Symptoms of abdominal ascites in women. Recommended food and medications for the development of abdominal ascites. Why does free fluid accumulate in the abdominal cavity?

Ascites or in another way dropsy is a pathological accumulation of mucous fluid in the abdominal region. Its quantity can exceed 20 liters. Abdominal ascites occurs with cirrhosis of the liver (75%), as well as with oncology (10%) and heart failure (5%). Outwardly, the disease manifests itself in the fact that the stomach increases significantly in size and progressive weight gain. Treatment of the disease is most often carried out surgically, the patient undergoes laparocentesis (pumping fluid with a special apparatus).

The reasons for the development of the disease

The accumulation of fluid in the abdominal cavity occurs differently in every body. In order to better understand the mechanism itself, you need to understand a little about human anatomy.

Inside, the abdominal cavity is covered with a membrane of connective tissue, which envelops some organs completely, and some partially or does not touch at all. This tissue ensures the normal functioning of all organs, because a special fluid is released from it, which does not allow the organs to stick together. During the day, it is repeatedly released and absorbed, that is, it is regularly updated.

Ascites causes disturbances in the main function of the abdominal cavity: excretion and reabsorption of fluid, as well as barrier protection against various harmful substances.

Cirrhosis is the main cause of ascites:

the liver synthesizes less protein;
healthy liver cells are gradually replaced by connective cells;
a decrease in the amount of protein albumin leads to a decrease in plasma pressure;
fluid leaves the walls of blood vessels and enters the body cavity and tissue.

Cirrhosis of the liver provokes an increase in hydrostatic pressure. The liquid cannot be in the walls of blood vessels and is squeezed out - ascites develops.

Trying to reduce the pressure in the vessels, the lymph drainage increases in the body, but the lymphatic system does not have time to do its job - a significant increase in pressure occurs. The fluid that enters the abdominal cavity is absorbed for some time, but then this stops happening.

Oncological or inflammatory diseases lead to the fact that the peritoneum begins to secrete too much fluid, which cannot be sucked back, and lymph drainage is disturbed.

The main causes of ascites:

Liver problems.
Acute and chronic heart disease.
Damage to the mucous membrane of the abdominal cavity, due to peritonitis of various etiology and malignant formation.
Diseases of the genitourinary system, including renal failure and urolithiasis.
Diseases of the digestive tract.
Protein deficiency.
Autoimmune diseases such as lupus erythematosus.
Serious eating disorders: fasting.
Abdominal ascites in newborn babies is the result of fetal hemolytic disease.

Symptoms of the disease

Ascites can develop for a long time: from 1 month to six months, and it can occur spontaneously as a result of portal vein thrombosis. The first symptoms of the disease occur when fluid in the abdominal cavity accumulates in an amount of about 1,000 ml.

Symptoms:

bloating and gas production;
bursting sensation in the abdomen;
abdominal pain in the abdominal region;
heartburn;
an increase in the size of the abdomen, protrusion of the navel;
weight gain;
pathologically rapid heart rate and shortness of breath;
difficulty trying to bend over;
swelling of the lower extremities;
possible umbilical hernia, hemorrhoids, rectal prolapse.

When a person is in a standing position, the abdomen has a rounded shape, but in the prone position it seems to spread. Deep stretch marks appear on the skin. The increasing pressure makes the veins on the sides of the abdomen very visible.

Portal hypertension causes symptoms such as nausea, vomiting, jaundice, this is due to blockage of the subhepatic vessels.

Ascites against the background of tuberculous peritonitis is manifested by weight loss, intoxication, and fever. Enlarged lymph nodes along the intestine are identified.

Ascites in heart failure is accompanied by edema of the feet and legs, acrocyanosis, pain on the right side of the chest.

An increase in body temperature is not a direct symptom of the disease, but it occurs in some diseases that provoke ascites:

Peritonitis;
Pancreatitis
Cirrhosis;
Malignant tumors.

If the cause of the disease is myxedema, then the temperature, on the contrary, can be much lower than normal - about 35 degrees. This is due to the fact that the thyroid gland produces an insufficient amount of hormones, as a result, the metabolism and the body's ability to generate heat are reduced.

Risk factors

Some people are more susceptible to the disease than others. Persons at risk:

People who take alcoholic beverages and drugs for a long time.
People who have received a blood transfusion.
Suffering from hepatitis, not necessarily of a viral nature.
Having significant excess weight.
Suffering from type 2 diabetes mellitus.
Have high blood cholesterol levels.

Classification of ascites

The disease is classified depending on how much fluid is in the abdomen, the presence of infection and the response to treatment.

The amount of fluid divides the disease into three types:

The initial stage of ascites with a small amount of fluid (no more than 1.5 liters).
The second stage with a moderate fluid content in the abdominal cavity. It is accompanied by edema and an increase in the volume of the abdomen. The patient suffers from a lack of oxygen with little physical activity, heartburn, constipation and a feeling of heaviness in the abdomen.
Third stage with a lot of fluid or massive dropsy. The skin on the abdomen strongly stretches and becomes thinner, the veins of the peritoneum are clearly visible through it. The patient suffers from heart failure and shortness of breath. Fluid in the abdomen can become infected and peritonitis begins. The likelihood of death is high.

Depending on the presence or absence of infection, the disease is divided into 3 stages:

Sterile ascites. The studied liquid shows the absence of bacteria.
Infected ascites. The analysis shows the presence of bacteria.
Spontaneous peritonitis.

The response to the initiation of treatment allows the disease to be divided into two types:

Disease amenable to drug treatment.
A disease that occurs secondarily and is not amenable to drug treatment.

Diagnosis of the disease

To make a diagnosis, a complex of various procedures is required, according to the results of which it is possible to say with accuracy about the amount of fluid inside the abdominal cavity and the addition of various complications.

