What is the name of the accumulation of fluid in the abdominal cavity. Abdominal ascites: symptoms, diagnosis and treatment of the disease

Ascites can develop rapidly (over several days) or over a long period (weeks or months). Clinically free fluid in abdominal cavity manifests itself when a fairly large volume is reached - from 1.5 liters.

The amount of fluid in the abdominal cavity sometimes reaches significant numbers - 20 liters or more. By origin, ascitic fluid can be inflammatory (exudate) and non-inflammatory, resulting from a violation of hydrostatic or colloid-osmotic pressure in pathologies of the circulatory or lymphatic system (transudate).

In more than 80% of cases, ascites is caused by decompensation of a chronic disease or an acute inflammatory process in the liver.

The reasons

There are several groups of diseases in which ascites develops:

• pathologies accompanied by an increase in pressure in the portal vein of the liver, that is, portal hypertension (cirrhosis of the liver, Budd-Chiari disease, thrombosis in the portal vein system, Stuart-Bras syndrome);
• malignant neoplasms (carcinomatosis of the peritoneum, primary liver cancer, Meigs syndrome, mesothelioma of the peritoneum, sarcoma of the greater omentum, pseudomyxoma of the peritoneum);
• congestion in the inferior vena cava system (chronic constrictive pericarditis, right ventricular heart failure);
• inflammatory processes in the abdominal cavity (tuberculous peritonitis, bacterial peritonitis, polyserositis with systemic lupus erythematosus, peritoneal alveococcosis);
• other conditions (nephrotic syndrome, Whipple's disease, intestinal lymphangiectasia, Menetrie's disease, myxedema, chronic pancreatitis, protein edema during fasting).

In more than 80% of cases, ascites is caused by decompensation of a chronic disease or an acute inflammatory process in the liver. The second most common cause of ascites is neoplastic processes in the abdominal cavity (about 10%). Diseases of cardio-vascular system lead to the development of ascites in about 5% of cases, other causes are quite rare.

The risk of re-development of ascites within 6 months is 43%, within 1 year - 69%, within 2 years - 74%.

Views

Depending on the amount of fluid in the abdominal cavity, they speak of several degrees of the pathological process:

1. Small ascites (no more than 3 liters).
2. Moderate (3-10 liters).
3. Large (massive) (10–20 liters, in rare cases - 30 liters or more).

According to the infection of ascitic contents, the following are distinguished:

• sterile (uninfected) ascites;
• infected ascites;
• spontaneous bacterial peritonitis.

According to the response to ongoing therapy, ascites is:

• transitory. Disappears in the background conservative treatment in parallel with the improvement of the patient's condition forever or until the period of the next exacerbation of the pathological process;
• stationary. The appearance of fluid in the abdominal cavity is not an accidental episode; it persists in an insignificant volume even despite adequate therapy;
• resistant (torpid, or refractory). Large ascites, which can not only be stopped, but even reduced with large doses of diuretics.

If the accumulation of fluid continues to increase steadily and reaches enormous sizes, despite the ongoing treatment, such ascites is called tense.

Signs

The main signs of ascites are a uniform increase in abdominal volume and an increase in body weight. Often, an increase in the volume of the abdomen with ascites is mistaken by patients for the manifestation of obesity, pregnancy or bowel disease, accompanied by increased gas production.

Ascites can develop rapidly (over several days) or over a long period (weeks or months).

In a standing position, the abdomen looks disproportionately large, saggy, in the patient's position on his back, the lateral flanks of the abdomen are spread (there is a "frog belly"). The skin of the anterior abdominal wall is taut, shiny, tense. Expansion and protrusion of the umbilical ring are possible due to increased intra-abdominal pressure.

If ascites is triggered by increased pressure in the portal vein, enlargement and tortuosity of the veins of the anterior abdominal wall ("Medusa's head") are noted. For cirrhosis, skin "liver signs" are characteristic: palmar erythema, spider veins on the chest and shoulders, brownish pigmentation of the forehead and cheeks, White color nail plates, purpura.

Diagnostics

For reliable confirmation of ascites, an integrated approach to diagnosis is required:

• collection of anamnesis (information about past infectious diseases, possible alcohol abuse, chronic pathology, previous episodes of ascites);
• objective examination of the patient (examination, palpation of the abdominal organs, abdominal percussion in the horizontal, upright position and on the side, as well as the determination of fluid fluctuations);
• Ultrasound examination;
• CT scan;
• diagnostic laparocentesis (puncture of the anterior abdominal wall with subsequent examination of ascitic fluid).

Treatment

To eliminate ascites, first of all, it is necessary to stop the underlying disease.

Treatment activities:

• a diet with fluid and salt restriction;
• diuretics (diuretics);
• hemodynamically active neurohormonal modulators - beta-blockers, angiotensin-converting enzyme inhibitors (ACE inhibitors), angiotensin receptor antagonists (ARA II);
• drugs that increase oncotic (blood plasma and albumin preparations) and osmotic (aldosterone antagonists) pressure in the blood;
• drugs to improve renal filtration;
• hepatoprotectors;
• antibiotic therapy (if necessary);
• therapeutic laparocentesis to reduce the volume of ascitic fluid;
• surgical treatment, in severe cases - liver transplantation.

