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

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

Classification of ascites

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

By the volume of the liquid accumulated in the cavity, there are:

1. transitory - up to 400 ml.
2. moderate - from 500 ml to 5 liters.
3. resistant (stressed) - more than 5 liters.

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

• sterile, in which the presence of harmful microorganisms is not observed.
• infected, in which microbes multiply in the contents of the abdominal cavity.
• spontaneous peritonitis caused by bacteria.

Also, ascites is classified by responsiveness to medication treatment:

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

Chylous ascites

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

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

Causes of fluid in the abdominal cavity

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

Other hepatic causes include:

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

9-10% of cases of ascites are associated with oncological pathologies of the abdominal organs, metastases in the stomach... The reasons for women often lie in oncopathologies of the pelvic organs. In malignant neoplasms, there is a deterioration in lymph circulation and blockage of the lymphatic drainage pathways, as a result of which the fluid cannot escape and accumulates.

Interesting: ascites, which has developed as a result of oncopathologies, often indicates the impending death of a person.

5% of cases of dropsy of the abdomen are associated with pathologies of the heart muscle, which are accompanied by circulatory decompensation. Doctors call this condition "cardiac ascites". It is characterized by significant edema of the lower extremities, and in advanced cases, edema of the whole body. As a rule, with heart disease, fluid is collected not only in the abdomen, but also in the lungs.

Rarely, dropsy of the abdomen can be caused by the following conditions:

• renal pathologies such as amyloidosis, glomerulonephritis.
• diseases of the pancreas.
• portal vein thrombosis.
• tuberculosis of the peritoneum.
• acute expansion of the stomach.
• Lymphogranulomatosis.
• Crohn's disease.
• intestinal lymphoangiectasia.
• protein starvation.

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

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

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

Abdominal fluid symptoms

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

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

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

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

Diagnostics

The specialist is able to suspect ascites in the patient already upon examination, by probing and "tapping" the stomach. To confirm the diagnosis, the patient undergoes studies that visualize the peritoneal cavity:

• Radiography.

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

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

1. clinical analyzes of blood and urine.
2. biochemical blood test (according to his data, the state of the patient's liver and kidneys is assessed).
3. study of the peritoneal contents obtained by puncture.

Video

Ascites treatment

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

Therapy for dropsy of the abdomen is carried out by conservative, symptomatic and surgical methods.

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

If the dropsy of the abdomen is caused by hypertension of the portal vein, appoint Albumin, hepatoprotectors and plasma transfusion.

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

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

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

With relapses of pathology, an operative intervention is prescribed, in which the inferior vena cava and portal veins are connected and collateral blood circulation is created. If, before the operation, specialists have repeatedly resorted to removing the ascitic fluid from the patient's abdomen, plasma transfusions are carried out at the same time, and a protein diet is recommended after the operation.

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

Predictions are determined by the severity of the pathology that caused ascites. Life expectancy is not directly related to the accumulation of fluid in the abdomen, however, the growing dropsy contributes to the aggravation of the underlying disease and worsening general condition sick.

Ascites is a pathological condition that requires urgent and mandatory medical intervention. Lack of treatment or started, but with a delay, leads to the rapid development of complications. If you suspect fluid accumulation in the abdomen, urgent examination and adequate treatment are necessary, which will help increase the chances of a favorable prognosis.

Update: December 2018

The accumulation of fluid in the abdominal cavity, which causes the abdominal enlargement, is called ascites. This condition is not so common, but its development almost always indicates the presence of a serious illness. It can occur with damage to the liver, heart, kidneys and a number of other organs. The main thing in this case is to timely determine the cause of its development and carry out the correct treatment.

In the overwhelming majority of cases, people with ascites are long-term patients who know about their diseased organ. However, there are cases when this condition is the debut of the disease. You can learn up-to-date information on what can cause ascites, modern diagnostic and treatment methods from this article.

Causes of ascites

This condition can occur due to a large number of different diseases, but most often, the cause of ascites lies in one of three organs - the liver, heart or kidneys. Their defeat is accompanied by the accumulation of fluid throughout the body, including in the internal organs, under the skin and in the abdominal cavity. More exotic reasons include some hormonal disorders, tuberculosis, lymphatic vascular damage, and a number of other pathologies.

Liver damage

Liver disease is the most common cause of ascites. The accumulation of fluid in the abdominal cavity can occur when its cells are damaged or due to compression of the portal vein.

Every minute liver cells produce a large amount of substances, including albumin, proteins, some vitamins (A, E, D, K), "good" cholesterol, blood clotting substances, etc. Protein produced by the liver is required to retain fluid in the lumen of blood vessels. It attracts water to itself, due to which, healthy person swelling does not occur. When cells are damaged, the amount of protein produced decreases, due to which the liquid begins to sweat through the vascular wall into the tissues and cavities (abdominal, chest, pericardial, etc.).

Compression of the portal (portal) vein can also cause ascites. It is a large vessel located on the back of the liver, in a small notch. With an increase in the organ, the vein can be strongly compressed, which leads to an increase in blood pressure on its walls. Because of this, the liquid is "forced" through the vein and enters the abdominal cavity immediately.

The table below describes liver diseases in which there is a malfunction of cells, an increase in an organ, or both. With the development of ascites, they must be excluded first.