Inspection - depending on what position the person is in, with tapping movements, you can detect dullness of the sound. When pushing to the side with one palm, the second palm, which fixes the abdomen, feels noticeable fluctuations of the liquid inside.
X-ray examination - allows you to detect ascites with an amount of fluid more than half a liter. If tuberculosis is detected in the lungs, a preliminary conclusion can be made that the disease has a tuberculous etiology. When pleurisy is detected and the boundaries of the heart expand, it can be assumed that the cause of the disease was heart failure.
Ultrasound examination - allows you to determine the presence of ascites, as well as detect liver cirrhosis or the presence of malignant tumors in the abdominal cavity. Helps to assess the permeability of blood through the veins and vessels. Examination of the chest area can detect heart disease.
Laparoscopy is a puncture of the abdominal cavity, which allows you to take fluid for laboratory research in order to determine the causes of the disease.
Hepatoscintigraphy - allows you to determine the degree of damage and the severity of the severity of changes in the liver caused by cirrhosis.
MRI and CT - allow you to determine all the places where the liquid is located, which could not be done by other means.
Angiography is an X-ray examination carried out along with the administration of a contrast agent. Allows you to determine the localization of the affected vessels.
Coagulogram - a blood test to determine the rate of its coagulation.
The laboratory parameters are determined: globulins, albumin, urea, creatine, sodium, potassium.
10. Revealing the level of α-fetoprotein is carried out for the diagnosis of liver cancer that can lead to ascites.

Treatment of ascitic syndrome

Abdominal ascites is most often a manifestation of another disease, therefore, treatment is selected based on the stage and severity of the underlying disease. Modern medicine has two methods of therapy: conservative and surgical (laparocentesis). Most patients are prescribed the second method of treatment, since it is considered the most effective, while it significantly reduces the risk of relapse and adverse consequences.

Conservative therapy is used most often when the patient can no longer be helped and the goal of doctors is to alleviate the condition and maximize the quality of life. Such treatment is prescribed in severe cases of liver cirrhosis and in advanced stages of cancer.

Both treatment options are not harmless, therefore, the treatment option is always selected individually.

Conservative treatment

The drug therapy is complex. Drugs are prescribed in order to remove ascitic fluid from the body, for this it is necessary: to reduce the intake of sodium into the body, to ensure its abundant excretion in the urine.

The patient should receive at least 3 g of salt daily. A complete rejection of it impairs protein metabolism in the body. Diuretics are used.

Pharmacology does not have in its arsenal any remedy that would fully meet the requirements of doctors. The most powerful diuretic Lasix flushes potassium from the body, therefore, in addition, the patient is prescribed drugs, for example, Panangin or Potassium Orotate, which restore its level.

Potassium-sparing diuretics are also used, Veroshpiron belongs to them, but it also has unpleasant side effects. When choosing a suitable drug, it is necessary to take into account the characteristics of the organism and its condition.

It is advisable to use diuretics to treat ascites in the presence of edema, since they remove fluid not only from the abdominal cavity, but also from other tissues.

With cirrhosis of the liver, drugs such as Fosinoprl, Captopril, Enalapril are often used. They enhance urinary sodium excretion without affecting potassium.

After the swelling of the extremities subsides, it is worth reducing the consumption of table salt.

When conservative is ineffective or impractical, laparocentesis is performed.

Surgical intervention

Surgical treatment consists of removing excess fluid by puncturing the abdomen. This procedure is called laparocentesis. It is prescribed for significant filling of the abdominal cavity with fluid ascites. The procedure is performed under local anesthesia, while the patient is in a sitting position.

During the paracentesis, the patient is punctured in the lower abdomen through which the fluid will be sucked out. The procedure can be performed at one time, or a special catheter can be installed for several days, such decisions are made by the doctor based on the patient's condition and the severity of the disease.

If the amount of fluid exceeds 7 liters, then laparocentesis is performed in several stages, since the risk of complications increases - a sharp drop in pressure and cardiac arrest.

Ascites and oncology

Ascites in tandem with cancer is a dangerous condition in itself, but, in addition to this, it can cause other consequences:

Respiratory failure.
Bowel obstruction.
Spontaneous peritonitis.
Hydrothorax.
Rectal prolapse.
Hepatorenal syndrome.

The presence of one of the listed complications requires prompt treatment. Untimely started therapy can lead to the death of the patient.

Preventive actions

Prevention of ascites is to prevent the diseases that cause it. If you have heart, kidney or liver problems, you should be examined regularly by a doctor and, if necessary, undergo treatment in a timely manner. It is important to treat infectious diseases on time, do not abuse alcohol, monitor diet and physical activity.

People after 50 years of age and with any chronic diseases should be treated with special care for their health. So, the development of ascites after the age of 60, against the background of hypotension, diabetes mellitus, renal and heart failure, significantly reduce the risk of a favorable outcome of the disease. The two-year survival rate at such a mature age with abdominal ascites is 50%.

Abdominal ascites or dropsy of the abdomen is a disease that manifests itself in the accumulation of free fluid. The fact is that the inside of the abdominal cavity is covered with a two-layer peritoneum.

As a result of various deviations between the two layers of this structure, a gradual accumulation of a large volume of liquid begins, which in its content is very similar to blood plasma.

In newborns, ascites develops with latent blood loss or if the fetus has hemolytic disease. In children under three years of age, ascites is usually associated with liver disease, but it can also be the result of exudative enteropathy, chronic eating disorders, and the manifestation of nephrotic syndrome.

The emergence of ascites is facilitated by disturbances in water-salt metabolism.

Causes of ascites

Most often, ascites occurs when:

kidney disease;
heart failure;
alimentary dystrophy;
cirrhosis of the liver.

In addition, ascites occurs due to damage to the lymphatic thoracic duct, peritoneum (tuberculosis, cancer seeding, and so on) and as a result of compression of the trunk of the portal vein of the liver or thrombosis of its branches.

Mechanisms of the onset and development of ascites

The fluid in the peritoneal cavity can be a filtrate of blood serum or lymph (transudate), or it can be an exudate formed during inflammation of the peritoneum itself. The fluid in the abdominal cavity can be serous, hemorrhagic, chyle, purulent. In most cases, it turns out to be serous.

Hemorrhagic fluid occurs most often in tuberculosis, malignant tumors, scurvy. When the ascites fluid has a milky appearance, they speak of chylous ascites.

It is formed as a result of the entry into the peritoneal cavity of a significant amount of lymph from the thoracic lymphatic duct or from the lymphatic vessels of the abdominal cavity. Chylous fluid is sterile, contains a large number of lymphocytes and separates into layers when standing.

The accumulation of fluid in the abdominal cavity (sometimes more than 20 liters) leads to an increase in intra-abdominal pressure and the displacement of the diaphragm into the chest cavity.

As a result, the respiratory movements of the lungs are significantly limited (up to the development of respiratory failure), the activity of the heart is disrupted, and the resistance to blood flow in the organs of the abdominal cavity increases, the functions of which are also impaired.