In more than 80% of cases, ascites is caused by decompensation of a chronic disease or an acute inflammatory process in the liver.

Prophylaxis

Ascites is a complication common diseases, therefore, the main measure of its prevention is timely and adequate treatment of the underlying disease. In addition, they contribute to the prevention of ascites:

• strict adherence to the recommendations of the attending physician;
• refusal to abuse alcohol;
• adherence to a diet.

The two-year survival rate in patients with ascites is 50%. When refractory ascites appears, half of the patients die within a year.

Consequences and complications

Ascites can lead to the following serious consequences:

• respiratory failure (due to an increase in the volume of the abdominal cavity and limitation of the excursion of the diaphragm);
• spontaneous bacterial peritonitis;
• refractory ascites;
• hepatic encephalopathy;
• hepatorenal syndrome.

The occurrence of spontaneous bacterial peritonitis in patients with cirrhosis of the liver leads to repeated bleeding from varicose veins of the esophagus. Mortality after the first episode of bleeding is 30-50%. In 70% of patients who survived one episode of bleeding from varicose veins of the esophagus, bleeding occurs again. The risk of re-development of ascites within 6 months is 43%, within 1 year - 69%, within 2 years - 74%.

Forecast

The two-year survival rate in patients with ascites is 50%. When refractory ascites appears, half of the patients die within a year.

Poor prognostic factors for patients with ascites:

• elderly age(over 60 years old);
• low blood pressure (systolic pressure less than 80 mm Hg. Art.);
• decreased glomerular filtration rate (less than 500 ml / min);
• a decrease in the content of serum albumin (less than 28 g / l);
• hepatocellular carcinoma;
• diabetes.

YouTube video related to the article:

Violate the function of not only the organ where cancer cells develop. With malignant lesions, in most cases, complications arise that significantly complicate the course of the disease.

The group of these complications also includes ascites. This term denotes the accumulation of excess fluid in the abdominal cavity, with such a violation, the abdomen can increase several times.

What is this disease?

If a person has cancer, then the likelihood of developing ascites reaches 10%. The accumulation of fluid does not occur with all malignant lesions.

Most often, ascites accompanies:

1. Malignant neoplasms, etc.

With ovarian cancer, the probability of ascites formation reaches 40%, and in 50% of this oncological lesion, women die precisely from ascites.

The accumulation of a large volume of fluid in the abdominal cavity leads to an increase in intra-abdominal pressure, this provokes a displacement of the diaphragm into the chest cavity. Such a pathological violation of the anatomy of internal organs limits the respiratory function of the lungs, negatively affects the work of the heart, on the blood circulation.

The accumulated fluid pushes the peritoneal organs and, therefore, does not change their functioning for the better. Massive and long-term persistent ascites causes a large amount of protein to be lost.

In connection with all the changes that occur, ascites causes a lot of complications - and respiratory failure, metabolic disorders. All these pathologies significantly worsen the course of the underlying disease.

Causes of occurrence

In the abdominal cavity healthy person there is always a small amount of circulating fluid.

This liquid prevents the internal organs from sticking together and allows the intestinal loops to move freely, without friction.

The exudate produced in the peritoneum is also absorbed here, that is, the body itself controls the process of fluid production.

In some diseases, including oncology, the resorptive, secretory and barrier functions of the peritoneal sheets are disrupted and then either too much fluid is produced, or it is not completely absorbed back.

This leads to the filling of the free space of the abdominal cavity with an ever increasing amount of exudate, in severe cases, its volume reaches 25 liters.

With the above oncological diseases, due to the proximity of organs, cancer cells can penetrate into the peritoneum and settle on its visceral and parietal layer. The developing cancer cells disrupt the resorptive function of the peritoneum, the lymphatic vessels cannot fully cope with their task and the produced fluid begins to accumulate.

So ascites is gradually formed, the defeat of the peritoneal sheets by malignant cells also provokes development.

As already mentioned, the main reason for the defeat of the peritoneum in cancer is its close contact with those organs where malignant neoplasms are formed.

But in addition to this, the causes of ascites in oncology also include:

• Tight fit of the abdominal folds to each other. This ensures the rapid capture of adjacent tissues by cancer cells.
• Abundant location of blood and lymph vessels in the peritoneum, which only increases and accelerates the transfer of cancer cells.
• The drift of atypical cells into the peritoneum during the operation.
• Germination of a malignant tumor through the walls of the peritoneum.

A course of chemotherapy can provoke the development of ascites; in the latter stages, fluid accumulation often occurs for a reason.

When the liver is damaged by metastases or with primary cancer of this organ, the reason for the accumulation of fluid lies elsewhere - the venous system of the organ is compressed, and the natural outflow from the intestine is disturbed. This type of ascites, as a rule, forms quickly and is difficult.

Symptoms of the disease

The formation of abdominal ascites in most patients with cancer occurs gradually, over several weeks or even months. Therefore, the first signs of this formidable complication are ignored.

Clinically, ascites begins to manifest itself after a sufficiently large amount of fluid has accumulated in the abdominal cavity, this complication manifests itself:

• Feeling of fullness in the abdomen.
• Abdominal pains of different nature and duration.
• Belching and heartburn.
• Nausea.

