Why liquid accumulates in the abdominal cavity. Causes, Symptoms and Treatment of Abdominal Ascites

Ascites abdominal cavity - This is a pathology characterized by the accumulation of liquid in the stomach. A similar violation is considered to be a complication of a series of extremely dangerous diseases. Usually ascites proceeds in progressive form. With a small volume, the liquid in the abdomen can be solved independently if the treatment of the primary disease will be effective.

With severe forms of this abdominal disorder, more than 15 liters of transduce can be accumulated, which can no longer find outputs.

Gradually, the accumulation of fluid in the abdominal cavity not only becomes the cause of mechanical squeezing of organs, but also predisposes to the emergence of a number of dangerous complications. Often, in patients with a severe form of edech-ascitic syndrome, obstruction is developing due to the intestinal compression, as well as peritonitis, as the transudate, the amount of which in the abdomen increases, is an ideal nutrient medium for microflora.

Etiology of abdominal ascites

Many diseases may cause the pathological cluster of the fluid. Often, men subject to alcohol addiction suffer from this violation. The alcohol cannot directly provoke the euch-ascitic syndrome, but the products of its decay quickly destroy the liver. This body is a multifunctional natural laboratory. It is the liver that is responsible for the products of proteins that regulate the degree of permeability of both blood and lymphatic vessels. The frequent drinking of alcoholic beverages contributes to the destruction of the tissues of this organ. Most people long years suffering from alcohol addiction, severe cirrosis forms are diagnosed. At the same time, the liver tissue is so destroyed that they cannot cope with their functions.

The causes of the occurrence and group of risk

In 70% of cases of the manifestations of ascites big role Plays precisely cirrhosis. With a severe form of burgting, accompanied by a cluster of the liquid in the stomach, the forecast is unfavorable.

Often, the abdominal ascites is developing against the background of diseases accompanied by portal hypertension. These pathological states include:

• sarcoidosis;
• hepatosis;
• drombosis of hepatic veins on the background of cancer;
• common thrombophlebitis;
• stenosis of the lower sex or portal vein;
• venous stagnation;
• alcohol hepatitis.

The accumulation of liquid in the abdomen can be a consequence of various diseases of the kidneys, gastrointestinal organs. Such a complication often accompanies such pathological conditions as:

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

Often, the escitis syndrome is developing against the background of cancer processes occurring in the body. Often, such a complication is observed in the damage to malignant tumors of the thick bowel, stomach, ovaries, breast and endometrial.

A number of factors predisposing to the appearance of ascites are distinguished. Significantly increase the risk of developing such a problem chronic hepatitis, alcohol abuse, injection drug injection, blood transfusion, accommodation in areas with unfavorable ecological situation, obesity, tattoo, high level Cholesterol I. diabetes 2 types. It is far from full list factors contributing to the development of ascites.

Newborn ascites is often found in development hemolytic disease The fetus that occurs in pregnancy. In young children, liquid in the abdominal cavity may begin to accumulate due to hemolytic disease, exudative enteropathy, hypotrophy, congenital nephrotic syndrome.

For effective treatment Ascite is an extremely important point is the definition of the root cause of the problem.

In order to prevent the resurrection of the fluid in the abdomen, it is necessary to direct the effort to eliminate the underlying disease.

Pathogenesis of the development of ascita

The peritoneum performs several of the most important functions at once, including fixes the organs located in this area, on anatomical places, and also protects them from injury. In any healthy man There is some liquid between the layers of the peritoneum, the volume is maintained normally using a branched network of lymphatic vessels. There is constantly circulation of the transudate, that is, the old is absorbed, and a new one comes into his place. However, certain severe diseases and pathologies can upset this subtle natural mechanism.

Ascites develops when the release of fluid in the abdominal cavity is disturbed, the process of its reverse absorption, or there is a decrease in the barrier for toxins.

Gradually, the volume of fluid increases, which leads to the emergence of a number of complications. First, compensatory mechanisms are launched, so the lymphatic system begins to work at the limit of its capabilities, pumping more than 15 liters per day, pulling it away from the liver. Normally, the volume of pumped lymphs in its assignment from this organ is about 7-8 liters. The venous grid is unloaded, which contributes to a temporary improvement general status. In the future, the overloaded lymphatic system no longer copes with this task. Oncotic pressure is significantly reduced, and the volume of interstitial fluid increases. Due to the data of pathological processes, the transudate is peashed, where it accumulates.

Symptomatic manifestations of the cluster of the liquid in the stomach

Despite the gradual development of the edema-ascitic syndrome, a rapid version is possible. 3 main stages of pathology are distinguished: transient, moderate and tense. The nature of symptomatic manifestations is completely dependent on the number of accumulated fluid.

• With transient ascite, the volume of transudate does not exceed 400 ml. In this case, only bloating is observed.
• With moderate ascite in the stomach, about 5 l liquid can be accumulated. In this case, manifestations become pronounced. The patient begins to note the problems with the work of the digestive organs and the growing signs of cardiac and respiratory failure.
• The stressful ascite is diagnosed when the volume of liquid accumulating in the abdomen varies from 5 to 20 liters. At this stage of development of pathology, the patient's condition becomes extremely difficult, as violations of a number of vital organs increase.

Usually, the eccho-ascitic syndrome develops gradually. With this classical version, the patient notes that its stomach slowly increases in size. As a rule, the pronounced signs of the appearance of the problem is first not observed, but the size of clothes is gradually increasing. In some cases, the patient may be disturbed with a rapid weight gain. A noticeable increase in dimensions is observed exclusively in the area of \u200b\u200bthe abdomen. When more than 3-5 liters of liquid accumulate in the abdominal cavity, pronounced signs of ascites appear. These include:

• feeling of cutting;
• nausea;
• belching
• abdominal pains;
• heartburn;
• navel protrusion;
• heartache;
• blowing of the abdomen in the sides;
• edema feet;
• dyspnea;
• cropping;
• bulk with sharp movements.

