Ascites ( other Greek: ἀσκίτης - dropsy, from ἀσκός - fur for storing fluid), abdominal dropsy - accumulation of free fluid in the abdominal cavity . Its amount can reach 25 liters. Ascites is a consequence of cirrhosis of the liver in 75%; malignant neoplasms - in 10%; heart failure in 5% of cases. In the clinical picture of patients, an increase in the volume of the abdomen and a progressive increase in weight are noted.
| Ascites | |
|---|---|
 A patient with severe ascites due to cirrhosis. | |
| ICD-10 | R 18. |
| ICD-9 | 789.5 |
| Diseasesdb | 943 |
| Medlineplus | |
| eMedicine | ped / 2927 med / 173 |
| Mesh | D001201 |
Causes of ascites
Ascites can be a manifestation of general circulatory disorders in heart disease , formed as a result of stagnation of blood in the abdominal cavity due to the difficulty of its outflow, as well as due to several other factors.
The main pathogenetic mechanisms:
- Blood stasis in a large circle of blood circulation with right ventricular heart failure ;
- Portal hypertension ;
- Peritoneal carcinomatosis during eviction of cancer cells of malignant tumors of the abdominal cavity into the peritoneal cavity;
- Local lymphostasis with filariasis of lymphatic vessels collecting lymph from the abdominal organs, or cancer metastases in regional lymph nodes;
- Hypoproteinemic edema during fasting, kidney disease;
- Exudation into the abdominal cavity with peritonitis of various etiologies, for example, with tuberculosis
and a number of others that are rare.
Ascites Classification
Ascites is classified according to the amount of fluid, the presence of ascitic fluid infection, and the response to medication.
- By the amount of fluid in the abdominal cavity:
- A small amount of fluid.
- Moderate amount of fluid.
- Significant amount of fluid (intense, massive ascites).
- By infection of the contents:
- Sterile contents.
- Infected Content
- Spontaneous bacterial peritonitis.
- According to the response to drug therapy:
- Ascites, amenable to drug therapy.
- Refractory ascites, which cannot be eliminated, or whose early relapse cannot be adequately prevented by treatment.
Signs of ascites
With large ascites, the abdomen is evenly enlarged, swollen, his skin is taut, shiny; in case of portal hypertension, ascites can be combined with expansion and tortuosity of the saphenous veins of the anterior abdominal wall (“jellyfish head”). Often there is a protrusion of the navel due to a significant increase in intra-abdominal pressure and the development of a hernia of the umbilical ring . When an insignificant amount of fluid accumulates in the horizontal position of the patient, the umbilical region is flattened and the flanks of the abdomen protrude (“frog stomach”). To confirm the diagnosis, imaging (x-ray, ultrasound) research methods are used.
The most common complication of ascites is spontaneous bacterial peritonitis . It occurs with infection of ascitic fluid, which in 90% of cases occurs spontaneously. Patients have abdominal pain , body temperature rises.
Pathogenesis
The central place in the pathogenesis of ascites is assigned to functional liver failure, impaired water-salt and protein metabolism, as well as damage to the vascular system of the peritoneum and its mesothelial cover. A large accumulation of peritoneal fluid in itself complicates the work of the circulatory system, worsens the conditions for the motor activity of the stomach and intestines, and limits the movement of the diaphragm. The immobilization of a large amount of fluid containing protein and salt is accompanied by metabolic disorders.
Pathological changes
In the peritoneal cavity, a huge amount of yellowish, rarely reddish fluid accumulates, which contains few uniform blood elements, relatively little protein. Along with the presence of ascites, lesions of the liver, heart, kidneys and other organs are noted. [one]
Current
The course of ascites is chronic, severe, the disease lasts for months. With the appearance of jaundice and edema, the outcome of the disease is unfavorable. [one]
Treatment
Elimination of the underlying disease. To alleviate the condition of the patient, a salt-free diet, diuretics are prescribed. Patients may undergo therapeutic laparocentesis , surgical procedures are performed.
Notes
- ↑ 1 2 Domrachev Georgy Vladimirovich. Pathology and therapy of internal non-communicable diseases of farm animals. - M. , 1960 .-- 504 p.