Visually, you can pay attention to the gradually increasing abdomen, in an upright position it hangs down, and in a horizontal position it spreads out on the sides. Stretching the skin of the abdominal wall allows you to see the net blood vessels and a protruding navel.

Pressure on the chest causes shortness of breath and heart failure. With ascites, it is difficult for a person to bend over, fasten shoes, put on trousers.

Photo of abdominal ascites in a man

But still, with ascites, which arises as a complication of a malignant lesion, the symptoms that occur in the primary focus come to the fore in people. And more often this is what leads to the fact that oncological ascites is detected already with a large accumulation of fluid.

Ascites in ovarian cancer and its causes

With ovarian cancer, the most severe consequences are caused by ascites. Fatal outcome with the accumulation of fluid in the abdominal cavity occurs in 50-60% of cases.

The development of ascites in ovarian oncology occurs in advanced cases, that is, when metastases spread to the abdominal cavity and liver.

The accumulating fluid, in turn, increases the size of the ovarian tumor, and this can result in ruptures and the release of exudate into the abdominal cavity. Ascites, which forms as a complication of ovarian cancer, leads to swelling of the lower abdomen, genital area. Swelling goes to the legs.

The accumulation of fluid at first does not cause pronounced changes in well-being, but then it may appear severe pain perceived by the patient as an attack of appendicitis. The development of ascites in ovarian cancer should not be ignored, the earlier treatment begins, the more chances of a favorable outcome of this complication.

Effects

Ascites in oncology is dangerous in itself, but in addition to this, it can cause other complications, these include:

• Spontaneously developing bacterial peritonitis.
• Respiratory failure.
• Hydrothorax.
• Bowel obstruction.
• and pinching.
• Rectal prolapse.
• Hepatorenal syndrome.

All of these complications must be treated as soon as possible, otherwise they significantly aggravate a person's well-being and can lead to his death.

Diagnostics

Patients with oncological diseases should always be monitored by a doctor, and the oncologist, depending on the localization of the neoplasm, should already assume the likelihood of complications.

Ascites can be suspected by external signs, patient complaints, palpation and abdominal percussion are of no small importance.

Mandatory assignment of instrumental methods:

• Ultrasound. In addition to fluid, this study can reveal the presence of tumors, their location, changes in the structure of internal organs.
• Tomography. This method is necessary to determine the amount of fluid and its location in the abdominal cavity.
• Laparocentesis. After anesthesia, the abdominal wall is punctured just below the navel and the fluid is pumped out. The procedure is prescribed for therapeutic and diagnostic purposes. Part of the exudate is sent for analysis, where the presence of albumin, glucose, types of cellular elements, pathogenic microflora is determined.

Stages

Depending on the amount of accumulated exudate, three stages of ascites are distinguished:

• Transient ascites - no more than 400 ml of fluid in the abdominal cavity. At this stage, there may only be bloating.
• Moderate ascites is exposed when the exudate in the abdominal cavity is not more than 5 liters. At this stage, the complication is manifested by clinical symptoms in the form of a malfunction of the digestive system, shortness of breath. In the absence of treatment for ascites, the development of peritonitis, respiratory and heart failure is possible.
• Strained or resistant ascites is characterized by the accumulation of up to 20 liters of fluid. The patient's condition is serious, the work of vital organs is significantly disrupted.

How to treat abdominal ascites in oncology?

Abdominal ascites, which develops as a complication of cancer, should be treated together with the underlying disease.

It is also important to start eliminating excess fluid in the first two weeks of its formation, since delaying therapy leads to the development of a lot of complications. Excess fluid can be removed with a puncture and pumping it out - laparocentesis, by taking diuretics.

Compliance with a special diet will help reduce intra-abdominal pressure, reduce the likelihood of further excessive exudate production.

Effective only if ascites is provoked. With cancer of the stomach, ovaries, and the use of chemotherapy drugs does not give a pronounced positive result.

Laparocentesis

Laparocentesis of the abdominal cavity with ascites is a puncture of the peritoneal wall with a special instrument and the intake of fluid for analysis or pumping it out.

Usually, for cancer, laparocentesis is prescribed if there is no effect from the use of diuretics, another indication is tense ascites.

The procedure takes place in several stages under local anesthesia:

• The patient is in a sitting position, the surgeon treats the intended puncture site with an antiseptic and then an anesthetic.
• First, after the injection of the anesthetic, an incision is made in the abdominal wall and muscles. It is carried out along the white line of the abdomen, retreating from the navel down by 2-3 cm.
• The final puncture is performed with rotational movements using a trocar. A flexible tube is attached to the trocar through which fluid will drain.
• If the puncture is done correctly, then a tense stream of liquid will stand out.
• The excess fluid is pumped out very slowly, it is necessary to constantly monitor the patient's condition. As the fluid is removed, the nurse should tighten the abdomen with a sheet or towel, this is necessary so that the pressure in the abdominal cavity decreases slowly.
• After the evacuation of the exudate, a sterile dressing is applied to the wound.

