dosage is adjusted, and ineffective diuretics are replaced with stronger ones ( Dichlorothiazide, Triampur).

Drugs used simultaneously with diuretics strengthening blood vessels(Diosmin, vitamins C and P), and drugs, preventing the loss of vascular fluid(Reopoliglyukin). To improve metabolism in the liver, protein agents (plasma concentrate, Albumin) are prescribed. Bacterial ascites requires the prescription of other drugs (those that fight the recommended type of microorganisms).

Diet for abdominal ascites

A patient with abdominal ascites must develop a number of eating habits:

reduce fluid intake;
give up salt (it contributes to water retention in the human body);
exclude fatty foods;
reduce the amount of nuts in your diet;
replace fresh fruits with dry ones;
instead of soups and borscht, drink broth with herbs (parsley, dill, fennel, celery help remove excess fluid from the body);
It is allowed to eat rabbit, chicken, and turkey meat.

Laparocentesis: how to pump out fluid

Laparocentesis is a puncture method for removing fluid from the peritoneum. About 4 liters are removed in one session, since getting rid of more exudate can lead to collapse. Among the consequences of a puncture of the abdominal cavity are various inflammations, the formation of adhesions and other complications.

Therefore, laparocentesis is indicated for patients with intense or refractory ascites. Moreover, if liquid has accumulated in large quantities, install a catheter or trocar. In the second case, the exudate flows freely into the substituted container.

Levine shunt

A Levine shunt is a plastic tube that is inserted into the abdomen and extends to the floor of the pelvis. The shunt is connected by a valve to a silicone tube that leads to the jugular and superior vena cava of the neck.

By adjusting the valve, abdominal fluid flows directly into the jugular veins. This allows you to increase the volume of blood directly in the circulatory system due to excess water in the peritoneum. The Levine shunt is used to treat refractory ascites, which is resistant to medications and relapses quickly after surgery.

Traditional methods of combating ascites

It should be remembered that folk remedies They do not help heal ascites, but only relieve symptoms and more quickly remove unnecessary fluid from the body.

Traditional medicine methods are definitely effective, but before using them you should consult your doctor. The total amount of fluid consumed per day for abdominal ascites should not exceed one liter.

Bean pod decoction

Pour 12 dried bean pods into 1 liter of water. Boil over low heat for about 10 minutes. Remove from heat and let sit for 20 minutes. Strain. Drink 200 ml before meals.

Herbal infusion

Pour horsetail and birch leaves with 1 glass of water. Boil for 15 minutes, then let cool. Drink ½ glass on an empty stomach.

Parsley tincture

Pour 300 g of fresh parsley into 1 liter of boiling water. Cook for 30 minutes. Cool. Take ½ glass hourly in the morning and at lunchtime.

Apricot decoction

Pour 1 cup of fresh or dried apricots into 1 liter of water. Cook for about 40 minutes. Cool. Drink 400 ml per day.

Herb tea

Pour hernia and bearberry in the form of leaves (in the same ratio) with 1 glass of water. Boil for a quarter of an hour. Drink the resulting tea on an empty stomach every day in the morning.

"Berry" tea

Pour 1 cup of boiling water over raspberry, lingonberry and currant foliage, rose hips (in equal parts). Next, cook over low heat for about 10 minutes. Then remove from the stove and let stand for a quarter of an hour. Strain. Drink twice a day instead of regular tea.

Life expectancy with ascites

Life expectancy with abdominal ascites depends on a number of factors:

Start of therapy. Diagnosing ascites at the initial stage with subsequent pumping of exudate means a favorable prognosis. This is due to the fact that the functionality of the internal organs has not yet been impaired or is only slightly impaired. Treatment of the underlying disease that provoked ascites guarantees complete healing. Long-lasting ascites or ascites with a progressive course causes disruption of the normal functioning of entire systems of internal organs, which leads to death.
Disease severity. Mild ascites is not capable of causing the death of the patient. In contrast, tense ascites, associated with the accumulation of 10-20 liters of fluid in the peritoneum, poses a serious threat to the life and health of the patient (death can occur within a few hours to several days).
Disease causing abdominal ascites. The prognosis cannot be positive if the patient suffers from multiple insufficiency of internal organs or if he has complete degeneration of at least one organ. For example, with decompensated liver cirrhosis, the chance of life is only 1/5. The outcome is more favorable if the disease has chronic course, and the patient undergoes regular hemodialysis. In this case, a person can live for several decades.
Complications with ascites. Ascites of the abdominal cavity can cause simple bleeding, or it can cause more severe illnesses. For example, bacterial peritonitis, hepatic encephalopathy, hepatorenal syndrome, etc., which, in turn, negatively affect already weakened internal organs and interfere with the restoration of their functionality. In this case, the prognosis depends on the degree of organ degeneration.