The most common (80% of cases) occurs against a background ascites of cirrhosis, which reached the final stage of decompensation. This stage is characterized by the depletion of resources liver, and serious violations of the abdominal hepatic circulation, i.e. the appearance of favorable conditions for storage of liquid.
What it is?
Ascites - this accumulation of fluid in the abdominal cavity, which is accompanied by a progressive increase in the abdomen and the growth of the patient's weight. This liquid is usually non-inflammatory in nature, that there is a transudate. Its amount may vary widely - from several hundred milliliters to 15-20 liters.
Causes of
The causes of the disease are ascites unexpected nature, the most common among them are presented below. It:
- malignant tumors and metastases;
- cirrhosis of the liver and an increase in blood pressure in the portal system;
- thrombosis (narrowing liver, inferior vena cava and portal vein thrombosis);
- acute and chronic inflammatory diseases of kidneys;
- nephrotic cider (urine output starts protein);
- chronic renal insufficiency;
- inflammation of the serous membrane of the heart;
- acute and chronic heart failure;
- certain infectious and inflammatory bowel disease for which there is diarrhea, and loss of protein;
- inflammation of the pancreas;
- tuberculosis;
- pseudomyxoma (mucus accumulation);
- anasrka.
Said disease is a complication of cirrhosis and beyond. In the body, it progresses gradually, first time does not manifest itself. Ascites, peritoneal cavity difficult amenable to successful treatment. However healing occurs if eliminate main pathogenic factor.
symptoms of ascites
Formation of abdominal ascites in most patients for cancer occurs gradually over a few weeks or even months. Therefore, the first signs of severe complications are ignored.
Clinically ascites begins to manifest itself after abdominal accumulate sufficiently large quantity of liquid, shown is a complication:
- Feeling of fullness in the abdomen.
- Different in nature and duration of abdominal pain.
- Belching and heartburn.
- Nausea.
Visually, you can draw attention to the gradually growing belly in a vertical position, it hangs down and spread out horizontally on the sides. abdominal skin stretch allows to see a network of blood vessels and blubber navel.
Pressure on the chest causes shortness of breath and disruption of the heart. When ascites man is hard to bend over to fasten shoes to wear pants.
What is ascites: photo
The photo below shows how the disease manifests itself in humans.
stage
Depending on the amount of exudate accumulated ascites is isolated three stages:
| transitory | fluid in the abdominal cavity is not more than 400 ml. In this step can only be bloating. |
| Moderate | exhibited when exudate in the abdominal cavity is not greater than 5 liters. At this stage complication manifested clinical symptoms of disorders of the digestive organs, shortness of breath. In the case of non-treatment of ascites may develop peritonitis, respiratory and cardiac failure. |
| Tense | characterized by the accumulation of up to 20 liters of liquid. The patient's condition serious, greatly disrupted the vital organs. |
Diagnostics
abdominal dropsy can be diagnosed by a doctor even without the use of special equipment - just palpate the abdomen of the patient. If the doctor finds probing stupidity abdominal side, the middle will show thympanitis, the patient has ascites.
For a more detailed diagnostics is needed to conduct ultrasound to the peritoneal cavity, to investigate liver and peritoneum make a puncture (paracentesis). Taking fluid for analysis reveals disease stage and to determine its treatment. Paracentesis is performed to determine the causes of the disease. Also paracentesis can be made in case of difficulty in breathing and the occurrence of pain.
In addition to these methods of diagnosis, the patient must pass tests of urine, blood, and go study the immunological type. On how much information the doctor will received analyzes the possibility of appointing additional independent analyzes and tests.
Abdominal ascites Treatment
Abdominal ascites, developing as a complication of cancer, to be treated in conjunction with the primary disease.
- It is also important to begin the removal of excess of excess fluid in the first two weeks of its formation, as the delay in treatment leads to the development of complications mass. Excess liquid may be removed by puncturing it and pumping - laparocentesis by receiving diuretics.
- Compliance with special diets can help reduce abdominal pressure, reduce the likelihood of further production of excessive exudate.
Chemotherapy is only effective if the ascites is precipitated by bowel cancer. In gastric cancer, ovarian and uterine use of chemotherapy does not express a positive result.
medication
The major drugs helps to remove excess fluid from the body, are diuretics. Due to their reception it is possible to achieve the transition from the abdominal cavity of excess fluid in the blood stream, which helps to reduce the symptoms of ascites.