Laparocentesis allows you to remove up to 10 liters of fluid at a time. But in this case, the patient is shown the administration of albumin and other medications in order to reduce the likelihood of developing renal failure.

If necessary, temporary catheters can be inserted into the peritoneum, which will drain the accumulating fluid. The installation of catheters greatly facilitates the well-being of cancer patients, but threatens with a drop in blood pressure and the formation of adhesions.

Laparocentesis may not always be performed. Contraindications for a puncture include:

• organs of the abdominal cavity.
• Expressed flatulence.
• The recovery period after the operated ventral hernia.

Laparocentesis is performed in outpatient... After the procedure and if the patient is in a satisfactory condition, he can be sent home.

Diuretics

Of diuretics, cancer patients with developing ascites are prescribed Diacarb, Furosemide or Veroshpiron for a long course.

A combination of two diuretics is also possible and it is necessary to drink them, even if there is no visible diuretic effect at the beginning of treatment.

When using diuretics, it is necessary to take preparations containing potassium, otherwise it is possible to provoke the development of disorders in water-electrolyte metabolism.

Diet food

Proper nutrition for abdominal ascites will help reduce fluid build-up.

It is necessary to minimize the addition of table salt to dishes and limit fluid intake. But it should be borne in mind that the body cannot be completely without salt.

It is useful to introduce potassium-rich foods into the diet:

• Spinach.
• Carrot.
• Baked potato.
• Fresh green peas.
• Dried apricots.
• Raisins.
• Grapefruit.
• Asparagus.
• Oatmeal.

The diet must be formulated in such a way as to comply with the restrictions regarding the underlying disease.

How long do patients live?

The development of ascites not only seriously worsens the well-being of an oncological patient, but also aggravates the course of the underlying disease.

The two-year survival rate of patients with dropsy is only 50%, and this is subject to timely treatment of the complication. The prognosis of the course of ascites worsens the elderly age of the patient, the presence of a large number, a tendency to hypotension, renal failure.

Video broadcast about abdominal ascites:

Abdominal ascites is a pathology characterized by the accumulation of fluid in the abdomen. Such a violation is considered a complication of a number of extremely life-threatening diseases. Usually, ascites is progressive. With a small volume, the fluid in the abdomen can dissolve on its own if the treatment of the primary disease is effective.

In severe forms of this disorder, more than 15 liters of transudate can accumulate in the abdomen, which can no longer find a way out on its own.

Gradually, the accumulation of fluid in the abdominal cavity not only causes mechanical compression of organs, but also predisposes to the appearance of a number of dangerous complications. Often, patients with a severe form of edematous-ascitic syndrome develop obstruction due to compression of the intestine, as well as peritonitis, since the transudate, the amount of which in the abdomen increases, is an ideal breeding ground for microflora.

Etiology of abdominal ascites

Many diseases can cause abnormal fluid accumulation. Often men with alcohol addiction suffer from this disorder. Alcohol cannot directly provoke edematous-ascites syndrome, but at the same time its decay products quickly destroy the liver. This organ is a multifunctional natural laboratory. It is the liver that is responsible for the production of proteins that regulate the degree of permeability of both blood and lymph vessels. Frequent intake of alcoholic beverages contributes to the destruction of the tissues of this organ. Most people long years suffering from alcohol dependence, severe forms of cirrhosis are diagnosed. At the same time, the liver tissues are so destroyed that they cannot cope with their functions.

Causes and risk groups

In 70% of cases of ascites manifestations big role it is cirrhosis that plays. With a severe form of liver damage, accompanied by the accumulation of fluid in the abdomen, the prognosis is poor.

Often, ascites of the abdominal cavity develops against the background of diseases accompanied by portal hypertension. Such pathological conditions include:

• sarcoidosis;
• hepatosis;
• hepatic vein thrombosis in the presence of cancer;
• widespread thrombophlebitis;
• stenosis of the inferior genital or portal vein;
• venous congestion;
• alcoholic hepatitis.

Accumulation of fluid in the abdomen may be due to various diseases kidneys, gastrointestinal tract and heart. A similar complication often accompanies such pathological conditions as:

• myxedema;
• glomerulonephritis;
• nephrotic syndrome;
• heart failure;
• pancreatitis;
• Crohn's disease;
• lymphostasis.

Often, edematous-ascitic syndrome develops against the background of oncological processes in the body. Often a similar complication is observed with a lesion malignant tumors large intestine, stomach, ovaries, breast and endometrium.

A number of factors predisposing to the appearance of ascites are distinguished. Significantly increase the risk of developing a similar problem chronic hepatitis, alcohol abuse, injection drug administration, blood transfusion, living in areas with unfavorable environmental conditions, obesity, tattooing, high cholesterol and type 2 diabetes. This is far from full list factors contributing to the development of ascites.

In newborns, ascites often occurs during development hemolytic disease fetus, which occurs during pregnancy. In young children, fluid in the abdominal cavity may begin to accumulate due to hemolytic disease, exudative enteropathy, malnutrition, and congenital nephrotic syndrome.

For effective treatment Ascites is extremely important to determine the root cause of the problem.

To prevent the re-accumulation of fluid in the abdomen, it is necessary to direct efforts to eliminate the underlying disease.