The accumulation of a significant amount of transudate in the abdominal cavity is accompanied by the emergence of a number of complications. Often, underwhelming and femuric hernia are often developing due to enhancing pressure. In addition, the heavy form of ascites can lead to the loss of the rectum. In some cases, the edema ascicitis syndrome leads to the appearance of hemorrhoids and varicocele in men. The squeezing of organs located in the abdominal cavity often becomes the reason for the development of obstruction and clusters of the carts.

Accumulating liquid creates prerequisites for the development of peritonitis. The transudate contains a large amount of protein, therefore is an excellent nutrient medium for pathogenic microflora. The development of peritonitis against the background of ascite usually leads to a fatal outcome. A significant increase in the volume of transudate is the cause of violation of all vital organs.

Methods for diagnosing an abdominal ascite

The process of identifying the accumulation of fluid in the abdomen currently does not cause difficulties. First of all, the doctor meets an anamnesis to identify diseases that can provoke the development of such pathology, and also conducts percussion, that is, the awake.

Even light cloth clicks cause vibrational fluid movements located inside. When accumulating a large number of transudate, if you attach palm on one side of the abdomen and slam on the other, there is a pronounced fluctuation.

To confirm the presence of fluid in the abdominal cavity cT scan and ultrasound. In addition, general and biochemical blood and urine tests are made to form a diagnosis. Depending on the history of the patient, the chest x-ray can be needed, the study of liquid taken from the abdomen, darplerographography, selective angiography and hepatoscintigraphy. If you cannot reveal the root cause of complications, diagnostic laparoscopy is carried out, which allows you to remove all the liquid and make the biopsy of the peritoneum.

Conservative Ascita therapy

To prevent the accumulation of transudate in the abdomen to treat primarily necessary primary disease.

Especially important comprehensive therapy in heart failure, tumors and lesions of the liver.

If there is a transient ascite, an explicit improvement can be achieved by conservative means. The patient is prescribed a strict abolving diet under the abdominal cavity ascite. In the diet, it is necessary to include products with a high content of potassium. These include:

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

Despite the fact that the diet has a lot of restrictions, it must be drawn up so that the patient's body gets everything needless proteins, Fats, Vitamins and Minerals. Depending on the peculiarities of the primary disease, a list of products can be significantly different to be excluded from the diet.

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

In addition, prescribed medicinal productscontributing to the restoration of the water and electrolyte balance.

Significant positive effect A diuretic drugs can give, but it is extremely careful to apply them. At a moderate stage of ascites, in addition to drugs and diet, it is limited to the puncture removal of fluid from the abdomen. Abdominal laparocentesis during ascite allows you to very quickly improve the patient's condition. For one puncture can be eliminated to 5 liters of transudate. A large amount of liquid is not recommended immediately, since due to the rapid decrease in intra-abdominal pressure, collapse may develop. In addition, this treatment method creates optimal conditions for inflammatory processes, infection, adhesion formation and other complications. Such a method of treatment is effective when there is an unknown ascite. In severe cases, when a frequent evacuation of a liquid from the abdomen is required, a constant peritoneal catheter is installed. When ascites progresses, treatment can only slow down this process.

Surgical treatment of ascites

Operational interventions to eliminate the abdominal liquid apply only in severe cases when other methods are not effective or there are complications of pathology. For example, when infected with the transudate microflora and the development of peritonitis, the entire accumulated fluid and the processing of the intestine and the abdominal cavity organs with special solutions is carried out. Not always such a radical method of treatment allows you to save a sick life, but there is no other method of eliminating an infected exudate.

Among other things, if a patient is diagnosed with heavy ascites, an peritonenevous shunt is installed or demeritonization of the walls of the abdominal cavity is performed. This allows you to directly remove the fluid. In addition, they can be held surgical interventionswhich indirectly contribute to the elimination of ascites. In some cases, measures are needed to reduce pressure in the portal system. To this end, the lymphovenous cooler or the reduction of spley blood flow is made. In addition, intrahepatic shunting can be performed. In rare cases, splectomy is carried out. With the development of ascites, on the background of the cirrhosis, improving the patient's condition and prevent the accumulation of the transudate can only liver transplantation.

Prediction at the abdominal cavity

The accumulation of liquid in the abdomen is a severe complication of any disease. The forecast of survival depends on the overall condition and primary pathology provoked the development of the problem. In addition, peritonitis, hepatorenal syndrome, hepatic encephalopathy and bleeding can significantly aggress the situation. To adverse factors worsening the forecast include:

• elderly age;
• liver cancer;
• elevated level of albumin;
• reducing glomerular filtration kidney;
• diabetes;
• hypotension.

In older people who have the above pathology, the forecast of the development of ascite is unfavorable. In this case, even with directional therapy, the life expectancy of patients rarely exceeds 6 months, and in the most favorable version - no more than 2 years.

Ascites is a formidable complication indicating that the primary disease occurs hard.

Currently, new techniques are currently being developed, allowing to improve the condition of patients with such a complication, but, as a rule, a good survival forecast is observed only in cases where pathology has been revealed at an early stage of development.

Ascites can develop rapidly (within a few days) or for a long period (weeks or months). Clinically, the presence of free fluid in the abdominal cavity is manifested when it is reached quite large volume - from 1.5 liters.

The amount of fluid in the abdominal cavity sometimes reaches significant numbers - 20 liters and more. By origin, the ascitic fluid may be inflammatory character (exudate) and non-inflammatory, being a consequence of the impaired hydrostatic or colloid-osmotic pressure in the pathologies of blood or lymphatic system (transudate).