The concentration of protein in serous ascites fluid is relatively low, but its total loss in massive ascites can be significant, especially with frequent repeated removal of fluid by puncture of the abdominal cavity (in this case, the loss of protein is combined with the loss of salts), which leads to the development of protein deficiency.

Pathogenesis of ascites in liver cirrhosis. What matters:

portal hypertension
hypoalbuminemia,
increased lymph formation in the liver,
sodium retention to the kidneys.

The process is initiated by peripheral arterial vasodilation caused by endotoxins and cytokines, nitric oxide serves as a mediator, as a result the "effective" plasma volume decreases, compensatory mechanisms of sodium retention by the kidneys are activated to maintain a constant intravascular volume. With severe ascites, the content of atrial natriuretic factor in the blood plasma is high, but not enough to cause natriuresis.

Types of ascites

In the International Classification of Diseases, the disease ascites (dropsy of the abdominal cavity) does not stand out as a separate disease. In fact, this is a complication of other pathologies that arose in the last stages.

According to the brightness of the manifestation of dropsy of the abdomen, there can be several types:

Initial ascites of the abdominal cavity with a small amount of fluid inside the abdomen (up to one and a half liters).

Ascites with moderate amount of water. It manifests itself in the form of edema of the lower extremities and a noticeable increase in the size of the chest. The patient is constantly worried about shortness of breath, severe heartburn, he feels a heaviness in the abdomen. The condition worsens the appearance of constipation.

Massive dropsy (a large amount of water, with a volume of more than 5 liters) is a dangerous disease. The skin on the abdomen becomes smooth and transparent, the peritoneal wall is strained as much as possible. At this stage, the patient develops respiratory and heart failure, the fluid can become infected and provoke peritonitis, which in most cases is fatal.

By the quality of the liquid:

According to expected forecasts:

Complications of ascites

The development of ascites is considered a prognostically unfavorable sign and significantly complicates the course of the underlying disease. Ascites can be complicated by bleeding, peritonitis, failure of the spleen, liver, brain damage due to edema, and heart dysfunction. On average, the percentage of mortality in patients with severe ascites reaches 50%.

Ascites symptoms

During a general examination, attention will be drawn to the increased size of the stomach. When the body is upright, the abdomen hangs down like an "apron"; in the prone position, the abdomen will be flattened - "frog belly". With a larger volume of ascitic fluid in the abdominal cavity, a protrusion of the navel can be detected.

If the cause of ascites was the presence of portal hypertension, then on the anterior abdominal wall you can see a venous pattern in the form of a "Medusa's head". This pattern occurs due to the fact that there are dilated, convoluted venous collaterals on the anterior abdominal wall, which are located around the navel. With FGDS, varicose veins of the esophagus can be detected.

With a large accumulation of fluid in the abdominal cavity, intra-abdominal pressure will increase significantly, as a result of which the diaphragm will be pushed into the chest cavity.

Because of this, the movement of the lungs in the chest cavity will be limited, which, in turn, can lead to the development of respiratory failure. The patient will have severe shortness of breath (respiratory rate 20 or more), cyanosis of the skin, tachycardia.

With a significant volume of ascites, total protein will decrease. For this reason, the following are possible:

swelling on the face
swelling of the upper and / or lower extremities.

If the cause of ascites was the development of heart failure, then in addition to the signs of ascites itself, there will be:

swelling of the legs,
acrocyanosis,
tachycardia.

From the side of the digestive system, the following are possible:

constipation
loss of appetite,
nausea.

Diagnosis of ascites

The diagnosis can be made on the basis of a physical examination in the case of a significant amount of fluid, but instrumental studies are more informative.

Ultrasonography and CT can detect a significantly lower volume of fluid (100-200 ml) compared to a physical examination. Spontaneous bacterial peritonitis is suspected if a patient with ascites has abdominal pain, fever, or unexplained worsening.

Diagnostic dye laparocentesis is indicated if ascites is recently detected, its cause is unknown, or spontaneous bacterial peritonitis is suspected.

Approximately 50-100 ml of fluid is collected for macroscopic evaluation, protein studies, cell counting and cell differentiation, for cytological examination, bacteriological culture and, if clinically indicated, for Ziehl-Nielsen acid resistance staining and / or amylase test ...

Unlike ascites in inflammation or infection, ascites fluid in portal hypertension looks clear and straw-yellow, has a low protein concentration (usually less than 3 g / dl, but sometimes more than 4 g / dl), a low number of PMN (less than 250 cells / μl), a higher gradient of serum albumin concentration compared to ascitic fluid, which is determined by the difference between the serum albumin concentration and the albumin concentration in ascitic fluid (more informative).

A gradient of more than 1.1 g / dL indicates portal hypertension is the most likely cause of ascites. Cloudy ascitic fluid and PMN counts greater than 500 cells / μL indicate infection, while hemorrhagic fluid is usually a sign of tumor or tuberculosis. Milk (chyle) ascites is rare and is usually associated with lymphoma.

Clinical diagnosis of spontaneous bacterial peritonitis can be difficult; its verification requires a thorough examination and mandatory diagnostic laparocentesis, including bacteriological culture of fluid.

Bacteriological blood culture is also shown. Sowing ascitic fluid on a blood culture before incubation increases the sensitivity by almost 70%.

Since spontaneous bacterial peritonitis is usually caused by a single microorganism, detection of mixed flora during bacteriological culture may suggest hollow organ perforation or contamination of the test material.

Ascites treatment

Getting down to the issues of therapy, I would like to note that the relief of ascitic syndrome depends on the underlying disease. After all, ascites is always a consequence, not a cause of the development of an ailment. In the arsenal of traditional medicine, there are two ways of treatment: conservative (symptomatic) and surgical.

In some cases, the preference is given to the surgical method, because it is considered the most effective (valvular heart disease). Either the indication for its implementation is to improve the patient's well-being.

With regards to conservative therapy, it often becomes a priority. Unfortunately, sometimes it happens, so there is nothing more to help such patients. This is especially true for advanced cases (oncopathology, liver cirrhosis, dystrophic phase). The purpose of this approach is to maintain the patient's condition at a certain level, preventing the deterioration of his health (right ventricular heart failure).

Of course, the treatment of ascites, both conservative and surgical, is far from harmless. Therefore, the treatment of this syndrome should be approached very, very individually.