- To start with patients prescribed the smallest dose of diuretics to minimize the risk of side effects. An important principle of treatment of diuretics - a slow increase in urine output, which will not lead to a significant loss of potassium and other important metabolites. Most often recommend taking aldactone drugs Veroshpiron, triamterene, amiloride. Simultaneously administered potassium supplements. Simultaneously, the treatment regimen administered gepatoprotektory.
- However, doctors perform daily monitoring of patient urine output, and the ineffectiveness of the treatment dose drugs increase or replace them with a more powerful means of, for example, or Triampur Dihlotiazid.
Furthermore diuretics patients prescribed means to strengthen the vascular wall (vitamin C, vitamin P, Diosmin), drugs that prevent the exit of fluid outside the vascular bed (Reopoligljukin). Improves Hepatic cell exchange administering proteinaceous drugs. Most often used for this purpose a concentrated plasma or albumin solution at 20% concentration.
Antibacterial drugs are prescribed in case of ascites is a bacterial nature.
Abdominal paracentesis
When ascites abdominal paracentesis is a surgical manipulation, whereby liquid is removed from the abdominal puncture. At one time should not be pumped out more than 4 liters of fluid, as it threatens to collapse development.
The more often a puncture is performed with ascites, the higher the risk of inflammation of the peritoneum. In addition, it increases the likelihood of formation of adhesions and complications from procedures carried out. Therefore, when setting massive ascites preferred catheter.
The indications for paracentesis is a tense and refractory ascites. The fluid may be pumped through the catheter, or it simply flows freely to the dishes prepared in advance, after the installation of the trocar into the abdominal cavity.
Peritoneovenoznoe bypass (shunt Levin)
Sometimes is used to treat refractory ascites i.e. one that does not give medication and quickly returns after a puncture. The operation is to increase blood volume by continuously Incoming fluid from the peritoneal cavity into the general blood system.
Levine shunt - is a long plastic tube is installed in the abdominal cavity, reaching the pelvic floor. Next, the shunt valve and connected to silicone tube which extends subcutaneously in the neck for subsequent connection to the internal jugular vein and superior vena. The valve is opened by the resultant force of the diaphragm displacement and increase intra-abdominal pressure. Thus, there is unimpeded fluid flow in the superior vena cava.
Diet
It includes reducing the fluid consumption as well as salts for the reason that it holds in the body fluid. Doctors recommend a diet of Avicenna. Such a diet with ascites provides virtually complete rejection of fatty foods, consumption of nuts in large quantities, the rejection of fresh fruit to dry.
Also, liquid food (soup, soup) should be replaced broth with supplements as celery, parsley, fennel. Diet for ascites does not regulate how much meat should consume sick, but all meat should be lean types (chicken, turkey, rabbit).
How many people live with ascites?
The life of people diagnosed with ascites varies widely, depending on many factors. Life expectancy of patients with ascites due to:
- The time of the start of treatment. If ascites is diagnosed in the early stages of development, when the vital organs function is not impaired (or slightly violated), eliminating the underlying disease can lead to complete cure of the patient. At the same time, long-term progressive ascites may occur loss of many organ systems (respiratory, circulatory, excretory), resulting in death of the patient.
- Severity of ascites. Transient (bland) ascites does not represent an immediate threat to a patient's life, while tense ascites, accompanied by the accumulation abdominal tens of liters of liquid may lead to acute cardiac or respiratory failure and patient death within hours or days.
- Underlying disease. This is perhaps the main factor determining the survival of patients with ascites. The fact that even during the most modern treatment of a favorable outcome is unlikely, if the patient has a deficiency of several organs. For example, with decompensated cirrhosis (when the body is almost completely disrupted function) patient chances survival 5 years after the diagnosis is less than 20%, and with decompensated heart failure - less than 10%. More favorable prognosis in patients with chronic renal failure as well as patients on hemodialysis, and keep all doctor's prescription, can live for decades or more.
The presence of ascites substantially weights for the basic disease and its prognosis worsens. Complications of ascites may be a spontaneous bacterial peritonitis, hepatic encephalopathy, hepatorenal syndrome, bleeding.