More than 80% of cases of ascites are caused by decompensation of chronic disease or acute inflammatory process In the liver

The reasons

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 (liver cirrhosis, badda disease - kiaari, thrombosis in the portal vein system, Stuart - Braz syndrome);
• malignant neoplasms (peritoneal carcinomatosis, primary liver cancer, Maigs Syndrome, Mesothelioma of the peritoneum, Sarcoma of the Bolshoi Salna, pseudomixoma of the peritoneum);
• stagnant phenomena in the system of the lower vein (chronic content pericarditis, right-handed heart failure);
• inflammatory processes in the abdominal cavity (tuberculous peritonitis, bacterial peritonitis, is polyspeed with a systemic red lupus, peritoneum alveococcosis);
• other states (nephrotic syndrome, Upple's disease, intestinal lymphangectasia, Menetry's disease, Myxedema, Chronic pancreatitis, protein swelling during starvation).

In more than 80% of cases, ascites is caused by the decompensation of chronic disease or an acute inflammatory process in the liver. The second frequency is the cause of ascite - neoplastic processes in the abdominal cavity (about 10%). Diseases of cardio-vascular system The development of ascites is entitled in 5% of cases, other reasons are rarely found.

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

Views

Depending on the amount of fluid in the abdominal cavity, there are several degrees of the pathological process:

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

The infection of ascitic content is distinguished:

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

According to the response to the therapy, ascites happens:

• transient. Disappears against the background of the conservative treatment carried out in parallel with the improvement of the patient's condition forever or before the period of the next exacerbation of the pathological process;
• stationary. The appearance of fluid in the abdominal cavity is not a random episode, in a minor volume, even despite adequate therapy;
• resistant (torpid, or refractory). Large ascites, which fails not only to stop, but even reduce the larger doses of diuretics.

If the fluid accumulation continues to grow steadily and reaches huge sizes, contrary to the treatment, such ascites is called tense.

Signs

The main signs of ascites are a uniform increase in the volume of the abdomen and the increase in body weight. Often, an increase in the abdomen during ascite patients are mistakenly taken for manifestation of obesity, pregnancy, or intestinal diseases accompanied by increased gas formation.

Ascites can develop rapidly (within a few days) or for a long period (weeks or months).

In position, the stomach looks disproportionately large, dug, in the patient's position lying on his back the side flanks of the abdomen (there is a "frog abdomen"). Leather front abdominal wall Stretched, shiny, tense. Possible expansion and protrusion of the umbilical ring due to the increase in intra-abdominal pressure.

If the ascite is provoked by an increase in pressure in the portal vein, the expansion and convolutions of the veins of the anterior abdominal wall are noted ("Medusa's head"). For cirrhosis, skin "liver signs" are characteristic: palm erythema, vascular stars on breasts and shoulders, brownish pigmentation of forehead and cheeks, white color Nail plates, purple.

Diagnostics

For reliable confirmation of ascites, a comprehensive approach to the diagnosis is required:

• collection of Anamnese (information about the transferred infectious diseases, possible abuse of alcohol, chronic pathology, previous episodes of ascites);
• objective examination of the patient (inspection, palpation of abdominal organs, abdominal percussion in horizontal, vertical position and on the side, as well as the definition of fluid fluctuations);
• Ultrasound examination;
• cT scan;
• diagnostic laparocentsis (puncture of the front abdominal wall followed by the study of ascitic fluid).

Treatment

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

Medical measures:

• diet with a limitation of liquid and salt;
• diuretics (diuretics);
• hemodynamically active neurogormonal modulators - beta blockers, angiotensin-plating enzyme inhibitors (IAPF), angiotensin receptor antagonists (ARA II);
• tools that increase in blood oncotic (blood plasma and albumin) and osmotic (aldosterone antagonists) pressure;
• preparations for improving renal filtering;
• hepatoprotectors;
• antibiotic therapy (if necessary);
• therapeutic laparocentsis to reduce the volume of ascitic liquid;
• surgical treatment, in severe cases - liver transplantation.

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

Prevention

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

• strict following the recommendations of the attending physician;
• refusal of alcohol abuse;
• compliance with diet.

Two-year survival in patients with ascites - 50%. With the appearance of refractive ascites, half patients die over the year.

Consequences and complications

Ascites can lead to the following severe consequences:

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

The emergence of spontaneous bacterial peritonitis in patients with cirrhosis of the liver leads to repeated bleeding from the varicose extended 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 the varicose veins of the esophagus, bleeding occurs. The risk of resolution of ascites for 6 months is 43%, within 1 year - 69%, for 2 years - 74%.

Forecast

Two-year survival in patients with ascites - 50%. With the appearance of refractive ascites, half patients die over the year.

Adverse prognostic factors for patients with ascites:

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

Video from YouTube on the subject of Articles:

Ascites (stomach watering) is a condition characterized by the accumulation of free fluid in the abdominal cavity (more than 25 ml), which can be both inflammatory (exudate) and non-inflammatory (transudate) character. The disease is manifested by an increase in the abdomen circumference, a breath disruption, pain in the peritoneum, a feeling of gravity and cutting.

Most often (in 80% of cases) ascites arises against the background of the liver cirrhosis that has reached the final stage of decompensation. This stage is characterized by the exhaustion of liver resources, serious impairment of hepatic and abdominal circulation, that is, the appearance of favorable conditions for the accumulation of fluid.

What it is?

Ascites is a cluster in the abdominal cavity of the fluid, which is accompanied by a progressive increase in the abdomen and the increase in the patient's weight. This liquid is usually unprepaid, that is, it is a transudate. Its quantity can vary significantly - from several hundred milliliters to 15-20 liters.

Causes of occurrence

The causes of ascitic disease have an unexpected nature, the most common among them are shown below. It:

• malignant neoplasms and metastases;
• cirrhosis of the liver and an increase in blood pressure in the portal system;
• thrombosis (narrowing of hepatic, lower hollow and portal veins);
• acute and chronic inflammatory diseases kidney;
• nephloral Sidrom (protein begins with urine);
• chronic renal failure;
• inflammatory defeat serous shell hearts;
• acute and chronic heart failure;
• some infectious and inflammatory bowel diseases, in which diarrhea and loss of protein are observed;
• inflammation of the pancreas;
• tuberculosis;
• pseudomixoma (accumulation of mucus);
• anasrot.