Liver disease	Brief description of the disease	Pathological mechanism
Hepatitis with a blood route of transmission (with severe course) Hepatitis B; Hepatitis C; Hepatitis D.	These are severe viral diseases that target liver cells, damaging and reducing their function. Until now, no therapy has been developed that can cure 100% of patients, therefore, in some of them, hepatitis becomes chronic.	Cell disruption
Autoimmune hepatitis	This pathology is associated with impaired immunity, due to which blood cells begin to attack and gradually destroy liver tissue.
Alcoholic liver disease	Alcohol has a direct damaging effect on liver tissue. The constant use of large doses of ethanol inevitably leads to severe chronic illness.
Drug overdose (with the development of drug-induced hepatitis)	Some pharmaceuticals can also be toxic to this organ if taken incorrectly. These include: Paracetamol; Most pain relieving anti-inflammatory drugs (Ibuprofen, Diclofenac, Ketorolac, and others); Chlorpromazine; Certain antimicrobial drugs (rifampicin, tetracycline, isoniazid).
Budd Chiari Cider	This is a rare condition in which the veins inside the liver are blocked. The result is a malfunction and swelling of the liver. Often accompanied by ascites.
Reye's syndrome	A serious complication that occurs in children who have had a viral infection (smallpox, flu, adenovirus infection etc.). It is extremely rare and can result in death or disability.
Cirrhosis, including: Primary biliary; Secondary (arising after other liver diseases); Congenital.	Cirrhosis is the replacement of normal liver tissue with non-functioning connective tissue. Typically, this is a slow and gradual process. End stage cirrhosis - severe liver failure and death from poisoning by body toxins.	These pathologies combine two pathological mechanisms - they lead to both narrowing of the portal vein and damage to liver cells.
Primary sclerosing cholangitis	It leads to overgrowth of the hepatic ducts and a decrease in organ function. Almost always leads to primary biliary cirrhosis.
Wilson-Konovalov disease	An inherited disorder in which a person lacks a copper transporter protein. Because of this, the trace mineral builds up in the liver and brain, causing severe damage.
Fatty liver disease	In the case when the liver tissue is replaced not by connective, but by adipose tissue, doctors diagnose “ fatty degeneration". The disease can occur as a result of poisoning, diabetes mellitus, a number of hormonal diseases, etc.

Despite the large number of various liver diseases, the correct diagnosis can be made based on the patient's condition and the results of some studies. Which ones? Information on this is presented below.

Heart failure

Blood moves through the body due to the continuous work of the heart and blood vessels. In case of violation of the functions of the heart muscle, the blood flow begins to slow down, which leads to its stagnation and the release of fluid into organs and tissues. First of all, swelling occurs on the legs and arms. However, in severe heart failure, the liquid part of the blood can accumulate around internal organs and in the abdominal cavity.

Ascites against the background of cardiovascular diseases can occur when:

Damage to the heart muscle. Due to a decrease in the number of working cells and their replacement with connective tissue, organ failure may occur. Damage can be caused by:

• any form ischemic disease heart, including heart attack and angina pectoris;
• infections (endo-, peri- and myocarditis);
• autoimmune diseases (lupus erythematosus, scleroderma, and others);
• amyloidosis - a metabolic disorder in the body, due to which a pathological protein (amyloid) is deposited in the walls of organs;
• trauma and injury to the organ.

Overload of the heart. Some diseases lead to increased pressure on the walls of the organ and their stretching. Such overload can occur due to blood retention in the ventricles / atria or with increased pressure in the vessels. Overload can be caused by:

• Hypertension, with late initiation of therapy or improper treatment. After the diagnosis, the patient needs to constantly take drugs that reduce blood pressure, and periodically visit the local therapist (1 time per year). If you lose control over the course of the pathology (with a constantly increased pressure), you must re-consult a doctor;
• Arterial hypertension, which can occur with hormonal disorders (Itsenko-Cushing's syndrome, hyperthyroidism, etc.), damage to the renal tissue, damage to parts of the brain;
• Congenital and acquired defects, such as open interventricular / interatrial septum, stenosis or valve failure, stenosis or coarctation (expansion) of the aorta, and others.

Cardiomyopathies. This group genetic diseases, in which the structure of the heart wall is disturbed. There are two options - either it becomes too thick (hypertrophic form), or becomes thinner (dilated form).

Heart failure is a condition that requires proper and timely treatment. The development of ascites in cardiac pathology is always an unfavorable sign, indicating an insufficient amount of therapy or a severe course of the disease.

Kidney damage

This organ performs a large number of functions, one of which is the removal of excess fluid and toxins from the body. During the day, the kidneys filter about 180 liters of blood. When the kidney tissue is damaged, this process is disrupted, which leads to the accumulation of fluid in various parts of the body: on the legs and arms, on the face, in the abdominal cavities, heart and in internal organs.

This condition is aggravated by the constant loss of protein in the urine, which occurs due to the destruction of the renal filter. Since the protein in the blood vessels becomes less, the arteries and veins cannot hold all the liquid part of the blood. As a result, the swelling becomes even larger and spreads throughout the body.

Not every kidney disease can cause this fluid retention. The following pathologies most often lead to the destruction of renal tissue and disruption of the filtration process:

• Glomerulonephritis. This term is understood as a whole group of diseases that have several characteristics. First, they almost always lead to the destruction of the renal filter and force a person to use hemodialysis (at the final stage). The second - glomerulonephritis is an autoimmune disease that develops due to the "error" of the body's defense systems. As a result, blood cells begin to attack and destroy healthy kidney cells;
• Tubulointerstitial nephritis (abbreviated as TIN). This is a disease in which the components of the kidney filter (tubules) die off. Most often, it occurs after poisoning with various toxins, including heavy metals, drugs, methanol and other substances. Also, cases of TIN development were noted after severe viral diseases, radiation exposure, against the background of cancer of any organ;
• Diabetic nephropathy. Diabetes is not easy elevated level blood glucose. This is a serious illness that gradually affects the entire body, including the kidneys. In the absence of adequate treatment and constant sugar control, the kidney filter begins to slowly and irreversibly deteriorate, which can lead to widespread edema and ascites;
• Congenital malformations of the kidneys. Polycystic disease, underdevelopment of renal tissue, absence (agenesis / aplasia) of the kidney - all these conditions can cause fluid retention in the patient's body;
• Systemic disease. Lupus erythematosus, periarteritis nodosa, rheumatoid arthritis, systemic scleroderma is a rare but serious disease that damages the connective tissues of the human body, including the kidneys;
• Hypertonic disease. Constantly high blood pressure negatively affects the work of all organs, but primarily the heart and kidneys. Hypertension, which is not treated or treated incorrectly, inevitably leads to shrinking of the kidneys and impaired function.