Pathogenesis of ascites development

The peritoneum performs several important functions at once, including fixing the organs located in this area at anatomical places, and also protects them from injury. Any healthy person has a little fluid between the layers of the peritoneum, the volume of which is maintained normally with the help of an extensive network of lymphatic vessels. The transudate is constantly circulating here, that is, the old one is absorbed, and a new one comes in its place. However, certain serious illnesses and pathologies can upset this subtle natural mechanism.

Ascites develops when the flow of fluid into the abdominal cavity is disturbed, the process of its reabsorption, or there is a decrease in the barrier to toxins.

Gradually, the volume of fluid increases, which leads to the appearance of a number of complications. Compensatory mechanisms are triggered first, therefore lymphatic system begins to work at the limit of its capabilities, pumping more than 15 liters of fluid per day, taking it away from the liver. Normally, the volume of the pumped lymph when it is diverted from this organ is about 7-8 liters. The venous mesh is unloaded, which contributes to a temporary improvement general condition... In the future, the overloaded lymphatic system can no longer cope with this task. Oncotic pressure decreases significantly, and the volume of interstitial fluid increases. Due to these pathological processes, sweating of the transudate is observed, where it accumulates.

Symptomatic manifestations of fluid accumulation in the abdomen

Despite the gradual development of edematous-ascitic syndrome, a rapid variant is also possible. There are 3 main stages of pathology: transient, moderate and intense. Character symptomatic manifestations depends entirely on the amount of accumulated liquid.

• With transient ascites, the transudate volume does not exceed 400 ml. In this case, only swelling is observed.
• With moderate ascites, about 5 liters of fluid can accumulate in the abdomen. In this case, the manifestations become pronounced. The patient begins to notice problems with the work of the digestive system and the growing signs of heart and respiratory failure.
• Tense ascites is diagnosed when the volume of fluid accumulating in the abdomen varies from 5 to 20 liters. At this stage of the development of the pathology, the patient's condition becomes extremely difficult, as disruptions in the work of a number of vital organs are increasing.

Usually edematous-ascites syndrome develops gradually. With this classic version, the patient notices that his stomach is slowly increasing in size. As a rule, there are no pronounced signs of a problem at first, but the size of the clothes gradually increases. In some cases, the patient may be worried about unreasonable weight gain. A noticeable increase in size is observed exclusively in the abdomen. When more than 3-5 liters of fluid accumulates in the abdominal cavity, pronounced signs of ascites appear. These include:

• feeling of fullness;
• nausea;
• belching
• abdominal pain;
• heartburn;
• protrusion of the navel;
• heartache;
• swelling of the abdomen in the sides;
• swelling of the legs;
• dyspnea;
• difficulty in turning;
• gurgling with sudden movements.

The accumulation of a significant volume of transudate in the abdominal cavity is accompanied by the appearance of a number of complications. Often, due to increasing pressure, umbilical and femoral hernias develop. In addition, severe ascites can lead to rectal prolapse. In some cases, edematous ascites syndrome leads to the appearance of hemorrhoids and varicocele in men. Compression of the organs located in the abdominal cavity often causes the development of obstruction and accumulation of feces.

The accumulating fluid creates the prerequisites for the development of peritonitis. Transudate contains a large amount of protein, therefore it is an excellent breeding ground for pathogenic microflora. The development of peritonitis against the background of ascites is usually fatal. A significant increase in the volume of transudate becomes the cause of disruption of the work of all vital organs.

Methods for the diagnosis of abdominal ascites

The process of detecting the accumulation of fluid in the abdomen is currently not difficult. First of all, the doctor gets acquainted with the history to identify diseases that can provoke the development of such a pathology, and also conducts percussion, that is, tapping.

Even slight clicks in the abdomen cause vibrational movements of the liquid inside. With the accumulation of a large amount of transudate, if you put your hand on one side of the abdomen and slap on the other, a pronounced fluctuation is observed.

To confirm the presence of fluid in the abdominal cavity, computed tomography and ultrasound are performed. In addition, to make a diagnosis, general and biochemical analyzes blood and urine. Fluoroscopy may be required depending on the patient's history. chest, study of fluid taken from the abdomen, dopplerography, selective angiography and hepatoscintigraphy. If it is not possible to identify the root cause of the complication, diagnostic laparoscopy is performed, which allows you to remove all the fluid and make a biopsy of the peritoneum.

Conservative therapy of ascites

To prevent the accumulation of transudate in the abdomen, first of all, it is necessary to treat primary disease.

Especially important complex therapy with heart failure, tumors and liver damage.

If there is transient ascites, clear improvement can be achieved with conservative means. The patient is prescribed a strict salt-free diet for abdominal ascites. It is imperative to include foods high in potassium in the diet. These include:

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

Despite the fact that the diet has many restrictions, it must be designed so that the patient's body receives all essential proteins, fats, vitamins and minerals. Depending on the characteristics of the primary disease, the list of foods that are recommended to be excluded from the diet may vary significantly.

The amount of liquid consumed per day should be limited to 1 liter.

In addition, drugs are prescribed to help restore water and electrolyte balance.