The specified disease is the complication of the liver cirrhosis and not only. In the body progresses gradually, at first there is no manifest itself. The abdominal cavity ascites is difficult to successfully treatment. However, healing occurs when eliminating the main pathogenic factor.

Symptoms of ascites

The formation of the abdominal cavity ascite in the majority of patients under cancer occurs gradually, within a few weeks or even months. Therefore, the first signs of this terrible complication remain ignore.

Clinically ascites begins to appear after the abdominal cavity will accumulate a sufficiently large amount of fluid, this complication appears:

1. A feeling of resolving in the stomach.
2. Different in character and duration abdominal pains.
3. Believed and heartburn.
4. Nausea.

You can visually pay attention to the gradually increasing belly, in the vertical position it hangs down, and in the horizontal breaks on the sides. Stretching the skin of the abdominal wall allows you to see the network blood vessels And protruding the navel.

Pressure on the chest causes shortness of breath and interruptions in the work of the heart. With ascite, a person is difficult to lean, fasten the shoes, put on pants.

What does ascite look like: photo

The photo below shows how the disease is manifested in humans.

Stages

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

Diagnostics

Locking the abdomen can be diagnosed by a doctor even without the use of special equipment - enough forgive the abdominal cavity of the patient. If, when taking a doctor, the doctor will detect stupidity in the abdomen on the side, while the in the middle will find a tympanite, the patient is sick ascite.

To carry out a deeper diagnosis, it is necessary to conduct an ultrasound in the cavity of the peritoneum, to explore the liver, as well as make the peritonean puncture (paracentesis). Taking fluid on the analysis allows you to identify the stage of the disease and determine its treatment. Paracentesis is carried out to clarify the causes of the disease. Also, paracentesis can be made in the event of difficulties with breathing and the occurrence of pain.

In addition to the above diagnostic methods, the patient must pass urine tests, blood, as well as to undergo immunological type studies. From how much information does the doctor give the received analyzes, the possibility of appointing additional analyzes and tests depends.

Treatment of abdominal ascites

Abdominal cavity ascites, developing as a complication of an oncological disease, should be treated together with the main disease.

1. It is also important to begin the elimination of excess of excess fluid in the first two weeks of its formation, since the tightening of therapy leads to the development of the mass of complications. Excessive fluid can be removed using a puncture and pumping it - laparcense, by receiving diuretic agents.
2. Compliance with a special diet will help reduce intra-abdominal pressure, reduce the likelihood of further production of excessive exudate.

Chemotherapy is effective only if the ascis is provoked by bowel cancer. When grazing the stomach, ovaries and uterine, the use of chemotherapies does not give a pronounced positive result.

Medicia treatment

The main drugs that help remove excess fluid from the body are diuretics. Due to their reception, it is possible to achieve the transition of an extra liquid from the abdominal cavity in the bloodstream, which helps to reduce the symptoms of ascites.

• To begin with, patients are prescribed the smallest dose of diuretics to minimize the risk of side effects. An important principle Diuretic treatment is a slow increasing diurea, which will not lead to significant losses of potassium and other major metabolites. Most often we recommend the reception of the preparations of aldakton, Veroshpiron, triamtenen, amyloride. In parallel, potassium preparations are prescribed. At the same time, hepatoprotectors are introduced into the treatment scheme.
• At the same time, doctors carry out daily control of the diurea of \u200b\u200bthe patient and with the ineffectiveness of treatment of the dose of drugs, or replace them on more strong means, for example, on triampur or dichlotiazide.

In addition to diuretic drugs, patients prescribe funds aimed at strengthening the walls of the vessels (vitamin C, vitamin P, diosmin), preparations that prevent fluid output beyond the vascular channel (REOPOLIGULUKIN). Improves the exchange of hepatic cells. Introduction of protein preparations. Most often, a concentrated plasma is used for this purpose, or an albumin solution in a 20% concentration.

Antibacterial drugs are prescribed if the ascite has a bacterial nature.

Laparocentsis of abdominal cavity

With the cavity laparocentsis ascite is a surgical manipulation, in which the liquid from the abdominal cavity is deleted puncture. It is not possible to pump out more than 4 liters of exudate, as it threatens the development of a collapse.

The more often the puncture is carried out during ascite, the higher the risk of developing inflammation of the peritoneum. In addition, the likelihood of adhesion formation and complications from the procedure increases. Therefore, with massive ascites, the installation of the catheter is preferable.

Indications for the conduct of a laparcenosis is a voltage and refractory ascite. The liquid may be daded with a catheter, or it simply flows freely into the pre-prepared dishes, after installation in the abdominal cavity of the trochar.

Peritoneovochny shunting (Shunt Levin)

Sometimes it is used to treat refractive ascites. Togo that does not give up drug therapy and quickly returns after puncture. The operation consists in an increase in the volume of circulating blood by constant flow of fluid from the abdominal cavity into the overall blood flow system.

Shunt Levin is a long plastic tube installed in abdominal cavity, reaching a pelvic bottom. Next, the shunt is connected to the valve and silicone tube, which subcutaneously passes to the neck area for the subsequent connection with the inner jugular and the upper hollow vein. The valve opens with the resulting displacement force of the diaphragm and an increase in intra-abdominal pressure. Thus, there is a unimpeded flow of fluid into the upper hollow vein.

Diet

It provides for a decrease in the use of fluid, as well as salts due to the fact that it delays in the body liquid. Doctors advise a diet on Avicenna. Such a diet under ascite provides for almost a complete refusal of oily food, eating nuts in large quantities, rejection of fresh fruits in favor of dry.

Also liquid food (borsch, soup) should be replaced with broth with additives in the form of celery, parsley, fennel. The diet during ascite does not regulate how much meat should use the patient, but all the meat should be low-fat type (chicken, turkey, rabbit).

How many people live with ascites?