Neglected kidney disease is almost always difficult. However, ascites is only one of many symptoms. In such patients, edema develops throughout the body, well-being, the work of the heart, brain and other organs worsens.

Other causes of ascites

Having excluded the presence of diseases of the kidneys, heart and liver, as possible causes, it is necessary to start assessing the state of other organs. The problem may be hiding in an impaired outflow of lymphatic fluid, a decrease in thyroid function, or damage to the peritoneum. In particular, the accumulation of fluid in the abdominal cavity can occur with the following conditions:

Symptoms

The accumulation of fluid in the abdominal cavity can be difficult to determine. Abdominal enlargement can occur not only with ascites, but also with pancreatitis, intestinal paresis, intestinal obstruction, pregnancy and a number of other conditions. Therefore, it is important to be able to distinguish free liquid in the abdomen from its bloating, accumulation of feces, enlargement of other organs, etc. To do this, you can use the following simple techniques:

1. Place your hands on the sides of your abdomen. After that, with one hand, lightly push the stomach 2-3 times. If the second hand felt a splash of fluid or its movement, then most likely the cause of the abdominal enlargement is ascites;
2. Assess the shape of the abdomen in two positions: standing and lying. If a person retains the rounded shape of the abdomen and sags down a little while he is standing, but in the prone position the abdomen seems to "spread" and flatten out, then the presence of fluid should be suspected.

Also, in addition to direct changes in the abdomen, the patient may experience a number of other symptoms of abdominal ascites, due to fluid accumulation and increased intra-abdominal pressure. The most common of them are:

• Difficulty breathing, including shortness of breath or a wet cough;
• Frequent urge to urinate;
• Constipation development;
• Constant weakness and decreased performance.

However, it should be noted that it is much easier and better to diagnose the disease if a person with a suddenly enlarged belly see a doctor. He will be able to more reliably examine, palpate and "tap" the abdominal wall and, if necessary, send the patient for further examination or to a hospital.

How to determine the cause of ascites

In the first section, a huge number of reasons for this condition were given. To suggest a diseased organ and determine the most likely disease in a person, a comprehensive examination is necessary. It should begin with a thorough clarification of all complaints and possible harmful factors, and end with a specialized diagnosis. Below, we describe the principles of this diagnosis and how to find out the true cause of ascites.

Analysis of all complaints and harmful factors

To determine the affected organ, it is necessary first of all to find out if a person has specific symptoms indicating diseases of the heart, kidneys, liver, lymph vessels, etc. The manifestations of these diseases can be quite diverse, but they have some common features. The most typical ones that help make a diagnosis are described in the table:

Affected organ / disease	Feature of edema	Typical symptoms
Heart or vessels	They are located all over the body, must be on the legs. In most cases, firm to the touch, cold. The skin over the edema is often pale or takes on a bluish tint.	Episodes pressing pain behind the middle of the chest in the past; Constantly high blood pressure; Shortness of breath that appears / worsens with exertion.
Liver	Depending on the severity of the disease, there are 2 options for the manifestation of the disease: Only ascites. It is typical for the initial stages of liver cirrhosis; Common edema. Soft to the touch, the skin above them is not changed (except for the abdomen). Occur with severe organ damage.	The appearance on the abdomen of enlarged and clearly contoured veins. They are figuratively compared to the "head of a jellyfish"; The development of increased bleeding is possible (easy bruising, nosebleeds, etc.); There may be a dull, constant pain, low intensity, in the right hypochondrium.
Kidney	As a rule, edema occurs throughout the body and in the internal organs. The most characteristic location is on the face. They are soft to the touch, the skin above them is not changed.	Often, edema is the only manifestation of the disease that the patient notices.
Thyroid	The development of dense edema throughout the body is characteristic, without skin changes.	Characterized by severe weakness, drowsiness and low performance; If the disease lasts for a long time, the weight increases, the facial expression becomes puffy.
Mesenteric tuberculosis	The accumulation of fluid occurs exclusively in the abdominal cavity.	There are no specific symptoms. Perhaps a prolonged increase in temperature to 37-37.5 ° C, constant weakness and fatigue.

The next stage of diagnosis, after a careful questioning and examination of the patient, is the delivery of tests and instrumental examinations, such as ultrasound, X-ray, etc. In most cases, it is these methods that make it possible to establish the final diagnosis and find out the cause of the development of the disease.

Laboratory and instrumental diagnostics

Regardless of the specificity of the symptoms and the doctor's confidence in a specific diagnosis, a number of studies are conducted for each patient. Why is this necessary? Diseases are often disguised as one another - lupus erythematosus can hide behind the guise of glomerulonephritis or hyperthyroidism "pretend" to be hypertension. There are many such examples, which is why for the treatment of abdominal ascites it is necessary to consult a doctor and undergo all the necessary examinations. This will improve the quality of therapy and the likelihood of recovery.

Appointments for various examinations are written out, depending on the doctor's assumptions. At the moment, there is no universal analysis that could independently determine the cause of fluid accumulation. Certain studies are recommended to evaluate the performance of each system. Which ones are described below.