Significant positive effect can give diuretics, but they should be used with extreme caution. With a moderate stage of ascites, in addition to drugs and diet, puncture removal of fluid from the abdomen is limited. Abdominal laparocentesis with ascites can quickly improve the patient's condition. Up to 5 liters of transudate can be eliminated in one puncture. It is not recommended to immediately remove a large amount of fluid, since collapse may develop due to the rapid decrease in intra-abdominal pressure. In addition, this method of treatment creates optimal conditions for inflammation, infection, adhesion formation and other complications. This treatment is effective when there is unstressed ascites. In severe cases, when frequent evacuation of fluid from the abdomen is required, an indwelling peritoneal catheter is inserted. When ascites progresses, treatment can only slow the process down.

Surgical treatment of ascites

Surgical interventions to eliminate fluid from the abdominal cavity are used only in severe cases when other methods are not effective or there are complications of the pathology. For example, when a transudate is infected with microflora and the development of peritonitis, all accumulated fluid is removed and the intestines and abdominal organs are treated with special solutions. Such a radical method of treatment does not always save the patient's life, but there is no other method of eliminating the infected exudate.

Among other things, if a patient is diagnosed with severe ascites, a peritoneovenous shunt is inserted, or deperitonization of the abdominal walls is performed. This allows the liquid to be removed directly. In addition, surgical interventions can be performed that indirectly contribute to the elimination of ascites. In some cases, measures are required to reduce the pressure in the portal system. For this purpose, a lymphovenous fistula or reduction of splenic blood flow is often done. In addition, intrahepatic shunting can be performed. In rare cases, splenectomy is performed. With the development of ascites against the background of cirrhosis, only liver transplantation can improve the patient's condition and prevent the accumulation of transudate.

Prognosis for abdominal ascites

The accumulation of fluid in the abdomen is a serious complication of any disease. The prognosis of survival depends on the general condition and the primary pathology that provoked the development of the problem. In addition, peritonitis, hepatorenal syndrome, hepatic encephalopathy and bleeding can significantly aggravate the situation. Adverse factors that worsen the prognosis include:

• elderly age;
• liver cancer;
• elevated albumin levels;
• decreased glomerular filtration of the kidneys;
• diabetes;
• hypotension.

In older people with the above pathologies, the prognosis for the development of ascites is unfavorable. In this case, even with targeted therapy, the life expectancy of patients rarely exceeds 6 months, and in the most favorable variant, no more than 2 years.

Ascites is a formidable complication, indicating that the primary disease is difficult.

Currently, new techniques are being actively developed to improve the condition of patients with such a complication, but, as a rule, a good prognosis of survival is observed only in cases where the pathology was detected at an early stage of development.

Water in the stomach is alarming symptom, which the doctor diagnoses by ultrasound. It is recommended to undergo such an examination if the patient notices an increase in the abdominal cavity. Such a complaint should not be ignored by a specialist, since cancer can progress with a fatal outcome.

What is ascites

it dangerous disease, in which a large amount of fluid accumulates in the abdominal cavity. Other organs can also suffer from this: heart, lungs. The pathology is not inflammatory. In the abdominal region with such a disease, which is popularly called "frog belly", up to 20 liters of fluid can accumulate.

In more than 75% of cases, this problem is a consequence of progressive cirrhosis. The main task of the doctor is to remove symptoms and prolong the period of remission.

Let's figure out what the problem is and why fluid accumulates. The peritoneum, which lines the walls of the organ, secretes a small amount of fluid - in its composition, it is similar to blood plasma and is needed for the normal functioning of organs, otherwise they will simply stick together.

The liquid is released and absorbed throughout the day, however, under the influence of pathological factors, this process can be disrupted. Due to the imbalance, intra-abdominal pressure begins to increase, the abdomen increases in size, and fluid appears.

Why fluid can accumulate in the abdominal cavity

One of the reasons is liver cirrhosis, but this is not the only provoking factor. So, it should be remembered that pathology develops slowly and for the first few months it may not manifest itself in any way. Moreover, the problem is that this disease is quite difficult to treat, the main thing is to eliminate the factor that causes this ailment.

Most often, the appearance of fluid in the abdominal cavity is caused by:

• heart diseases;
• the presence of malignant tumors;
• abdominal tuberculosis;
• problems in the endocrine system;
• gynecological diseases.

It is important to note that not only adults, but also children suffer from ascites.

Moreover, pathological processes can occur even when the fetus is in the womb, which is associated with congenital malformations liver. Most often this happens when there is infectious diseases in the mother: rubella, herpes, measles, etc. Also at risk are those children whose mothers smoke during pregnancy, abuse drugs, strong medicines.

Ascites can appear in diabetes mellitus as a result of blood transfusion. To avoid the appearance of such a problem in babies, it is advisable for pregnant women to avoid going to tattoo artists.

Manifestation and symptoms

The main symptom worth paying attention to is the appearance of free fluid that is not naturally excreted from the body. As a result, the abdomen increases in size, and over time, this problem only gets worse.

From the very beginning, you may not notice this, however, with the development of the disease, it becomes impossible to strain the stomach or relax it.