The life of people with diagnosed ascites varies in wide limits, which depends on a number of factors. The life expectancy of the patient with ascites is due to:

1. Time began treatment. If the ascite is detected in the early stages of development, when the functions of vital organs are not violated (or violated slightly), elimination of the underlying disease can lead to the complete cure of the patient. At the same time, with a long progressive ascite, the defeat of many organs and systems (respiratory, cardiovascular, excretory) can occur, which will lead to the patient's death.
2. The severity of ascites. Transient (weakly expressed) ascis does not represent a direct threat to the patient's life, while the intense ascites, accompanied by an accumulation in the abdominal cavity of tens of liters of fluid, can lead to the development of acute heart or respiratory failure and patient death within hours or days.
3. The main disease. This is perhaps the main factor that determines the survival rate of patients with ascites. The fact is that even when conducting the very modern treatment A favorable outcome is unlikely if the patient has insufficiency of several organs at once. For example, with a decomposed cirrhosis of the liver (when the function of the organ is almost completely broken), the chances of the patient for survival for 5 years after the diagnosis is set to less than 20%, and with decompensited heart failure - less than 10%. More favorable forecast for chronic renal failureSince patients who are in hemodialysis and comply with all prescriptions of the doctor can live tens of years and more.

The presence of ascites significantly takes the course of the main disease and worsens its forecast. Complications of the ascite itself can be spontaneous bacterial peritonitis, hepatic encephalopathy, hepatorenal syndrome, bleeding.



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1. Prikip Andrei Zinovievich became interested in the defense ecology situation with resource saving, utilization of waste of resources, purification around the environment in the Russian Federation is close to tragic. Prikip Andrei Zinovievich discovered: "To say something invalid on the pretext of the state around the environment in the Russian Federation, it is rather difficult. Andrei Prokipa as a motion was quite indifferent to this topic, but at the moment we leave for a large number, and I become more and more radical - naturally, the situation is rather languid. We are immersed in some barbarism - and I see it pretty true, actually what is in our forum We talk about values. Together with what business, with which we speak, aware of environmental difficulties and is ready to take part in their resolution. " In the Russian Federation, the lands cleaning system are badly established. For many municipalities and including companies there are monetary difficulties for waste disposal. According to the texts of Andrei's prikipa, the price of a garbage can 20 thousand rubles, and this is a bad problem for a variety of farms and lands. The specialist has also led these selective polls, which have established, in fact, in relation to environmental tasks in residence spaces, respondents are established on 1st space. Air pollution - 17%, on the 2nd space - the difficulty of garbage processing - 15%, on the third space - Pollution of rivers and lakes - 10%. On the view of all members of the action, the adepts of power, business, social organizationsThe media is only only common efforts to neutralize pollution and cleaning the medium around us. Prikip Andrei Zinovievich with experts exchanged the views of the options common work In implementing programs to tighten the responsibility of manufacturers and buyers for saving natural resources. The question was about observing and increasing the environmental stereotypes of industrial production throughout the current cycle of food products - from controlling the origin of raw materials before disposal.

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2. Andrei Procipip said that there will be a small business in 2020 in Russia, the imbalance does not fall in Russia, meanwhile, how much market players feel comfortable and how difficult it is to survive small. On the one hand, the state is being made attempts to relax, on the other hand, bureaucracy and taxes are tightened. Prikip Andrei Zinovievich told that waiting for a small business in 2020. Unlike the State Analytics, he did not glorify the benefit of tax benefits, which in fact do not promise any benefit, and also told you to pay attention to and where the straw is to raise. Small business in 2019 experiencing a crisis. Nardu with a facilitated form of registration and supervisory holidays increased VAT up to 20%. There was a mandatory registration of self-employed, as well as a law on social entrepreneurship remained in suspended state. Small business was between two lights - the Mastodonts dictate the overestimated prices for raw materials, and customers demand a delay by payment. And then it would seem to join banks and realize the state initiative on preferential lending to small businesses, but they do not rush to part with money. Andrei Prokip emphasized that the small business remained in the role of ex-beloved - it seems like a sympathy for her, but it's better not to do life. Also ridiculous it seems the idea of \u200b\u200bpreferential tenders. Small business was able to compete on Roven with "big uncles", but given the fact that the tenders are still held in the dark - the tangible improvement in businessmen did not receive. From a psychological point of view, the period of 2020 will also be crisis. Even if the government does work on errors - the mood of the population will be quite pessimistic and the government must be prepared for this. There will be no one year of systematic improvement in the financial climate, so that the Russian has learned to believe and notice the improvement that it is in principle not peculiar). Andrei Prikipov about the positive dynamics Andrei Prokip also commented on successes in supporting small businesses. Although it looks more like the fact that the rescue of the imminent work of the hands of immersing or "help" of the former mistress. It is important to note the non-interference by the state in the sphere of satrapses and franchising. Significantly growing the direction of business from scratch, many "selfmeikers" appear, which through information technologies and fresh ideas succeed. Having only 200-300 rubles you can buy a franchise and start making a profit every month after the project is launched. Found new ways to develop an investment market. Now in the network you can sell a standing business idea and get good money for it. These conditions will be valid if the state will also keep non-interference policies. Whatever a difficult business situation - the number of registered entrepreneurs is growing. In 2019, this mark exceeded 6 million. According to the eminent businessman, the trend towards growth in 2020 will be preserved. Another question is whether the success of the undertaking of entrepreneurs is - whether the number of registrations with hopes for credit benefits is not connected. The technology market is growing. There were many innovations in virtual reality, robotics, IT technologies for business and entertainment. If we talk about offline activities, a restaurant business is experiencing a positive trend. The vast majority are occupied by coffee shops and cozy canteens. Entrepreneurs have ceased to focus on an ethnic, offering visitors to the original atmosphere, creative approaches to maintenance and feeding dishes. Andrei Prokip summed up an interview with RenTV observation that most successful projects are celebrated in the intellectual sphere: "Russians began to sell their ideas and receive direct benefits." He also wished the government to disambigate the people and correspond to him in intellectual Development!