System under study	Required analyzes	Necessary instrumental examinations
Heart or vessels	Clinical blood test: ESR - an increase in the indicator may indicate an inflammatory disease (endocarditis, myocarditis, pericarditis, systemic diseases, etc.); Norm: less than 10 mm / hour in women less than 15 mm / hour in men Leukocytes - an increase in the number of cells is also a sign inflammatory process; Rate: 4.1-9.0 * 10 9 cells / l Erythrocytes - a decrease in the indicator indicates the presence of anemia. This is a disease that leads to a deficiency of oxygen in the tissues and a more severe course of cardiovascular diseases. Norm: in women: 4.0-5.2 * 10 12 cells / l in men: 4.3-5.6 * 10 12 cells / l Hemoglobin - a decrease in its content is another sign of anemia. Norm: for women: 120-160 g / l in men: 130-180 g / l Blood biochemistry CRP - an increase in the rate is often a sign of infection or systemic disease (lupus, scleroderma, rheumatoid arthritis, etc.). Norm - up to 5 mg / l Cholesterol - total cholesterol, LDL, HDL reflect the state of fat metabolism in the human body. Their enlargement is often a sign of plaque formation on the arterial wall. The norm is less than 5 mmol / l LDL is a "bad" cholesterol, which is the main cause of narrowing of the arteries, the development of coronary artery disease, heart attacks, strokes and other vascular accidents. The norm is less than 3.0 mmol / l HDL is the “healthy” fraction of fats that includes phospholipids and lowers blood cholesterol. A decrease in HDL is a sign of developing atherosclerosis. The norm is more than 1.2 mmol / l Glucose - this indicator allows you to assess the presence / absence of prediabetes and diabetes. Norm - up to 6.1 mmol / l Atrial sodium uretic peptide. This is the most modern and reliable indicator for assessing heart function. Its decrease is observed in diseases that lead to heart failure. Rate: 20-77 pg / ml	Electrocardiography (ECG) is the simplest method to determine the type of heart disease. Taking an ECG takes several minutes and does not require any preparation from the patient; Holter ECG monitoring is a method of recording an electrocardiogram within 24 hours. Used to detect latent rhythm disturbances in a patient. It is carried out as follows: a small device (the size of mobile phone) and the electrodes are connected. The next day, the holter is removed and connected to the computer. Then the doctor analyzes the data obtained; Echocardiography (ultrasound of the heart) is the best research method to determine the increase (hypertrophy and dilatation) of the heart, cardiomyopathies, and inflammatory diseases. The method is less readily available in small towns than ECG, but it is also simple, fast and requires no training.
Liver	Clinical blood test: ESR and leukocytes. An increase in these indicators is often observed in hepatitis of various origins and systemic diseases (including lupus, primary sclerosing cholangitis and others). Blood biochemistry: CRP is a common sign of inflammatory liver diseases (hepatitis) and autoimmune diseases; Cholesterol, LDL, HDL - a decrease in these substances in the blood indicates a decrease in liver function. As a rule, such changes are noted with cirrhosis; Bilirubin - by the amount of this substance, one can judge the state of the liver. An increase in total bilirubin and its direct (bound) fraction is a sign of liver destruction and hepatitis, Wilson-Konovalov's disease, Reye's syndrome. An increase in indirect bilirubin is a sign of developing cirrhosis of the liver. Norm: total bilirubin - less than 17 μmol / l direct fraction: 1.7-5.1 μmol / l indirect fraction: 3.4-12 μmol / l Transaminases (ALT, AST) - a fold increase in this indicator is almost always a sign of liver damage. Norm: AST - up to 45 U / l ALT - up to 38 U / l Total protein is another indicator of liver function. Its decrease is usually a sign of cirrhosis. Norm: 65-87 g / l Analysis for ceruloplasmin - this study is necessary for patients in whom the doctor suspects Wilson-Konovalov disease. In the presence of this disease, the level of ceruloplasmin will be reduced. Norm: 20-60 mg / dl General urine analysis Density of urine - a decrease in density is often noted with severe damage to the kidney tissue. Norm: 1015-1025 g / l Protein, glucose - the appearance of these substances in the urine indicates damage to the renal filter. Norm: protein in urine - less than 0.033 g / l glucose in urine - absent Blood cells - in most cases, the appearance of erythrocytes or leukocytes in the urine is a sign of organ damage. This is typical for glomerulonephritis, TIN, diabetic or lupus kidney, and a number of other pathologies. Norm: erythrocytes - up to 2 in the field of view leukocytes - up to 5 in the field of view Determination of daily protein in urine is one of the most informative analyzes that allows you to reliably assess the loss of protein by the body and find out possible reason edema. Norm: in the absence of heavy physical activity - up to 80 mg / day after intense exercise - up to 240 mg / day The Nechiporenko test is one of the simplest and most effective methods for determining glomerulonephritis. To perform this test, it is enough to pass urine for analysis once (in the morning). The result will usually be ready in 1-2 days. Norm: leukocytes - up to 2000/1 ml erythrocytes - up to 1000/1 ml cylinders - up to 20/1 ml Zimnitsky's test is a complex but informative test that allows you to assess the condition of the renal tissues. The collection of the analysis takes place within 24 hours - every three hours the patient urinates into a container, after which all 8 containers are delivered to the laboratory.	Ultrasound is a rather mediocre method for assessing the condition of an organ. Ultrasound examination allows you to determine the change in the size of the organ, the presence of some stones, effusion in the kidney capsule and a number of other parameters. Ultrasound cannot assess the condition of the renal filter and, accordingly, it is impossible to confirm the presence of glomerulonephritis, amyloidosis, TIN, diabetic nephropathy and a number of other diseases. Doppler sonography is a method for assessing the patency of the renal arteries and, accordingly, the amount of nutrients entering the tissues; CT scan - the best way detection of stones and tumors in this organ; A kidney biopsy is the only way to diagnose glomerulonephritis. Also used to confirm the presence of cancer or other cancers.
Thyroid	Analysis for hormones: TSH - this hormone allows you to determine how much the function of the thyroid gland is reduced. As a rule, the more thyroid-stimulating hormone the brain produces, the worse the thyroid gland performs its functions. Norm: 0.4-4.2 μIU / ml T 3, T 4 - these hormones are produced by the thyroid gland, and also allow you to determine its condition. The presence of the disease is evidenced by a decrease in the number of T 3, T 4. Norm T 3: 70.3-204.5 ng / dl (1.08-3.14 nmol / l) Norm T 4: 55-138 nmol / l	Doppler ultrasound - used to assess the size of the gland, its structure and consistency. Other methods instrumental diagnostics are used quite rarely. If necessary, the doctor may also recommend a scintigraphic examination, computed tomography or a biopsy.
Mesenteric tuberculosis	Clinical blood test: ESR - typical excess of the norm. Blood biochemistry CRP - there is an increase in the indicator. Diaskin test is the most informative of the laboratory tests for tuberculosis. It is an advanced and highly specific mantu assay. In the forearm, a special drug is injected strictly intradermally. After that, a small bubble is formed, the state of which is assessed after 3 days. The presence of tuberculosis is evidenced by redness and an increase in the bubble more than 14 mm in diameter.	Plain X-ray of the lungs and abdomen; CT scan; Laparocentesis is a method of taking intra-abdominal fluid to determine its composition; Puncture of lymph nodes.
Carcinomatosis of the peritoneum	Laboratory diagnostics has low efficiency	In most cases, the diagnosis is made after a laparoscopic examination - examination of the abdominal cavity using special surgical instruments. Laparocentesis can also be helpful.
Lymphostasis

