Antipyretics for children are prescribed by a pediatrician. But there are emergency situations for fever when the child needs to be given medicine immediately. Then the parents take responsibility and use antipyretic drugs. What is allowed to give to infants? How can you bring down the temperature in older children? What medicines are the safest?
Ascites is a relatively common complication of various diseases internal organs. In this case, the liquid in abdominal cavity can be transudative and exudative. In the first case, it accumulates due to impaired blood circulation and lymph flow; in the second, it contains a large number of leukocytes and protein compounds due to the development of acute inflammatory processes.
Causes of fluid accumulation in the abdominal cavity
About 80% of all ascites are consequences of progressive liver cirrhosis. In the later stages of this disease, severe disruption of blood flow and stagnation of biological fluid occurs.
In another 10% of cases, fluid in the abdominal cavity is diagnosed due to oncology. As a rule, ascites accompanies ovarian cancer and is considered a very threatening symptom. Filling of the space between the digestive organs with lymph or effusion usually indicates a severe course of the disease and the proximity of death. The problem can also be a sign of such tumors:
- primary mesothelioma;
- lymphoma;
- secondary carcinomatosis;
- metastases at the porta hepatis;
- leukemia;
- pseudomyxoma;
- carcinomatosis.
Approximately 5% of ascites are symptoms of cardiovascular pathologies:
- circulatory decompensation;
- heart defects;
- constrictive pericarditis;
- chronic illnesses.
A concomitant symptom of these diseases is severe swelling face and limbs.
In the remaining 5% of diagnoses, free fluid in the abdominal cavity forms after surgery, due to:
- pancreatitis;
- diabetes;
- renal failure; systemic lupus erythematosus;
- portal hypertension;
- Meigs syndrome;
- veno-occlusive disease;
- peritonitis of various origins;
- Budd-Chiari disease;
- Whipple's syndrome and other pathological conditions.
Determination of the presence of fluid in the abdominal cavity by ultrasound
It is impossible to independently detect ascites, especially at the beginning of water accumulation. There are several telltale signs of a problem, for example:
- defecation disorders;
- dull or nagging pain in the intestinal area;
- changes in the frequency of urination and the volume of excreted biofluid;
- belching;
- sometimes – difficulty breathing;
- swelling of the limbs, face;
- "frog" belly.
But the listed symptoms are characteristic of many diseases, so it is difficult to associate them with the accumulation of fluid in the abdominal space. The only reliable method for diagnosing ascites is considered ultrasonography. During the procedure, not only the presence of trans- or exudate is clearly visible, but also its volume, which in some cases can reach 20 liters.
Therapy and pumping out fluid from the abdominal cavity
Refractory, “large” and “giant” ascites must be treated surgically, since large volumes of fluid cannot be removed using conservative methods.
Laparocentesis is a procedure for puncturing the abdomen with a trocar - a special device consisting of a needle and a thin tube attached to it. The procedure is performed under ultrasound control and local anesthesia. In 1 session, no more than 6 liters of liquid are removed, and slowly. Accelerated pumping out of ex- or transudate can lead to a sharp drop blood pressure And 
collapse blood vessels.
To compensate for the loss of protein and mineral salts, a solution of albumin, polyglucin, aminosteril, hemaccel and other similar drugs is simultaneously administered.
In modern surgery, installation of a permanent peritoneal catheter is also practiced. With its help, liquid is removed continuously, but very slowly.
Conservative treatment of ascites is effective in mild and moderate stages of the pathology. It is prescribed only by a specialist after identifying the causes of the problem.
Content
Water in the abdomen is an alarming symptom that a doctor diagnoses on an ultrasound. It is recommended to undergo such an examination if the patient notices an enlargement of the abdominal cavity. Such a complaint should not go unnoticed by a specialist, since when neglected clinical pictures ah the cancer progresses with a fatal outcome.
What is ascites
This is a dangerous diagnosis, which is characterized by increased accumulation of fluid in the abdominal cavity. Other important organs of the body, such as the lungs and heart, can be affected by ascites. The problem is not inflammatory in nature. The fluid accumulated in the peritoneal area can reach 15-20 liters in volume. This disease is popularly called “frog belly” and is prone to malignancy. For 75% of all clinical pictures, this is a complication of progressive cirrhosis, and the main goal of treatment is to suppress alarming symptoms and prolong the period of remission.
Why does fluid accumulate in the abdominal cavity?
The peritoneum, which lines the walls of the abdominal cavity, secretes a small amount of fluid that chemical composition similar to blood plasma. It is necessary for the normal functioning of internal organs, otherwise they would stick together. The liquid is absorbed and released throughout the day, but under the influence of pathological factors this natural process can be disrupted. With imbalance, intra-abdominal pressure increases and the abdomen increases in size. Urgent diagnosis followed by complex therapy is necessary.