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3. Caution, Janchenko Dmitry Mikhailovich, carefully a fraudster and pulls people in the blud amazingly, but the Ostap Bender is still alive and flourishes. At such thoughts, the events occurring in the city of Hero Volgograd. Over the years, in the city, Yangchenko Owls Dmitry Mikhailovich August 26, 1979, a native: G. Volzhsky, Volgograd Region, Director of LLC "Gasket Tehnolodzhi" Inn 3435911580. Local merchants know well, about whom, because many of them Already came across his hooks and gave him their money in debt, in growth, in business. Forever and ever. The secret of Dmitry Yanchenko is simple: the lifestyle is not for income, beautiful pastime, the ability to rub in trust provide him with wealthy people in a circle of communication, i.e. promising victims. Dmitry Mikhailovich Jacchenko Scheduler Scheme: First, he is represented by the owner and the leader of a large business, appears in society with people of the same format. Recently - often with the leadership of SMO Volgogradneftemash OJSC - Isakov George Vladimirovich. After that, such an image is leaving for a promising victim, he will use all his fantasy while inventing reasons for receiving money from her. At the same time, Yanchenko D.M. Born in 1979 Trying to get close together with Loch. Joint breaks, baths and women - the usual thing. But happiness lasts long. In another month, the other in the joint project Dmitry Yanchenko and the Loha case begin to go out of the hands badly. Those. in no way. At the last stage of the author's criminal scheme, Dmitry Mikhailovich Yangchenko makes everything that the victim does not appeal to the police, namely: persuasions, promises, small handlers. After that, a new range of divorce begins. Be careful!

4. Thirst for profit and fear of losing benefits from Sorokina Catherine Aleksandrovna awakened before the protection of the diploma! She knows how much a helper knows how much you can earn a student's diploma. Even beggar. Associate Professor of the Department of Sorokina Catherine Aleksandrovna, in collusion with Klimova Diana Viktorovna, Zavka Beadroy Aksenov V.A., not that wallets will unwind the poor students, but also the soul! Endless observations on the design of work signaling about the increase in the cost of protection! Due to its own stupidity, Sorokina Ekaterina Aleksandrovna pays special attention to its peers. Girls are obtained with special cruelty.

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Ascites, or abdominal Vodka.It is often a consequence of another, more dangerous and complex in the treatment of the disease. Nevertheless, ascites itself is able to complicate the life of the patient and lead to sad consequences. Modern medicine There are quite effective methods for the treatment of ascites at different stages. What you need to know about the first signs of ascites, the course of its development and what doctor to seek help?

Ascite as a frequent satellite of dangerous diseases

Under the ascite in medicine, the secondary pathological condition is understood, for which the accumulation of fluid in the abdominal cavity is characteristic. Most often, ascites is caused by a violation of the regulation of fluid exchange in the body as a result of serious pathological conditions.

IN healthy body In the abdominal cavity there is always a little liquid, while it does not accumulate, but is absorbed by lymphatic capillaries. For various diseases Internal organs and systems increase the rate of fluid formation and its absorption rate is reduced. In the development of liquid ascites, it becomes more and more, it begins to squeeze vital important organs. This contributes to the aggravation of the development of the main disease and the progression of ascites. In addition, since the main part of the fluid accumulates in the abdominal cavity, there is a significant decrease in the volume of circulating blood. This leads to the launch of compensatory mechanisms delaying water in the body. The patient significantly slows down the rate of formation of urine and its separation, while the number of ascitic fluid increases.

The accumulation of fluid in the abdomen cavity is usually accompanied by an increase in intra-abdominal pressure, circulatory impairment and cardiac activity. In some cases, the loss of protein and electrolyte disorders, causing heart and respiratory failure, which significantly worsens the forecast of the underlying disease.

The medicine distinguishes the three main stages of the development of ascites.

• Transient ascite. At this stage, no more than 400 ml of liquid accumulates in the abdominal cavity. You can identify the disease only with special research. Functions of organs are not violated. The removal of symptoms of ascites is possible with the help of therapy of the underlying disease.
• Moderate ascite.In the abdominal cavity at this stage accumulates up to 4 liters of liquid. There is an increase in abdomen in a patient. In the standing position you can see the dupile bottom of the abdominal wall. In the lying position, the patient often complains of shortness of breath. The presence of fluid is determined by percussion (climbing) or symptom of fluctuations (oscillations of the opposite wall of the abdomen when closing).
• Intense ascites.The amount of fluid at this stage can reach, and in some cases even exceed 10-15 liters. The pressure in the abdominal cavity rises and violates the normal work of vital organs. The patient's condition is severe, it must be urgently hospitalized.

Separately consider refractive ascites, practically non-treatable. It is diagnosed if all types of therapy conducted do not give results and the amount of fluid is not only not reduced, but also constantly increases. Forecast with this form ascite unfavorable.

Causes of Ascita

According to statistics, the main causes of the occurrence of the abdominal ascites are:

• liver disease (70%);
• oncological diseases (10%);
• heart failure (5%).

In addition, ascites may be accompanied by the following diseases:

• kidney disease;
• tuberculous defeat of the peritoneum;
• gynecological diseases;
• endocrine disorders;
• rheumatism, rheumatoid arthritis;
• lupus erythematosus;
• sugar diabetes of second type;
• uremia;
• diseases of the digestive system;
• peritonitis of noncommunicable etiology;
• violation of the outflow of lymphs from the abdominal cavity.

The emergence of ascites except specified diseasesThe following factors can be facilitated:

• abuse of alcohol leading to liver cirrhosis;
• injections of narcotic drugs;
• blood transfusion;
• obesity;
• high cholesterol;
• tattoo;
• accommodation in the region for which there are cases of viral hepatitis.

In all cases, the basis of the appearance of ascites is a complex combination of violations of the vital functions of the body, leading to the accumulation of fluid in the abdominal cavity.