Treatment

Measures to eliminate ascites can be conditionally divided into 2 groups. The first is aimed at removing fluid from the abdominal cavity with the help of medicines and small surgical interventions. The second - for the treatment of the disease that caused ascites. This process is usually much more complex and time consuming.

In some cases (for example, with cirrhosis, glomerulonephritis, cardiomyopathy, etc.), it is impossible to completely get rid of the disease, but its course can be controlled. How to do it? Individual therapy, if necessary, is selected by the attending physician. We will describe general principles therapy of diseases.

Removing fluid from the abdomen

At the moment, there are recommendations of national associations of doctors, which doctors adhere to. They include a specific algorithm through which ascites can be effectively and safely removed. This algorithm includes the following provisions:

Hospitalization. Treatment should be carried out in a hospital for 4 groups of patients:

• With the onset of the disease;
• With the ineffectiveness of therapy at home;
• With a large volume of fluid in the abdomen;
• With the development of complications (impaired consciousness, decreased kidney function, pressure drop, etc.)

Mode. During the first week, it is important to stay in bed, since in a horizontal position the excretion of excess water and sodium improves, blood flow to the kidneys is facilitated;

Nutrition. It is necessary to limit the intake of salt (sodium chloride), since 1 g of sodium attracts 250-300 ml of water. The more it enters the bloodstream, the more water is retained in the body. For the duration of the preservation of ascites, it is not recommended to salt food. After removing the liquid, it is allowed to use salt during cooking, but you should not additionally add salt to the food;

Water regime. In the absence of an elevated temperature (more than 37.5 ° C), the consumption of drinks should be reduced to 1 liter / day;

Diuretic medicines. In most cases, it is necessary to start eliminating fluid with these drugs. There are two main types of diuretics that are used for ascites. The choice between them is made by the attending physician, depending on the cause of the disease. This is a very important nuance, since the appointment of the wrong medication can lead to severe heart failure, human poisoning and death. The most commonly used drugs are listed below:

• Loop diuretics: Furosemide, Torasemide. These drugs are strong enough to remove large amounts of fluid from the body. However, together with water, they remove the vital electrolytes - potassium and sodium. Therefore, in diseases that occur with a deficiency of these ions (for example, severe liver failure), loop diuretics are used with great caution;
• Potassium-sparing diuretics: Spironolactone, Eplerenone, Canreonat. This group acts more delicately and does not lead to significant losses of liquid and ions. On the contrary, they retain potassium in the body. Therefore, these diuretics are contraindicated in pregnancy and in diseases with impaired electrolyte secretion (for example, renal failure).

Laparocentesis. Puncture of the abdominal cavity with ascites is performed only in 2 cases:

• When a large volume of fluid accumulates in the abdominal cavity. This condition is called "tense ascites". If some of the water is not removed from the abdomen and the intra-abdominal pressure is not reduced, the patient may experience compression of internal organs, disrupt the functioning of the lungs and heart;
• With the ineffectiveness of pharmacological preparations.

In most cases, laparocentesis takes a short time - about 10 minutes. At one time, the surgeon can remove up to 2-4 liters. It is impossible to eliminate all ascites at once, as this can lead to a drop in pressure and cause a shock state in the patient. Immediately after the procedure, an intravenous infusion of albumin is necessary. This solution will help keep water within the bloodstream and prevent fluid re-accumulation in the abdomen.

Treating the cause of ascites

In addition to removing excess water from the body, it is also necessary to prevent re-accumulation of water. To do this, it is necessary to conduct a full therapy of the underlying disease. Depending on the affected organ, the patient is referred to a doctor of a certain profile: gastroenterologist, cardiologist, nephrologist, oncologist, phthisiatrician, etc. Only the attending doctor can take into account all the necessary nuances and find the best solution. We can only describe the general principles that must be adhered to during therapy.

Liver

In 80% of cases, ascites occurs due to cirrhosis of the liver, which developed against the background of viral hepatitis B, C, or a combination of both. Since these diseases do not manifest themselves for a long time, most of the liver cells have time to collapse. In its place, connective tissue grows, which compresses the vena cava and facilitates the exit of fluid through its walls. Other illnesses rarely lead to ascites.