Reasons
This disease is a complication of liver cirrhosis and more. It progresses gradually in the body; at first it does not manifest itself in any way. Abdominal ascites is difficult to treat successfully. However, healing occurs if the main pathogenic factor is eliminated. The causes of ascitic disease are unexpected, the most common among them are presented below. This:
- heart failure;
- malignant neoplasms;
- impaired pressure of the portal vein of the liver;
- abdominal tuberculosis;
- development of mesothelioma, pseudomyxoma;
- malfunctions endocrine system;
- diseases in women (from the field of gynecology).
Why does hydrocele occur in newborns?
Abdominal ascites can progress at any age, and infants with this characteristic disease are no exception. The pathological process worsens during the prenatal period and is characterized by a congenital disorder of liver function. This disease is caused at such a young age by infectious diseases of a pregnant woman. These include the following diagnoses:
- rubella in pregnancy;
- syphilis;
- toxoplasmosis;
- listeriosis;
- hepatitis;
- herpes;
- measles.
Newborns whose mothers abused drugs during pregnancy were at risk. medicines, alcoholic drinks, chemical reagents. In addition, ascites progresses in the case of blood transfusion during pregnancy, obesity, and type 2 diabetes. To prevent a child from developing abdominal ascites from the first days of life, a pregnant woman is not recommended to have permanent makeup or tattoos.
How does fluid accumulation in the abdominal cavity manifest?
The main symptom of peritoneal ascites is free fluid in the abdominal cavity that collects and is not excreted naturally. This sign of the disease provokes an increase in the abdominal cavity in size, and over time this process only progresses. At first, the patient does not notice characteristic changes in appearance, but then cannot tense and relax his stomach. Additional symptoms of ascites are as follows:
- abdominal pain;
- signs of dyspepsia;
- weight gain;
- shortness of breath when walking;
- big belly;
- heartburn, belching;
- fluctuation;
- state of general discomfort;
- increased swelling of the limbs.
Diagnostics
Determining ascites using visual examination and palpation of the abdominal cavity is very problematic. A description of symptoms is necessary to collect medical history data, but such actions by a specialist are not enough to make a final diagnosis. It is necessary to undergo a clinical examination, visualize foci of transudate, determine the nature and stage of pathological process. Diagnostics involves the following methods:
- ultrasound. Helps evaluate the systemic blood flow of the portal vein, the presence of liver cirrhosis, and peritoneal tumors. The method is non-invasive, painless, but at an early stage of ascites it is not very informative.
- Radiography. This diagnostic method visualizes foci of ascites, determines the volume of fluid, and the boundaries of the abdominal cavity. On the screen you can see cirrhosis of the liver and tuberculosis, suggesting heart failure.
- Laparocentesis. An invasive method that involves the collection and further study of ascitic fluid in laboratory conditions. Additionally, a liver biopsy (puncture) is performed to identify the etiology of the pathological process.
- CT and MRI. Both methods accurately determine abnormal fluid effusion, and diagnose pathology in hard-to-reach parts of the abdominal cavity. Laparocentesis complements complex diagnostics.
- Angiography. This is a type of radiography where a contrast agent is injected into the vessels to determine the etiology of the pathological process. This method can detect cirrhosis even at an early stage.
How to treat ascites
After performing radiography and angiography, the doctor can make a prognosis and determine an effective treatment regimen. The approach to the problem is comprehensive, and for advanced clinical situations does not exclude surgery to remove oncology, laparocentesis. It all depends on the signs and symptoms, the diagnosis performed, and the recommendations of a specialist. At first, doctors try to remove the source of pathology conservatively, but if fluid continues to accumulate in the abdominal cavity, surgery is definitely not possible. Otherwise, oncology will only progress.
How is abdominal dropsy treated therapeutically?
The main goal of drug therapy for ascites is to remove fluid accumulation in the abdominal cavity using a non-invasive method. Treatment is appropriate at an early stage, when the peritoneum is not yet completely filled with transudate. For ascites, the doctor prescribes diuretics and calcium supplements. In the first case, we are talking about medications such as Veroshpiron, Diacarb, Lasix, Torasemide, after taking which the water in the abdominal cavity disappears. In the second - calcium tablets, Panangin and Asparkam. Additionally, it is recommended to take multivitamin complexes.
How to remove fluid in the abdomen using surgical methods
If ascites is diagnosed in an advanced stage, surgery to pump out the transudate cannot be avoided. In this way, you can temporarily remove a large belly, but if you do not eliminate the cause of the disease, its symptoms will very soon remind you of themselves again. It is important to understand that we are talking about oncology, and surgery cannot be avoided. Surgical intervention for ascites, the following actions are provided:
- Laparocentesis. A puncture of the abdominal cavity is performed to further drain ascitic fluid. The procedure may take several days and requires hospitalization of the patient.