Signs of pathology

One of the main external signs of the abdominal ascite is an increase in the size of the abdomen. In the standing position in the patient, it can hang in the form of apron, and in the lying position to form the so-called frog abdomen. It is possible to protrude the navel and the appearance of stretch marks on the skin. In portal hypertension caused by an increase in pressure in the portal vein of the liver, an venous drawing appears on the front abdominal wall. This drawing is customary to call the "head of jellyfish" due to the remote similarity with the mythological jellyfish Gorgon, on the head of which instead of the hair was inventive snakes.

In the stomach appear pain and feeling of cutting from the inside. A person is experiencing difficulties in the slopes of the body. External manifestations also include swelling of legs, hands, face, cyanosis skin Pokrov. The patient develops respiratory failure, tachycardia. Perhaps the appearance of constipation, nausea, belching and loss of appetite.

With laboratory I. instrumental research The doctor confirms the diagnosis and establishes the reason that caused ascites. For this, ultrasound, MRI, diagnostic laparocentsis and laboratory research. Using ultrasound, the presence of a free fluid in the abdominal cavity and its volume, an increase in the liver and spleen, the expansion of the hollow and a portal vein, a violation of the kidney structure, the presence of tumors and metastases.

MRI allows layers to study one or another fabric, to identify even a minor amount of ascitic fluid and diagnose the main disease that caused ascites.

In addition, the doctor conducts a study with palpation and percussion. Palpation helps to identify signs indicating the defeat of a certain organ (liver or spleen). Percussion is used directly to detect ascites. Its essence lies in the appealing of the patient's abdominal cavity and analyzing the penny sounds. With pronounced ascite, for example, a stupid percussion sound is determined above the entire surface of the abdomen.

Laboratory testing of blood shows a decrease in the concentration of erythrocytes, an increase in the number of leukocytes and ESO, it is possible to increase the concentration of bilirubin (with cirrhosis of the liver), proteins of the acute phase of inflammation. Urine analysis during ascite on initial stage It may show a greater amount of urine of a smaller density, since ascites cause deviations in the operation of the urinary system. With the terminal stage, urine density can be normal, but its total is significantly reduced.

Principles of therapy

General principles for the treatment of ascites suggest primarily therapy of the underlying disease. The treatment of the ascite itself is aimed at removing the liquid from the abdominal cavity and preventing recurrences.

Patients with the first degree of ascites do not need medical treatment and compliance with the baking diet.

Patients with a second degree of ascis are assigned a diet with a reduced content of sodium and diuretic therapy. It should be carried out with constant monitoring of the patient's condition, including the content of electrolytes in the blood serum.

Patients with a third degree of disease remove fluid from the abdominal cavity, and in the future diuretic therapy in combination with a volatile diet.

Forecast treatment

Ascites usually indicates serious violations in the work of affected organs, but nevertheless, he is not a fatal complication. With timely diagnosis and proper treatment It is possible to complete the liquidation of the ascitic fluid from the abdominal cavity and the restoration of the functions of the affected organ. In some cases, such as cancer, ascites is able to quickly progress, causing complications and even the patient's death. This is due to the fact that under the course of ascites, a major influence has a major disease that can cause serious lesions of liver, kidneys, hearts and other organs.

Other factors affect the forecast:

• Degree of ascita. Transient ascite (first degree) is not the immediate threat to the patient's life. In this case, all attention should be paid to therapy of the main disease.
• Time start time. When identifying ascites at that stage, when vital organs are still destroyed or their functions are amazed slightly, eliminating the underlying disease can also lead to a complete recovery of the patient.

On the statistics of survival rate during ascite also affects the type and severity of the underlying disease. With a compensated liver cirrhosis, 50% of patients are able to live from 7 to 10 years, and with decompensited - five-year survival rate does not exceed 20%.

In cancer diseases, ascites, as a rule, appears in the later stages, and five-year survival is no more than 50% with timely treatment. The average life rate in such patients is 1-2 years.

With incorrect treatment, ascites may cause serious complications, worsening the forecast:

• bleeding;
• peritonitis;
• brain swelling;
• cardiac dysfunction;
• heavy breathing failure.

Ascitis relapses can also occur as side effects With incorrect treatment. Recurring is very dangerous, since in most cases the ascites cannot be curable lead to a fatal outcome.

Conservative treatment of abdominal ascites

Conservative or symptomatic treatment Ascites will be applied in cases where the abdominal cavity ascites is at an early stage of development or as palliative therapy for oncology and the inappropriateness of the use of other methods.

In all cases, the main task of treatment is the removal of ascitic fluid and maintaining the patient's condition at a certain level. To do this, it is necessary to reduce the amount of sodium entering the body and strengthen its excretion with urine.

You can achieve positive results only with an integrated approach, observing a diet, controlling weight changes and taking diuretic drugs.

Main principles of diet The ascite is as follows:

• Minimum salt. Its excessive consumption leads to the development of edema, and therefore ascites. Patients are recommended to maximize the reception of salted food.
• Minimum fluid. With moderate or tense ascite, there must be no more than 500-1000 ml of fluid in its pure day per day.
• Minimum fat. Food consumption with a large amount of fats leads to the development of pancreatitis.
• A sufficient amount of proteins in the diet. It is protein deficiency that can lead to edema.

Based oily meat and fish, roasted dishes, smoked, salt, alcohol, tea, coffee, spices.

In the treatment of ascites, it is necessary to control the weight dynamics. At the beginning of a baking diet during the week, daily weighing is made. If the patient has lost more than 2 kg, then the diuretic drugs are not assigned to it. With weight loss less than 2 kg over the next week, drug therapy begins.

Diuretic preparations help to bring extra liquid from the body and contribute to the transition of a part of a liquid from the abdominal cavity in the bloodstream. Clinical manifestations Ascites are significantly reduced. The main drugs used in therapy are furosemide, mannitol and spironolactone. In the outpatient basis, furosemide is appointed intravenously no more than 20 mg 1 time in two days. It removes the liquid from the vascular bed through the kidneys. The main disadvantage of furosemide is an excessive removal of potassium from the body.

Mannitol is used in conjunction with furosemide, since their action is combined. Mannitol displays a liquid from the intercellular space into the vascular bed. Appointed 200 mg intravenously. However, on an outpatient basis, it is not recommended.