Conservative treatment of ascitic syndrome

Should be complex, remove ascitic fluid. This requires:

create a negative sodium balance;
to increase the excretion of sodium in the urine.

The creation of a negative balance is achieved by limiting the intake of sodium from food into the body (salt up to 3 g per day). It has been proven that a completely salt-free diet negatively affects the metabolism of proteins in the body. Enhanced sodium excretion. Appointment of diuretics is practiced (potassium-saving and potassium-not saving).

The pharmaceutical industry does not have a single diuretic (diuretic) drug for the treatment of ascites that would completely satisfy clinicians in all respects.

The use of the most "powerful" diuretic Lasix (Furosemide) is limited because it promotes the elimination of potassium from the body. It is prescribed under the guise of potassium preparations (Panagin, Asparkam, polyionic mixtures, Potassium Orotate) and control of the electrolyte balance of the body.

Lasix is administered intramuscularly or intravenously for a week, then the drug is prescribed in tablets several times a week.

Of the potassium-sparing diuretics, spironolactones (Veroshpiron) are used according to the scheme - 4 doses throughout the day. The effect develops after 2-3 days. Spironolactones also have a lot of side effects - menstrual disorders in women, gynecomastia in men (enlargement of the mammary glands), decreased libido (sex drive) in both sexes.

Doses are calculated individually, it all depends on how the patient feels, what other diseases he has. It is necessary to take into account the fact that high dosages threaten the development of side effects: imbalance of electrolytes in the body, the development of encephalopathy (non-inflammatory diseases of the brain), dehydration.

It is important to remember that diuretics not only reduce ascites, but also help to remove fluid from other tissues. While there is edema, it is not dangerous, but if you continue to take diuretics after they disappear, then the following complications may develop:

a decrease in the volume of circulating blood;
the appearance of functional renal failure due to a decrease in renal blood flow;
the development of electrolyte imbalance disorders up to seizures;

Withdraw diuretics preferably step by step. In the beginning Lasix, then Veroshpiron.

Now drugs such as Captopril, Enalapril, Fosinopril have begun to be used to treat ascites. Their action is based on enhancing the excretion of sodium from the body and increasing the amount of daily urine. At the same time, they retain potassium in the body. This is especially true for cases of ascitic syndrome developed against the background of liver cirrhosis.

renal failure;
severe electrolyte imbalance;
hepatic encephalopathy.

The conservative treatment of ascitic syndrome includes adherence to bed rest. It has been proven that it improves renal and portal venous blood flow, thereby reducing the formation of toxic metabolites (substances) in the liver, and improving the functioning of the lymphatic system.

With an improvement in general well-being, a semi-bed rest is recommended, otherwise the risk of developing congestion and pressure sores is quite high. Along with bed rest with severe ascites, it is recommended to limit fluid intake (on average 1 liter per day).

Surgical treatment of ascitic syndrome

Surgical manipulation is more often used, which is called laparocentesis. The goal is to remove excess ascitic fluid from the abdominal cavity. The indications for its implementation are the accumulation of a large volume of ascitic fluid or the lack of effect from the appointment of diuretics. Laparocentesis is performed most often in a sitting position under local anesthesia.

A puncture is made with a special instrument (troocar) in the lower part of the anterior abdominal wall of the abdomen, through which excess fluid is removed. How much fluid will be removed at one time, or an indwelling catheter will be inserted, the attending physician decides. It is important to remember that removing large volumes of fluid at a time (more than 5-6 liters) can cause a number of complications. The most severe - a sharp drop in blood pressure, cardiac arrest.

Prognosis for ascites

The prognosis for ascites is determined mainly by the severity of the disease that caused the ascites. So, the prognosis for patients with oncological pathology, metastases in the lymph nodes and ascites is much worse than for patients with glomerulonephritis, etc.

The accumulation of fluid in the abdomen also does not particularly affect life expectancy. Just growing ascites can aggravate the course of the underlying pathology and worsen the patient's well-being.

Prevention of ascites

Prevention of ascites is the prevention of diseases that cause it. That is, it is necessary to treat infectious diseases in a timely manner, not to abuse alcoholic beverages, to exercise moderately and to eat right. If you have problems with the heart, kidneys or liver, you need to be regularly examined by specialists and carefully follow their instructions.

Questions and answers on the topic "Ascites"

Question:Hello. After an ultrasound examination of the liver and gallbladder, I was told that there was fluid in the abdominal cavity. The skin is yellowish. Question: can I drink a diuretic? The liver is slightly enlarged, the gallbladder is also but without stones. Thanks.

Answer: Hello. A diuretic for ascites helps to significantly alleviate the patient's condition, but they are not able to completely eliminate the fluid in the abdomen. And all because the described complication is secondary, it is impossible to defeat the dropsy of the abdomen without eliminating the root cause. The fluid will constantly accumulate in the peritoneum, and provoke a worsening of general symptoms. Any diuretic drugs for ascites can be prescribed at the stage of diagnosis, wishing to alleviate the patient's well-being, or be part of an extensive complex therapy of the disease that became the root cause of the development of a dangerous complication.

Question:Good afternoon. My husband is 32 years old, diagnosed with gastric adenocarcinoma T4N2M2. Trial laparoscopy was performed. From the protocol of the operation: during revision: the stomach is totally affected by an infiltrative tumor, the serous cover grows, spreads to the abdominal esophagus to the level of the diaphragm. The esophagus in the tumor conglomerate is not differentiated. dense, increased to 1.5-2 cm l / y paracardial, in the abdominal space, in the area of the left gastric artery, a conglomerate of dense l / y up to 2.5 cm. The tumor grows into the abdominal space, pancreas, spleen gate. on the parietal peritoneum there are multiple whitish knots of 0.3-1.0 cm. To date, the sutures were not removed to the husband and ascites began - he complains of abdominal pain, bloating, which does not allow him to sleep at night. The spouse has general weakness, increased sweating and nausea. Tell me how you can get rid of ascites? Doctors, except for diuretics, do not prescribe anything, but there are no results, the pain only intensifies. Does ascites depend on the amount of fluid consumed?

Answer: Hello. You should contact your surgeon to decide on the possibility of laparocentesis and to a chemotherapist to decide on the possibility of using chemotherapy.

Question:Good afternoon. Which specialist should i go to to remove fluid from the abdominal cavity?