Additional symptoms include:

• stomach ache;
• weight gain;
• shortness of breath;
• heartburn;
• general discomfort;
• swelling of the legs.

Diagnosis of the disease

It is rather difficult to determine this disease only by examining the patient. A description of the symptoms is required by the physician to collect information, but to deliver final analysis, this is not enough. It is necessary to undergo an examination that will help determine the nature and stage of the disease.

Diagnostics includes the following:

Treatment of ascites with traditional medicine

After the diagnosis, doctors can make a preliminary prognosis, determine the appropriate treatment regimen. The approach for this disease should be complex, and if the form is neglected, it is possible to carry out an operation. It all depends on the symptoms, the stage of the disease.

At first, doctors try to remove the focus of fluid conservatively, but if it continues to accumulate, and the previous methods did not help, they will have to prepare for the operation. But let's talk in more detail.

the main goal drug treatment- removal of fluid by a non-invasive method. Treatment will only be effective at an early stage when the cavity is partially filled. In this case, diuretics (Diacarb or Torasemide) and drugs with high content calcium (Asparkam). Additionally, they can prescribe the intake of multivitamin complexes.

If treatment with pills does not help, an operation is prescribed.

It should be noted that the operation being carried out will remove the liquid, but not the cause itself, therefore, it will be imperative to eliminate the provoking factor.

Surgical intervention includes:

1. Laparocentesis. In this case, an abdominal puncture is performed to drain fluid. The procedure can take 2-3 days, you cannot do without hospitalization.
2. Bypass surgery. In this case, doctors form a duct to ensure fluid exchange and stabilize pressure.
3. Liver transplant. This method is usually used in oncology or in the last stages of cirrhosis.

In addition, it is worth adhering to medical nutrition, which will reduce the accumulation of fluid, prolong the period of remission, and eliminate the main symptoms. During this period, raisins, dried apricots, spinach should be included in the diet.

Unconventional treatments

Some people try alternative medicine, but it can be useful only if the disease is at an early stage and there is little fluid in the cavity, there are no complications.

Pumpkin acts as an excellent prophylactic agent, which improves liver function. Therefore, it is so important to include porridge and other dishes with this product in the diet.

Parsley decoction is a good diuretic. Take 2 tablespoons. herbs, soak in 200 ml of boiling water. Cover the container with the mixture and leave to infuse for two hours. Drink 100 ml of the drink 5 times a day. You can substitute milk for water.

Diuretics can be made from beans: take 2 tablespoons. beans, make a decoction, boil for 15-20 minutes in 2 liters of water. Drink 100 ml three times a day.

Finally, it must be said that timely treatment and compliance with all the doctor's recommendations will avoid serious health problems.

The accumulation of free fluid in the abdominal cavity occurs as a result of an inflammatory reaction, impaired lymph outflow and blood circulation due to various reasons... This condition is called ascites (dropsy), and its appearance can lead to the development of serious consequences for human health.

The fluid accumulated in the peritoneum is an ideal habitat for pathogenic microflora, which is the causative agent of peritonitis, hepatorenal syndrome, umbilical hernia, hepatic encephalopathy and other equally dangerous pathologies.

To diagnose ascites, one of the safest and most non-invasive, but highly accurate methods is used - examination using ultrasound waves. Detection of the presence of fluid in the abdominal cavity by ultrasound is carried out as directed by the attending physician based on the existing clinical signs pathological process.

The abdominal cavity is an anatomically separate zone, which constantly releases moisture to improve the sliding of the visceral sheets of the peritoneum. Normally, this effusion is able to be absorbed dynamically and not accumulate in areas convenient for it. In our article, we want to provide information on the causes of abnormal fluid reserve, diagnosis pathological condition on ultrasound and effective methods of its treatment.

Why does free fluid accumulate in the abdominal cavity?

Ascites develops as a result of various kinds of pathological processes in the pelvic organs. Initially, the accumulated transudate does not have an inflammatory nature, its amount can range from 30 ml to 10-12 liters. The most common causes of its development are impaired secretion of proteins, which ensure the impermeability of tissues and pathways that conduct lymph and circulating blood.

This condition can provoke congenital anomalies or development in the body:

• cirrhosis of the liver;
• chronic heart or kidney failure;
• portal hypertension;
• protein starvation;
• lymphostasis;
• tuberculous or malignant lesions of the peritoneum;
• diabetes mellitus;
• systemic lupus erythematosus.

Often, dropsy develops with the formation of tumor-like formations in the mammary glands, ovaries, digestive organs, serous membranes pleura and peritoneum. In addition, free fluid can accumulate during complications. postoperative period, pseudomyxoma of the peritoneum (accumulation of mucus, which undergoes reorganization over time), amyloid dystrophy (violation of protein metabolism), hypothyroid coma (myxedema).

The mechanism for the formation of dropsy is the seepage into the abdominal cavity of fluid from the main lymphatic ducts, blood vessels and organ tissues

Signs of ascites

In the early stages of the development of this condition, patients do not have any complaints, the accumulation of free fluid can only be detected using ultrasound. Visible symptoms appear when the amount of transudate exceeds one and a half liters, a person feels:

• an increase in the abdominal part of the abdomen and body weight;
• deterioration in general health;
• a feeling of fullness in the abdominal cavity;
• swelling lower limbs and tissues of the scrotum (in men);
• belching;
• heartburn;
• nausea;
• difficulty breathing;
• flatulence;
• tachycardia;
• protrusion of the umbilical node;
• discomfort and pain in the abdomen;
• stool and urinary disorders.