The greatest value in the treatment of liver diseases is the elimination of harmful factors:

• If the patient has viral hepatitis, special antiviral therapy is necessary;
• With the development of autoimmune hepatitis, biliary cirrhosis or sclerosing cholangitis, glucocorticosteroids or immunosuppressants are used;
• In the presence of Budd-Chiari syndrome, it is necessary to restore the patency of the liver vessels, with the help of medications (fibrinolytics and anticoagulants) or surgery.

In addition to specific treatment, such patients are necessarily prescribed hepatoprotectors that protect the remaining liver cells. These include:

• Ursodeoxycholic acid preparations: Ursosan, Ursofalk, Ursodez, Exhol;
• Phospholipids: Essentiale Forte, Rezalut, Essliver, Antraliv.

To determine the most suitable therapy regimen for you, you need to contact a gastroenterologist. Only a doctor can choose the most suitable drugs and correctly treat the disease. Self-medication is dangerous - it can lead not only to a deterioration in well-being, but also significantly reduce life expectancy.

A heart

In the treatment of heart disease, there are several therapies that can help eliminate symptoms of the disease, improve the condition of the heart muscle, and increase a person's life expectancy. These include the fight against high blood pressure and excessive amounts of blood cholesterol, prevention of blood clots in arrhythmias and protection of the heart from adverse factors.

To accomplish all these tasks, an integrated approach and joint work of the patient and the doctor is required. Typically, treatment includes the following components:

Therapy component	a brief description of	Purpose of the recommendations
Diet	Limit the intake of fatty foods - you must refuse to cook food in butter / vegetable oil; reduce the consumption of fatty meats; avoid a lot of sour cream, mayonnaise, etc. Limit consumption of rapidly digestible carbohydrates - any flour products, chocolate, sweets and other similar products; Reduce salt intake - food should not be salted. It is not prohibited to use this seasoning in cooking.	Reduce the amount of "harmful" fats in the body and prevent blockage of the arteries that supply blood to the organs; Reduce blood pressure and the amount of "excess" fluid in the bloodstream; Prevent the development of diabetes and pre-diabetes, which aggravate the course of heart disease.
Lifestyle change	Refusal to drink alcohol; Stopping smoking and other drug use; Leading an active lifestyle - walking regularly at a comfortable pace (1-2 km / day), going to the pool, daily gymnastics and similar activities; Avoid stress and excessive physical exertion (if possible).	Prevention of vascular damage by toxic substances and stress factors; Fighting overweight and, accordingly, increased content cholesterol.
ACE inhibitors / angiotensin receptor blockers (ARBs)	ACE inhibitors: Enalapril; Captopril; Lisinopril; Pirindopril; Ramipril. ARBs: Valsartan; Irbersartan; Losartan; Candesartan; Telmisartan.	These drugs have two very important effects: They gently reduce blood pressure, preventing rupture and injury of arterial vessels; Only ACE inhibitors and ARBs have a protective effect on the heart. In the course of numerous studies, it has been proven that they increase the life expectancy of patients and prevent the development of complications: heart attacks, strokes, severe coronary artery disease, etc.
Other remedies for pressure	Calcium channel blockers: Nifedipine; Amlodipine; Diltiazem; Verapamil. Diuretics: Hydrochlorothiazide Acetazolamide; Spironolactone Torasemide. Beta blockers: Metoprolol; Bisoprolol; Carvedilol.	In severe hypertension, the use of a single drug (ARB or ACE inhibitor) is often insufficient. Therefore, they are combined with one of the medicines listed in this group.
Antiarrhythmic drugs	Sodium channel blockers: Lidocaine; Propafenone; Etmozin. Potassium channel blockers: Amiodarone; Sotalol; Bretilius. Calcium channel blockers: Verapamil; Diltiazem. Beta blockers (listed above)	The fight against rhythm disturbances is one of the most important components of therapy. It is the severe arrhythmias that become frequent reasons sudden cardiac death, irreversible myocardial damage and coronary artery disease.
Means that reduce the amount of "blood fats"	Statins are the drugs of choice when cholesterol and LDL are increased: Atorvastatin; Rosuvastatin; Simvastatin; Fluvastatin. Fenofibrate; Ciprofibrate; Bezafibrat.	These drugs are necessary for the prevention / treatment of atherosclerosis - the process of buildup of plaque on the walls of arteries. By closing the lumen of the vessels, the plaque disrupts the nutrition of vital organs: kidneys, heart, brain and others.
Medicines that prevent blood clotting	Necessarily prescribed after the transferred vascular accidents (myocardial infarction, ischemic stroke, transient ischemic attacks) or with arrhythmias. After vascular complications, the drugs of choice are combinations of acetylsalicylic acid with magnesium (CardioMagnyl, ThromboMag, Trombital); For the treatment of arrhythmias, Warfarin, Dabigatran, Rivaroxaban, Apixaban are used.	Used to prevent blood clots from forming, which can lead to blockage of the pulmonary arteries and death.

It should be noted once again that the final treatment regimen is determined by the attending doctor. He can correct it at his discretion, depending on the type and severity of the pathology, the state of the patient's body. However, the general principles of treatment to be followed have been described above.