Answer: Hello. To the attending physician who observes the patient for the underlying disease (which caused ascites). Removal of fluid from the abdominal cavity can be performed both surgically (then to the surgeon) and by other means (depending on the indications).

Question:Good afternoon. My mother is 68 years old. She is diagnosed with coronary artery disease, atrial fibrillation, type 2 diabetes mellitus, cardiac cirrhosis of the liver and gout. She has ascites. Very large belly. Severe pain and swelling of the legs. He walks with difficulty. He takes furosemide 3 tablets 40mg + 0.5 tablets 100mg hypotheasite and asparkam. But the swelling does not go away. Can you please tell a doctor what specialty is it best for her to contact?

Answer: Hello. Ascites can be caused by heart problems as well as a number of other causes. It is better to understand the conditions of the hospital. It can be a general therapy department, it can be cardiology.

Question:Good afternoon. Two years ago, my mother underwent an operation to resect 4/5 of the stomach (cancer), after the operation, chemotherapy was not prescribed, in October 2012. Mom's temperature rose to 38-39, which did not subside for a month, were examined, the ultrasound scan showed a large accumulation of free fluid in the abdominal cavity, the doctors prescribed two chemotherapy sessions, but the accumulation of fluid is increasing every day. Is it possible to get rid of ascites without chemotherapy?

Answer: Hello, when a large amount of fluid accumulates, it is removed mechanically, the procedure is called laparocentesis, and chemotherapy has a therapeutic effect, inhibits further progression in the form of fluid accumulation, but, unfortunately, it is not always effective.

It is called ascites. Ascites are usually caused by inflammation and circulatory problems. Ultrasound is used for diagnosis and treatment.

The prognosis of treatment depends on the state of the person's immune system and the specific cause that caused the pathology.

Signs of ascites

The characteristic symptoms of ascites are an increase in intra-abdominal pressure, an increase in the abdomen from accumulated fluid.

Ascites (abnormal accumulation of fluid) disrupts the lungs and organs of the gastrointestinal tract.

The reasons for the accumulation of fluid can be different: ascites can appear due to several disorders of the body, pathology of organs. The most common reason why ascites begins may be liver cirrhosis.

Diagnosis of ascites is carried out using an ultrasound scan and a doctor's examination. After diagnosis, treatment takes a long time. A person should be relieved of both ascites and the disease that caused it at the same time.

The duration of the course, the severity of the disease, the further prognosis depend on the health of the person, the cause of the disease. Ascites can appear suddenly or gradually over several months.

Symptoms of ascites begin to appear if more than one liter of fluid has accumulated in the abdomen.

Symptoms of abnormal fluid accumulation:

dyspnea;
increase in weight and volume of the abdomen;
swelling of the legs;
belching;
discomfort when bending;
distension of the abdomen, pain;
heartburn;
swelling of the scrotum (in men).

Usually, at first, a person pays attention to symptoms such as a protrusion of the navel, an increase in the abdominal part - in a standing position, the stomach sags, looks like a ball, and when a person lies down, the stomach "spreads".

In women, white stretch marks can be a symptom - this is one of the signs of ascites.

Some symptoms are associated with additional ailments, the underlying cause of ascites.

For example, if the excess fluid is caused by pressure in the vessels of the liver, then there are pronounced veins on the abdomen (front, side).

If there are problems in the vessels under the liver, then the characteristic signs of the disease are vomiting, jaundice, nausea.

All of the above is characteristic of tuberculous ascites, as well as headache, increased fatigue, weakness, palpitations.

Outflow problems in the lymphatic vessels contribute to the rapid enlargement of the abdomen. If there is a lack of protein, then signs of ascites are swelling of the extremities, shortness of breath.

If the disease is associated with problems in the lymphatic vessels, then an ultrasound scan of the veins, vessels of the problem area is prescribed. If cancer is suspected, an ultrasound scan is also performed.

Why does pathology arise?

Reasons for fluid accumulation:

oncology (malignant formation);
cirrhosis of the liver (occurs in 75% of people);
heart failure;
various kidney diseases;
tuberculosis;
increased pressure in the liver;
gynecological diseases (in women);
pancreatitis.

One of the most difficult cases is the presence of oncology. A patient with a disappointing prognosis and exacerbated symptoms may be prescribed an operation.

Newborns can also have ascites. Usually, it is caused by developmental disorders in the gastrointestinal tract in a child, various congenital edema.

Of course, in this case, the main causes of the pathology are various diseases or bad habits of the mother who carried the child.

Excess fluid can cause a lack of protein in your baby's food. Sometimes the prognosis of the course of ascites for newborns is disappointing

To understand exactly why excess fluid began to accumulate in the body, you need to visit a specialist and undergo hardware diagnostics.

Mechanism of fluid accumulation and diagnostics

The development of the disease in each person is different. Let's take a look at the human body in order to better understand how this happens.

Inside is the serous membrane (membrane) that covers the organs. Some it covers completely, some barely touches. In addition to enveloping the organs, the membrane produces fluid.

During the day, it is released and absorbed, allowing the organs to function normally and not stick together. If a person suffers from an excess of fluid, then the function of its production is impaired.

The reverse process takes place, creating a favorable environment for toxins. In this regard, characteristic symptoms appear.

If a person is sick with cirrhosis of the liver, then the fluid accumulates in a different way.

There are four possible pathways for ascites formation:

With cirrhosis of the liver, pressure rises, as a result of which fluid accumulates in the abdomen;
The body tries to reduce the load on the veins by draining lymph. Lymphatic hypertension is formed (the body cannot cope with the load), fluid flows out of the vessels into the abdominal cavity. For some time it absorbs liquid, then it ceases to cope with it;
With cirrhosis of the liver, the number of liver cells decreases, less protein is produced, the fluid leaves the vessels, the free peritoneum ceases to be such;
Simultaneously with the accumulation of fluid in the abdominal cavity, there is an outflow of fluid from the blood. This is followed by a decrease in the amount of excreted urine, an increase in blood pressure.

After the fourth point, the accumulation of fluid occurs faster and worsens. Further complications are possible due to oncology (if any).

If a person suffers from heart failure, then the pressure in the liver rises, as a result of which the liquid evaporates from its vessels.

The inflammatory process of the peritoneum provokes a large production of fluid, which cannot be dealt with, as a result of which it penetrates into the peritoneum.