When a large amount of effusion accumulates in the peritoneum, a person can hear a characteristic splash of fluid and feel a wave.

If an ultrasound examination of the abdominal cavity shows that there is excess moisture, the attending physician must accurately establish the root cause of the pathological condition. Pumping out the accumulated transudate is not effective method treatment of ascites.

Preparation for an ultrasound scan and the course of its conduct

This study does not have any contraindications or restrictions, in emergency cases it is carried out without preliminary preparation of the patient. A planned procedure requires improved visualization of pathological changes in organs. The patient is advised to exclude foods containing a large amount of fiber and increasing gas production from the diet 3 days before the study.

On the eve of the study, drink a laxative or make a cleansing enema. To reduce the accumulation of gases in the intestines on the day of the ultrasound scan, you need to take Mezim or activated carbon. Modern ways ultrasound diagnostics allow you to determine the most likely areas of accumulation of free fluid in the abdominal cavity.

That's why qualified specialists inspect the following anatomical areas:

• The upper "floor" of the peritoneum, which is located under the diaphragm. Special diagnostic value have spaces located under the liver and formed by the main department small intestine- the ascending and descending parts of the colon. Normally, the so-called lateral canals do not exist - the integument of the peritoneum is tightly attached to the intestine.
• The small pelvis, in which, with the development of pathological processes, effusion can accumulate, flowing from the lateral canals.

The physical characteristics of the moisture accumulated in the peritoneum for any reason do not allow the ultrasonic wave to be reflected, this phenomenon makes the diagnostic procedure as informative as possible. The presence of effusion in the studied anatomical spaces creates a dark moving focus on the monitor of the apparatus. In the absence of free liquid, the diagnosis takes no more than 5 minutes.

To detect excess moisture, the ultrasound probe is moved along the anterior and middle axillary lines on both sides of the patient's body down the abdomen

If the transudate cannot be detected, indirect signs may indicate its presence:

• displacement of the colon loops;
• sound change during percussion (tapping) - tympanic in upper divisions peritoneum, blunt in the lower.

Types of abdominal dropsy by ultrasound

The international qualification of diseases does not distinguish ascites as a separate disease - this condition is a complication last stages other pathological processes. According to the brightness of clinical symptoms, the following forms of ascites are distinguished:

• initial - the amount of water accumulated inside the abdomen reaches 1.5 liters;
• with a moderate amount of liquid- manifested by swelling of the legs, a noticeable increase in the size of the chest, shortness of breath, heartburn, constipation, a feeling of heaviness in the abdomen;
• massive (the volume of effusion is more than five liters) is a dangerous condition characterized by tension in the walls of the abdominal cavity, the development of insufficiency of the function of the cardiac and respiratory systems, and infection of the transudate.

In bacteriological assessment of the quality of free liquid, which is produced in special laboratory conditions, a distinction is made between sterile (absence of pathogenic microorganisms) and infected (presence of pathogenic microbes) dropsy.

According to the diagnostic prognosis, there is ascites, which lends itself drug therapy, and a stable pathological condition (its re-occurrence or not amenable to treatment).

What is done after confirming the pathology with ultrasound?

Course treatment measures depends on what disease caused the accumulation of excess moisture in the peritoneum. For accurate diagnosis of the pathological process, practicing specialists conduct a comprehensive examination of the patient, including:

• biochemical and general clinical analyzes of blood and urine;
• research on oncological markers and indicators of electrolyte metabolism;
• survey radiography of the chest and abdominal cavities;
• coagulogram - evaluation of the parameters of the coagulation system;
• angiography of blood vessels to assess their condition;
• MRI or CT of the abdomen;
• hepatoscintigraphy - modern technique studies of the liver using a gamma camera, which allows visualizing the organ;
• diagnostic laparoscopy with therapeutic puncture of the ascitic fluid.

To pump out the transudate from the abdominal cavity, the method of therapeutic laparocentesis is used - a puncture is made in the anterior wall of the abdomen, through which excess fluid is removed

Patients with cirrhosis of the liver are recommended to undergo intrahepatic portosystemic shunting, the technique of which consists in placing a metal mesh stent to create an artificial connection between the collar and hepatic veins. If the disease is severe, organ transplantation is necessary.

In conclusion of the above information, I would like to emphasize once again that the accumulation of free fluid in the abdominal cavity is considered an unfavorable manifestation of the complicated course of the underlying ailment. The development of ascites can provoke a violation of the functional activity of the heart and spleen, internal bleeding, peritonitis, cerebral edema.

The mortality rate of patients with massive abdominal dropsy reaches 50%. Measures that prevent the occurrence of this pathological condition consist in the timely treatment of infectious and inflammatory processes, proper nutrition, refusal to drink alcohol, moderate sports, preventive examinations of medical specialists and the exact implementation of their recommendations.