Kidney

Treating chronic kidney disease that can cause ascites is almost always a complex and lengthy process. Depending on the specific type of disease, the question of the need to prescribe hormones-glucocorticosteroids, surgery to correct defects, permanent hemodialysis or other therapeutic measures is being decided. However, the general principles of therapy for these pathologies are the same. These include the following guidelines:

1. Salt restriction. Since the elimination of electrolytes is impaired when renal functions are impaired, taking even a small amount of salt can lead to fluid retention and an increase in blood pressure... The maximum allowable dose for these diseases is no more than 1 g / day. This amount can be achieved by consuming fresh food and unsalted drinks;
2. Quitting alcohol and smoking;
3. Maintaining adequate urine output. With chronic damage to an organ, toxic substances begin to accumulate in a person's blood. They lead to sleep disorders, constant weakness, decreased performance and poor health. Therefore, it is important to regularly use diuretics to improve the elimination of "toxins";
4. Regular monitoring of toxic substances in the blood. This exercise helps prevent the development of severe complications such as brain damage (encephalopathy);
5. Reduction of the inflammatory process. When autoimmune diseases, such as glomerulonephritis, lupus erythematosus, rheumatoid arthritis, it is necessary to reduce the body's immune functions. Due to this, the kidney tissue will be damaged much less. As a rule, hormones-glucocorticosteroids (Prednisolone, Dexamethasone) or immunosuppressants (Sulfasalazine, Methotrexate) are used for this purpose;
6. Taking nephroprotective drugs. ACE inhibitors and ARBs, in addition to protecting the heart, have similar effects on the kidneys. By improving the condition of their microvessels, they prevent further damage to them and distance hemodialysis from the patient.

Most diseases that can cause the accumulation of fluid in the abdominal cavity are chronic and practically incurable. Despite this, a person can control their course with adequate treatment. The recommendations listed above are one component of such treatment that can slow down kidney damage and increase life expectancy.

FAQ

Question:
Is it possible to cure abdominal ascites with oncology?

This is a difficult question. Removing the liquid, in most cases, is not difficult. This procedure is carried out according to the principles described above. However, it is much more difficult to eliminate a malignant tumor. At stages 1-2, it is possible to carry out surgical treatment followed by a course of special therapy. In advanced stages, the only way out is chemotherapy, which is not always effective.

Question:
Is it dangerous to use hormones and immunosuppressants in the treatment of kidney disease?

These drugs have side effects in the form of a decrease in immunity. This makes it easier for the infection to enter the body. However, without the use of these medicines, the destruction of a vital organ can occur, which will inevitably end in death. The benefits of hormones and immunosuppressants are greater than the risks.

Question:
How often does fluid accumulate in the abdomen due to blockage of the lymph vessels?

Question:
Are there folk remedies for the treatment of abdominal ascites?

Definitely not. Ascites is a sign of an advanced disease of one of the internal organs. Anyone who suspects this pathology is strongly recommended to go to the hospital to see a therapist.

Question:
Are there any treatment considerations for hypothyroidism?

Removal of fluid from the abdomen is carried out according to the principles described above. Along with these activities, doctors are trying to support the function of the thyroid gland with the help of thyroxin preparations.

Question:
What is the prognosis for life with ascites?

Each case is individual and depends on the specific disease. Therefore, only your doctor can make an adequate prognosis.

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 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 an oncological disease, then the probability 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 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 restricts the respiratory function of the lungs, negatively affects the work of the heart, blood circulation.

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

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

Causes of occurrence

In the abdominal cavity of a 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 rapid capture by cancer cells of adjacent tissues.
• Abundant arrangement 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 in 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 usually develops 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 the vertical position it hangs down, and in the horizontal position it spreads out on the sides. Stretching the skin of the abdominal wall reveals the network of blood vessels and the protruding navel.

The 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 nevertheless, with ascites, which arises as a complication of a malignant lesion, in people those symptoms that occur with the primary focus come to the fore. 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 severe pains may appear, perceived by the patient as an attack of appendicitis. The development of ascites in ovarian cancer should not be overlooked, the earlier treatment begins, the more chances for 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 location 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 appointment 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 disruption 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 and reduce the likelihood of further excessive exudate production.

It is 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, in 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 bandage 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 introduction 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

From diuretics, oncological patients with developing ascites are prescribed Diakarb, 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 can help reduce fluid retention.

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 foods rich in potassium 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 impairs the health 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. Worsens the prognosis of the course of ascites elderly age patient, presence of a large number, tendency to hypotension, renal failure.

Video broadcast about abdominal ascites:

The accumulation of free fluid in the abdominal cavity occurs as a result of an inflammatory reaction, impaired lymph flow 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 - a study 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 of the 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 reserving, diagnosing a pathological condition by ultrasound and effective methods of its treatment.

Why does free fluid accumulate in the abdominal cavity?

Ascites develops due to 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 be provoked 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 during the formation of tumor-like formations in the mammary glands, ovaries, digestive organs, serous membranes of the 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 of formation of dropsy is the seepage of fluid from the main lymphatic ducts, blood vessels and organ tissues into the abdominal cavity.

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 abdomen and body weight;
• deterioration in general health;
• a feeling of fullness in the abdominal cavity;
• swelling of the lower limbs and scrotal tissues (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 a ultrasound procedure the abdominal cavity showed the presence of excess moisture, the attending physician must accurately establish the root cause of the pathological condition. Pumping out the accumulated transudate is not an effective method of treating ascites.

Preparation for ultrasound and the course of its conduct

This study does not have any contraindications or restrictions, in urgent 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 recommended 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 do 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 can determine the most likely areas of accumulation of free fluid in the abdominal cavity.

That is why qualified specialists inspect the following anatomical areas:

• The upper "floor" of the peritoneum, which is located under the diaphragm. The spaces located under the liver and formed by the main department are of particular diagnostic value. 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, an effusion can accumulate, flowing from the lateral canals.

The physical characteristics of moisture accumulated in the peritoneum for any reason do not allow the ultrasound wave to be reflected, this phenomenon makes the diagnostic procedure as informative as possible. The presence of effusion in the examined anatomical spaces creates a dark moving focus on the monitor of the apparatus. In the absence of free fluid, 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 it is not possible to detect a transudate, indirect signs may indicate its presence:

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

Types of abdominal dropsy by ultrasound

International classification 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 the 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 diagnostic forecasts, there is ascites, which is amenable to drug therapy, and a stable pathological condition (its reoccurrence or not amenable to treatment).