Usually, doctors use an ultrasound scan to help diagnose ascites. Along with this, the liver is examined for cirrhosis.

An ultrasound is also done to understand the state of the heart, the patient's veins, and the place of fluid accumulation.

You can conduct an examination without an ultrasound scan - palpate the patient's abdomen. If fluid fluctuations are felt, then ascites is diagnosed.

Modern technologies and ultrasound allow us to examine a liquid with a volume of more than half a liter.

Hepatoscintigraphy (analogue of ultrasound) is used to establish the state of the liver, the degree of cirrhosis.

The degree of cirrhosis, its development is established by a coagulometer - a device that helps to determine blood coagulability.

Sometimes doctors take an alpha-fetoprotein venous blood test that can identify liver cancer that is causing excess fluid.

X-rays of organs also help diagnose. For example, an x-ray of the lungs will help to identify the degree of tuberculosis, the presence of fluid, the reason for the accumulation of fluid.

There is angiography - a study of blood vessels (analogue of ultrasound), which helps to identify the causes of ascites (ascites of vascular origin).

Possible analysis of biopsy of the peritoneum, liver. Sometimes doctors take a fluid test, and then conduct research. The patient may be prescribed an analysis of urea, sodium, creatinine, potassium.

Methods for treating ailment

There are now several treatments for ascites. This disease is most often associated with disorders of the gastrointestinal tract, liver.

Taking this fact into account, doctors most often prescribe a diet free of heavy food, harmful foods, alcohol, and salt.

Patients with ascites require strict adherence to a diet, otherwise there is a risk of complications or recurrence of the disease.

Do not eat radishes, garlic, onions, radishes, sorrel, cabbage, turnips, various types of citrus fruits. You should eat only skim milk, low fat dairy products.

You can not eat fried, salty, spicy. Various smoked meats, sausages, stewed meat are not recommended to be consumed. Pastry made from dough, any baked goods are also prohibited.

However, the diet for this disease does not imply a significant decrease in the diversity of the human diet. The patient should consume warm drinks.

Ninety percent of meals should be steamed. The bread can be dried. Puree meat soups are recommended. You can cook porridge without millet.

Eggs can be eaten as an omelet once or twice a week. For dessert, you can eat jelly, marshmallows.

The main goal of such treatment is to achieve weight loss of the patient. After a week, a person should lose at least two kilograms.

If this does not happen, then he is sent to the hospital, diuretics are prescribed. The patient is often tested for the content of electrolytes in the blood.

After undergoing such a course of treatment, the prognosis of the condition for a person suffering from ascites may improve.

The operation is prescribed in especially severe cases, if treatment with diets and drugs does not help. As a rule, with such a decision, the prognosis of ascites is disappointing.

It is likely that such a patient may have one of the stages of oncology. Symptoms of ascites and instrumental research methods will help to clarify this in more detail.

There are now the following operations for the treatment of ascites:

installation of a peritoneovenous shunt;
paracentesis, puncture of the abdominal wall (after the puncture, the transudate is removed);
liver transplant.

The most common surgery to eliminate ascites is to puncture the abdominal wall, in which the free fluid is simply pumped out.

Other types of intervention require special conditions - anesthesia, close monitoring. For example, liver transplants are performed with varying degrees of oncology.

If the patient is prescribed paracentesis, local anesthesia is done - the navel area. After that, an incision is made one centimeter long, and the excess liquid is pumped out.

This operation assumes a sitting position of the patient.

It should be noted that the operation has some contraindications. There is a risk of hepatic coma, internal bleeding.

For patients with infectious diseases, this type of operation is contraindicated. Paracentesis sometimes becomes the cause of complications - emphysema, hemorrhage in the abdominal cavity, dysfunction of organs.

Sometimes the operation is performed using ultrasound. The accumulated fluid after surgery can drain from the patient's body for a long time, which helps to get rid of the disease.

Those who want to get rid of ascites can use alternative medicine methods to relieve symptoms of the disease.

Alternative medicine is intended for those who have relatively "mild" symptoms of fluid accumulation, have a promising prognosis, and are not suspected of varying degrees of oncology.

Pumpkin helps the liver function better. For the treatment of ascites (fluid accumulation), you can make pumpkin porridge, baked pumpkin.

Parsley tincture is often used as a diuretic. Two tablespoons of parsley are soaked in a glass of hot water.

The container needs to be closed, it takes two hours to insist. It is necessary to drink one hundred milliliters of infusion five times a day.

Parsley can be soaked in milk. You need to take one parsley root, soak in a liter of hot milk, put in a water bath. Insist half an hour. Drink in the amount indicated above.

Doctors often prescribe diuretics. You can prepare a similar medicine at home. For example, you can make a decoction of bean pods.

The pods need to be crushed - you need two tablespoons of this powder. Next, you need to boil the powder in water (two liters) for fifteen minutes.

In order to overcome ascites, you need to drink three times a hundred milliliters a day.

Ascites is the accumulation of excess fluid in the abdomen.

Serous fluid is located between the peritoneal organs and the intestinal loops, which ensures the free movement of organs. With the development of various pathologies, it can accumulate, which leads to the appearance of an ailment.

Home treatment of ascites is considered a very topical issue.

Causes

The causes of the appearance of pathology are very diverse and are always associated with abnormal processes in the body. So in what diseases does ascites occur? The following violations can lead to the development of the disease:

In some cases, pathology is diagnosed in newborn children.... It can be a consequence of fetal hemolytic disease, which is associated with an immunological conflict.

Ascites - fluid in the abdomen

Symptoms

Before dealing with pathology, you should analyze its clinical picture. Symptoms may increase gradually or appear suddenly over days or hours.

The main manifestation of ascites is a significant increase in the size of the abdomen and a noticeable weight gain.... At the same time, many people complain of the appearance of bursting pains, nausea, heartburn, flatulence, belching.

As the abdomen enlarges, the navel protrudes and the skin tightens... In an upright position, the abdomen hangs down, while in a horizontal position it spreads out on the sides and protrudes in the region of the ribs.

With a significant increase in volume, severe shortness of breath, swelling of the extremities, and impaired motor activity are observed. It can be difficult for a person to bend over.

Often, patients complain of hernias and hemorrhoids.... Many patients have rectal prolapse and varicocele.