Spironolactone is also a diuretic, but it is able to prevent the excessive elimination of potassium.

Additionally, drugs that strengthen the vascular walls (vitamins, diosmin) are prescribed, means affecting the blood system ("gelatinole", "Reopolyglyukin"), albumin, antibiotics.

Surgical manipulations

Operational intervention during ascite is shown in cases where the accumulation of fluid cannot be eliminated using conservative treatment.

Therapeutic laparocentsis When ascite (puncture of the front abdominal wall) is able to derive large volumes of liquid - from 6 to 10 liters at a time. Conduct a procedure under local anesthesia with a preliminary devastation of the bladder. The patient takes a half-time or a stay. The puncture is made in the middle line of the abdomen between the navel and the pubic bone. The scalpel is performed by the cut of the skin through which a special tool is introduced into the abdominal cavity - Trocacar. The liquid in the desired volume is displayed through it. After the procedure, the wound is sorted. Laparocentesis during ascite can be performed only in hospital conditions, since it is necessary to comply with the norms of antiseptics and the ownership of the operation method. To simplify the procedure for those patients with which laparocentsis is required periodically, it is carried out through a constant peritoneal port.

Another effective surgical manipulation is orthehepatofrenopecia . It consists in drying the gland to the pre-treated portion of the surface of the diaphragm and the liver. Due to the occurrence of contact between the liver and the gland, the possibility of suction of ascitic liquid with adjacent tissues appears. Additionally, the pressure in the venous system and the fluid yield into the abdominal cavity through the walls of the vessels is reduced.

TYPE - Transjugular intrathole portoysystem shunting - Allows the decompression of the portal system and eliminate ascitic syndrome. Basically, the TIP is carried out with refractory ascite, non-treatable drug therapy. Under the TIP procedure in yarem Vienna The conductor is entered before entering the hepatic vein. Then, on the conductor, a special catheter is carried out in the liver itself. With the help of a long curved needle, a stent creates a channel between the pet and hepatic veins is installed in the carrier vein. Blood is directed to a hepatic vein with reduced pressure, which leads to the elimination of portal hypertension. After performing the TIP in patients with refractory ascites, there is a decrease in the volume of fluid in 58% of cases.

Despite the fact that ascites and caused by its diseases are quite serious and difficult to treat, timely complex therapy can significantly increase the chances of recovery or improve the quality of life of incurable patients. It is necessary to treat ascites only under the supervision of a doctor, since the complexity of the main disease rarely allows you to do with domestic or folk methods. This is especially true of ascites caused by oncology.

Ultrasound examination is one of the safest, non-invasive and at the same time of reliable methods for determining the free fluid in the abdominal cavity.

Causes of liquid accumulation

Despite the fact that a certain amount of fluid is always secreted in the peritoneum, it should not be diagnosed on the ultrasound. This is due to the fact that the released fluid is immediately absorbed, which provides free gliding the abdominal organs relative to each other. This maintains a balance between secretion and absorption processes.

Free liquid in the abdomen can be detected during ultrasonic diagnostics of abdominal organs and small pelvis

In the development of the pathological process in the abdominal cavity, this balance may violate, in connection with which the effusion is formed - ascites (or simply speaking, watering). The typical cause of ascite is an increase in pressure in the region of the gate vein, developing due to chronic diseases, such as hepatic pathology with portal hypertension syndrome (cirrhosis, malignant neoplasm), cardiovascular failure, peritonitis, etc.

Also, the accumulation of free fluid can be associated with the development of such pathological processes of the abdominal cavity, and in particular the gastrointestinal bodies like appendicitis, intestinal obstruction, malignant process localized in the gastrointestinal tract. In this case, often, due to infection, the fluid may acquire purulent.

In addition, the free fluid may arise due to closed (stupid) injuries of the belly. Then the blood cavity falls into the abdominal cavity or the contents of hollow organs of the abdominal cavity (gallbladder, stomach, intestines).

Ultrasound diagnostics allows not only to determine the presence of fluid in the region of the peritoneum, but to adjust the treatment tactics. Depending on the nature of the pathological process, conservative therapy, puncture or operational intervention can be applied.

Testimony for diagnostics

Ultrasound for free fluid is carried out with diseases such as:

Hepatic pathology	Cirrhosis, hepatitis
Acute abdominal pathology	Intestinal obstruction, appendicitis, cholecystitis
Malignant pathology	Tumors of abdominal organs, small pelvis, retroperitoneal space;
Injuries, when suspected of gap	Stomach, intestines, liver, spleen, gallbladder, bladder bladder
Gynecological diseases	Follicle gap, ovarian cyst, ectopic pregnancy

Contraindications for research

No restrictions and contraindications for diagnostics. In emergency cases, the ultrasound is carried out without preparation in any patient condition. With a planned survey, the patient is recommended to improve the quality of the imaging of the pathological process.

When planned diagnostics, it is necessary to adhere to a diet in advance (in 2-3 days), excluding gas-forming products from the diet, with a high content of fiber.

On the eve of the procedure, you should make a cleansing enema or accept the laxative. On the day of the procedure to reduce gases in the intestine you can drink activated carbon or mezim, according to the instructions.

Results of research

On the screen of the Uzi apparatus, the free fluid is defined as an anechogenic area (dark color), freely conducting ultrasonic waves. Typical location places: Space in the field of liver, spleen, right and left side canal, small pelvis.

In the case of ascites, there is a large amount of liquid in all departments of the peritoneal cavity. On the right, the liquid can be determined when peritonitis, liver injury, on the left side - may indicate the separation of the spleen. For gynecological pathology The liquid appears in the area of \u200b\u200bthe small pelvis.

To clarify the location of the patient may ask to change the positions (turn from one side to another) or get up from the couch.

The WSDD doctor defines an approximate volume of fluid at the site of its largest cluster, which makes it possible to estimate the level of blood loss, the severity of the disease.