What is done after confirming the pathology with ultrasound?

The course of therapeutic measures depends on what disease caused the accumulation of excess moisture in the peritoneum. To accurately diagnose 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, allowing to assess their condition;
• MRI or CT scan of the abdomen;
• hepatoscintigraphy - modern technique liver studies using a gamma camera, which allows visualizing the organ;
• diagnostic laparoscopy with medical puncture of 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.

Abdominal dropsy or ascites is a buildup of large amounts of fluid in the abdomen. The belly swells to a huge size, the navel protrudes outward and stretch marks diverge from it. The skin on the abdomen is so stretched that the capillaries shine through it.

Dropsy is not an independent disease, it occurs against the background of diseases of the internal organs. Ascites is dangerous because it puts pressure on the abdominal organs and disrupts their functioning.

Fluid builds up in the abdomen for several reasons:

• thrombosis of the hepatic and portal veins due to cirrhosis of the liver causes pressure and the plasma of internal organs begins to seep into the abdominal cavity and accumulate;
• persistent liver inflammation due to alcoholic hepatitis, which is caused by intoxication;
• with heart failure, edema occurs, which is the reason for the release of plasma and accumulation in the abdomen;
• alimentary dystrophy;
• imbalance of salt and water in the body;
• pathologies in which the outflow of lymph in the chest is disturbed;
• malignant tumors with metastases;
• tuberculous process of the abdominal cavity;
• diseases of the pancreas.

Dropsy can be caused by several reasons at once, then the patient's condition is classified as very serious.

The development of dropsy in children

Dropsy of the abdominal cavity can occur in newborns due to congenital, hereditary and acquired pathologies.

Among the congenital, there are three:

• incompatibility of the child's and mother's rhesus;
• swelling due to internal blood loss;
• nephrotic syndrome.

Hereditary pathology can be talked about when it comes to exudative enteropathy. Also, edema could be provoked by damage to the bile ducts and disorders of the digestive system, as well as the development of a severe form of dystrophy. In adolescents, the reasons for the development of dropsy are the same as in adults.

Signs of dropsy of the abdomen are pronounced:

• the abdomen increases to the size of an inflated ball gradually or rapidly;
• the abdomen strongly protrudes or hangs down, spreads when lying down;
• strongly dilated veins around the navel are visible.

According to the symptoms of abdominal dropsy, it is divided into types:

• initial stage - accumulation of liquid in an amount not exceeding 1.5 liters;
• moderate ascites - swelling of the legs and chest, accompanied by shortness of breath, a feeling of heaviness in the abdomen, heartburn and constipation;
• massive - the volume of fluid exceeds 5 liters, a dangerous condition for a person, characterized by heart failure, respiratory failure, the risk of developing peritonitis, as a rule, ends in death.

The composition of the abdominal fluid is divided into:

• sterile, in the absence of bacteria;
• an infectious disease if bacteria are found.

Also, dropsy of the abdomen is divided according to the possibility of cure:

• ascites of the abdominal cavity, which can be treated with drugs;
• persistent dropsy, rather repeated, which cannot be treated with medication.

Signs by which you can suspect ascites:

• respiratory failure;
• enlargement of the abdomen;
• swelling of the legs;
• constant belching and heartburn;
• pain in the abdomen and a feeling of fullness;
• in men, swelling of the scrotum.

If the dropsy is caused by thrombosis of the hepatic veins, then the veins are clearly visible in front and on the side of the abdomen. If thrombosis occurs in the vessels that are located under the liver, then the patient will suffer from vomiting, nausea and yellowness of the sclera and skin.

If we are talking about a tuberculous process, arrhythmia is added to the listed symptoms, general weakness, the patient gets tired quickly, he is tormented by a headache.

Diagnostics

To diagnose dropsy of the abdomen, ultrasound of the abdominal cavity, veins and vessels of the abdomen is used. Ultrasound is mainly performed to identify oncology and to determine the nature of the dropsy itself. If the dropsy is treatable, the doctor will prescribe a course of drug therapy.

If oncology is found, the patient can be operated on. A blood test from a vein can confirm liver cirrhosis or cancer that causes fluid to build up.

Angiography is performed to diagnose blood vessels. X-ray of the lungs can determine the stage of tuberculosis and the presence of edema. Also spend laboratory research abdominal fluid.

First of all, a diet is prescribed that excludes:

• the use of spicy vegetables - radishes, garlic, onions, radishes;
• sorrel, cabbage, heavy for digestion;
• citrus fruit;
• fatty and heavy foods;
• alcohol, carbonated drinks, including beer;
• salt and pickles;
• lean meats and fish.

The diet should be aimed at weight loss, at least 2 kg per week. If the diet does not work, then the patient is hospitalized.

In a hospital setting, diuretics are used, and the level of electrolytes in the blood is controlled. In a severe case, an operation is prescribed.

Modern medicine offers several options:

• establish a peritoneovenous shunt;
• make a puncture of the abdominal wall to extract the transudate;
• do a liver transplant.

Most often, a puncture is made and the liquid is pumped out, this procedure does not require general anesthesia... Liver transplant is done for different stages of oncology.

Liquid is not pumped out if infectious diseasesAlso, the procedure has a number of contraindications.

There are some home remedies for ascites:

• pumpkin porridge and pumpkin pieces baked in the oven;
• a decoction of parsley is used as a diuretic;
• a decoction of bean pods is also used as a diuretic;

As a prevention of dropsy of the abdomen, there should be timely treatment of diseases of the internal organs. When edema appears, you must give up excess fluid, salt and coffee.

It is necessary to consult a doctor if you suspect the development of ascites and not to self-medicate, so as not to aggravate the condition.