Depending on the cause of the development of the disease, general symptoms may also occur:

fever;
enlarged veins in the abdomen;
toxicosis;
general weight loss against the background of an increase in the size of the abdomen;
bluish tinge of the limbs.

In total, quite a lot of fluid can accumulate in the abdominal cavity. This figure is 5-20 liters.

How is ascites treated? This question worries many people. The main drugs that are used to remove excess fluid from the body are diuretics.

The use of such funds helps to ensure the transfer of excess fluid from the peritoneum to the bloodstream. This can significantly reduce the manifestations of pathology.

At the initial stage of therapy, the patient is prescribed a small amount of diuretics. This helps to minimize the risk of adverse reactions.

The key principle of diuretic therapy is to slowly increase urine output. This will help prevent significant losses of potassium and other essential metabolites. In most cases, agents such as Veroshpiron, Aldactone, Amiloride are used..

In addition to diuretics, the doctor may prescribe potassium supplements... Also, hepatoprotectors must be included in the therapy regimen.

During the treatment period, specialists carry out daily monitoring of the patient's diuresis. If the use of drugs does not give the desired effect, they are changed to stronger drugs. It can be Dichlothiazide or Triampur.

Also, during the period of therapy, medications are necessarily prescribed that help to strengthen the walls of blood vessels. These include vitamins C and P, Diosmin.

It is useful to take funds that prevent the excretion of fluid outside the vascular bed. These include Reopolyglyukin.

To normalize the metabolism of liver cells, protein preparations are administered. Usually, concentrated plasma or a solution of Albumin having a concentration of 20% is used for this. If the disease is of bacterial origin, antibiotics are indicated.

Many people wonder if ascites can be cured.... Medication can help you get rid of excess fluids. To completely cope with the disease, you need to eliminate the provoking factor.

Answering the question of how to get rid of pathology, one cannot fail to mention the effective alternative methods. Of course, they will not help to completely recover from the disease, but they will significantly improve the person's condition.

Treatment of ascites with folk remedies is carried out using the following products:

Power features

Diet for ascites plays a key role, especially in the early stages of the disease. To achieve good results, all prohibitions must be strictly observed.

So, the following should not be eaten:

In this case, food must be complete. The menu should contain a variety of products.

It is useful to use the following:

Course and prognosis

Many people are wondering if this ailment itself can go away..

Unfortunately, ascites does not disappear without adequate therapy, but is constantly progressing. This anomaly significantly worsens the prognosis of the underlying disease and is an unfavorable sign in terms of prognosis.

Ascites can be complicated by bleeding, peritonitis, spleen or liver failure.

There is also a threat of brain damage due to swelling. On average, the number of deaths within 2 years with severe ascites is 50%.

Prophylaxis

In order to prevent the development of the disease, you need to engage in its prevention:

Correctly and timely treat pathologies that can provoke ascites... These include hepatitis, cirrhosis, portal hypertension.
Follow a diet... Experts advise to limit the use of useless liquids that do not quench thirst - coffee, carbonated drinks.
Refuse excessive physical and psychological stress.

Now you know how to remove this pathology. To do this, first of all, you need to deal with the treatment of the underlying ailment that led to the appearance of ascites.

To do this, it is necessary to conduct a detailed diagnosis and strictly adhere to all medical recommendations.

Ascites (dropsy of the abdomen) is a condition characterized by the accumulation of free fluid in the abdominal cavity (more than 25 ml), which can be either inflammatory (exudate) or non-inflammatory (transudate) in nature. Ascites is manifested by an increase in abdominal circumference, respiratory failure, pain in the peritoneum, a feeling of heaviness and distention.

Causes

Ascites itself is not a disease, but is a complication of others: cirrhosis of the liver (75%), cancer (10%), impaired heart function (5%), other urological, gynecological, gastroenterological diseases, including impaired lymph outflow - (10 %). The scenario for the development of ascites depends on the disease that caused it. The pathological condition usually progresses gradually, over several months, however, there are cases of a sudden and sharp increase in the abdominal cavity.

Most often, ascites develops due to improper functioning of the liver. Diseases of this organ, in particular cirrhosis, are primarily responsible for the accumulation of fluid in the abdominal cavity. In addition, cancers affecting various organs (colon, stomach, liver, breast, pancreas) are another of the main causes that can lead to ascites. Other reasons include:

excessive alcohol consumption;
blood clots in the veins of the liver and heart;
pancreatitis;
kidney problems.

Protein is an essential substance that attracts and retains water. With its lack, it begins to pass from blood to tissue. In difficult historical times of famine, the population's limbs, faces, stomachs "swelled". This is called hypoproteinemic edema, or in common parlance - "swell with hunger." The accumulation of fluid in the abdominal cavity is the very ascites that arose as a result of the failure to receive important elements through food. Nowadays, for this reason, it is usually found only in the poor countries of Africa.

Common signs and symptoms

The accumulation of abdominal fluid leads to an increase in intra-abdominal pressure, as a result of which the dome of the diaphragm is pushed into the chest cavity. First of all, this negatively affects the work of the pulmonary and cardiovascular system: patients have a heart rhythm disorder, and severe shortness of breath also develops even at rest. In addition, ascites is accompanied by protein loss and imbalance in water and electrolyte balance.

An increase in intra-abdominal pressure threatens the development of an umbilical hernia, expansion of the veins of the spermatic cord, the formation of hemorrhoids, prolapse of a segment of the colon, the development of severe lumbar pain and pinching in the spine (it is difficult for the patient to roll over on his side and rise from a prone position).

Initially, the patient observes a sharp and unexplained weight gain. Along with this, there is an increase in the waist, this becomes especially noticeable when it is necessary to fasten the belt on the trousers. The patient also complains of frequent heartburn, belching, increased acidity in the mouth, heaviness in the stomach, nausea, and sometimes vomiting. Due to squeezing of the intestines, problems with stools in the form of prolonged constipation are possible.

As the dropsy progresses, an increase in the peritoneal region is observed: in the "standing" position, the abdomen protrudes, but in the prone position, free fluid begins to be distributed and protrude in the lateral sections.

Clinic based on the cause of development

Development, symptoms, progression strength and prognosis entirely depend on the severity of the disease that caused ascites (see table).

Initial pathology as the main cause of ascites	Clinic	The nature of the peritoneal fluid
Cirrhosis of the liver	Initially, the patient feels weakness, decreased appetite, palpitations are noted. Over time, characteristic signs join: pain in the right hypochondrium, yellowness of the skin and sclera, subfebrile body temperature. One of the complications of liver cirrhosis is portal hypertension (increased pressure of the portal vein), which is the main cause of ascites.	In a laboratory study, the presence of erythrocytes, leukocytes, protein, bacteria and enzymes is determined.
Peritonitis (inflammation of the peritoneum) due to tuberculosis of the genitals or intestines	The patient has a fever (temperature 38-39), a sharp weight loss, there is an increase in lymph nodes along the mesentery of the intestine. On palpation of the peritoneum, multiple nodes are determined in size from millet grain to large tumor-like formations.	The liquid removed from the abdomen has a density higher than 1016, the protein relative is 40-60 g / l. Rivalta's test (biochemical test proving the presence of exudate) is positive. Also, in the sediment of the studied fluid, erythrocytes, lymphocytes, tubercle bacillus are found in large quantities.
Peritoneal carcinosis, peritoneal mesothelioma	The initial period of the disease is asymptomatic. In the process of progression, the patient has severe lymphadenitis. The tumor, as a rule, is metastasis due to the initial cancer of the stomach, ovaries, uterus, intestines, mammary glands.	On microscopic examination, pronounced erythrocytosis is determined. The presence of cancerous (atypical) cells proves the oncological nature of ascites.
Meigs syndrome	The syndrome occurs exclusively in women. Patients complain of pain in the abdominal space, shortness of breath. Ascites is usually associated with hydrothorax (fluid accumulation in the pleural space). Meigs syndrome occurs with benign or malignant lesions of the female genital organs (eg, fibroma).	Peritoneal effusion is examined for abnormal cells, and a biopsy of the primary tumor of the uterus or ovaries is done.
Right ventricular (heart) failure is a chronic form. Diseases: pulmonary heart, myocarditis, pericarditis, heart defects.	The patient has acrocyanosis (blue skin), swelling of the legs, feet and hands, enlarged liver and spleen.	The released liquid is transparent, the density is not higher than 1015, the protein concentration is 2.5% or more. The cellular composition is dominated by endothelial cells.

Ascites in a child

Unfortunately, babies, including those recently born, are sometimes diagnosed with dropsy of the abdomen, indicating the presence of a serious pathology. Sometimes ascites is detected even in utero - with the help of an ultrasound examination carried out during pregnancy.

Causes of dropsy of the abdomen in children:

dysfunction of the liver due to genetic disorders (hemochromatosis, glycogenosis, Alagille's syndrome), persistent deficiency of liver enzymes, hepatitis C virus transmitted from the mother, poisoning with toxic elements;
autoimmune diseases;
heart failure;
the presence of a specific infection - tuberculosis, syphilis, etc.;
malignant oncological lesion of any organ.

Each child needs to be routinely monitored by a pediatrician and undergo laboratory and clinical examinations in a polyclinic or children's institutions in order to identify the development of any pathology at an early stage. Timely diagnosis of the disease improves the prognosis of effective treatment!

Treatment

The purpose of the therapeutic measures used for dropsy of the abdomen is to reduce the amount of free fluid in the abdominal cavity. To achieve the desired effect, the patient must necessarily receive treatment against the disease that caused ascites. Therefore, treatment does not depend on the sex of the patient, and in both women and men it is carried out based on the severity of the course and the cause that caused it.

From the first day of detection of pathology, it is necessary to follow a strict diet, which consists in the minimum use of salty, sweet, smoked and spicy foods. You should also reduce the amount of liquid you drink to 1-1.5 liters. The general regimen of the patient is bed and half-bed, restrictions on physical activity are recommended.

Correction of ascites is carried out with the help of drugs and surgery. The treatment regimen is selected by the attending physician, taking into account the diagnostic data and the complexity of the course of the underlying disease.

Drug therapy includes:

diuretics - Furosemide, Veroshpiron, Lasix;
Potassium donors - Asparkam, Panangin;
with portal hypertension, angiotensin II receptor antagonists and ACE inhibitors are prescribed;
hepatoprotectrons, "protecting" parenchymal cells from any damage (phospholipids, amino acids, vitamins and antioxidants);
intravenous drip of protein preparations - native (liquid) plasma, albumin solution 5%.

If drug therapy has not brought the desired result, then the patient is recommended more radical methods of correction. However, surgery is often the first choice when medical treatment is known to be ineffective.

A variety of surgical techniques used for ascites:

Abdominal puncture(abdominal puncture) - paracentesis or laparocentesis. During the procedure, about five liters of liquid are taken: this is the maximum threshold, since complete pumping out can lead to collapse - a sharp drop in blood pressure and disruption of blood supply to vital organs. If there is a need for frequent repeated punctures, then the patient is placed a peritoneal catheter, which facilitates the implementation of complex manipulations.

Drainage with an abdominal catheter

Peritoneovenous shunting(Levin shunt). It is sometimes used to treat refractory ascites i.e. one that does not respond to drug therapy and quickly returns after a puncture. The operation consists in increasing the volume of circulating blood by the constant flow of fluid from the abdominal cavity into the general blood flow system. A Levin shunt is a long plastic tube that is inserted into the abdominal cavity, reaching the pelvic floor. Next, the shunt is connected to the valve and a silicone tube, which passes subcutaneously to the neck for subsequent connection with the internal jugular and superior vena cava. The valve is opened by the force generated by the displacement of the diaphragm and the increase in intra-abdominal pressure. Thus, there is an unobstructed flow of fluid into the superior vena cava.

Peritoneovenous shunting is sometimes used for refractory (recurrent) ascites

Deperitonization of the abdominal walls... When performing the manipulation, individual sections of the abdominal cavity are resected in order to create additional pathways for the outflow of accumulated fluid. The mini surgery has a temporary effect.
Omentohepatophrenopexy... The operation is used for severe portal hypertension in order to reduce the pressure in the venous system. During surgery, the visceral fold of the peritoneum is sutured to the liver diaphragm. Manipulation helps to reduce venous stasis and, as a result, there is a decrease in the exit of fluid from the lumen of the vessels into the abdominal cavity.
Reinfusion... It is used for frequent relapses of ascites and consists in the reverse infusion of the pumped-out filtered liquid. This is carried out in order to prevent complications that may form due to the loss of blood cells important for the body. The technique allows to pump out free liquid up to 15 liters per day without danger to the patient's life.