- Transjugular intrahepatic shunting. The surgeon forms an artificial duct between the hepatic and portal veins to ensure water exchange and stabilize intra-abdominal pressure.
- Liver transplantation. The operation is appropriate for oncology, advanced cirrhosis.
Attention! The information provided in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and give recommendations for treatment, based on the individual characteristics of a particular patient.
Did you find an error in the text? Select it, press Ctrl + Enter and we'll fix it!Ascites or hydrocele of the abdomen- a pathology in which free fluid accumulates in the abdominal cavity. It happens that the amount of liquid reaches 20-25 liters, which brings maximum discomfort and suffering to the patient. Ascites is not an independent disease, but a complication or symptom of some pathology, for example, malignant neoplasms, liver cirrhosis, etc. The accumulation of fluid in the peritoneum often indicates untimely or incorrect treatment of the underlying disease.
The development of ascites is associated with disturbances in the circulation of lymph and blood in the peritoneal cavity, resulting in the accumulation of transudate or non-inflammatory fluid. The development of pathology is also associated with inflammation, leading to the formation of effusion and exudate. If a high concentration of protein and leukocytes is detected in the fluid, 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.
Based on the volume of liquid accumulated in the cavity, the following are distinguished:
- transient - up to 400 ml.
- moderate - from 500 ml to 5 l.
- resistant (stressed) - more than 5 liters.
Depending on the presence of pathogenic microflora in the fluid, 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 exposure to bacteria.
Ascites is also classified according to its responsiveness to drug treatment:
- ascites, amenable to conservative treatment methods.
- refractory ascites - resistant to drug therapy.
Chylous ascites
Chylous astitis is a rare complication of liver cirrhosis in 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.
The 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 liver cirrhosis in the final stage of decompensation, which is characterized by depletion of liver 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 causes in women often lie in oncological pathologies of the pelvic organs. With malignant neoplasms, there is a deterioration in lymph circulation and blockage of the lymphatic drainage pathways, as a result of which the fluid is not able to escape and accumulates.
Interesting: ascites that develops as a result of cancer pathologies often indicates a person’s approaching death.
5% of cases of abdominal dropsy 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 swelling lower extremities, and in advanced cases, swelling of the entire body. As a rule, with heart disease, fluid accumulates not only in the stomach, but also in the lungs.
Rarely, abdominal hydrops can be caused by the following conditions:
- renal pathologies, such as amyloidosis, glomerulonephritis.
- diseases of the pancreas.
- portal vein thrombosis.
- peritoneal tuberculosis.
- acute dilatation of the stomach.
- Lymphogranulomatosis.
- Crohn's disease.
- intestinal lymphangiectasia.
- protein fasting.
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 incompatibility of the blood group and Rh factor of the mother and fetus.
- various diseases of the liver and bile ducts.
- exudative enteropathy acquired hereditarily.
- protein deficiency leading to severe dystrophy.
Symptoms of fluid in the abdomen
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 symptoms of pathology does not appear immediately, only if the volume of the contents of the peritoneal cavity exceeds 1000 ml.
- 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 in a horizontal position, it looks spread out with clearly protruding lateral sections.
- The patient's navel protrudes greatly.
- 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 the stretched skin.
- 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 shift the diaphragm upward, which leads to a decrease in the volume of the chest cavity and compression of the lungs, which are difficult to expand when trying to inhale.
- Often the first complaints are a feeling of abdominal distension, bloating, and 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 specific case.
Diagnostics
A specialist can suspect ascites in a patient during an examination, by palpating and “tapping” the abdomen. 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 methods research:
- clinical blood and urine tests.
- biochemical blood test (based on its data, the condition of the patient’s liver and kidneys is assessed).
- study of peritoneal contents obtained by puncture.
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Treatment of ascites
Important: treatment of ascites should, first of all, be aimed at eliminating the cause of its development.
Treatment of abdominal dropsy is carried out using conservative, symptomatic and surgical methods.
For 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 lymphatic drainage.
If abdominal dropsy is caused by portal vein hypertension, Albumin, hepatoprotectors and plasma transfusion are prescribed.
In the absence of a positive effect from conservative treatment, as well as in the case of a large volume of accumulated fluid, symptomatic therapy is carried out. This method includes laparocentesis - a puncture of the peritoneal wall with pumping out the contents from its cavity. The procedure is performed in the operating room under local anesthesia. No more than 5 liters are pumped out in one procedure. The frequency of use of procedures is 1 time every 3-4 days.
Important: laparocentesis is a rather dangerous procedure, with each subsequent use of which the risk of damage 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.
For rapidly developing dropsy, drainage catheters are used, which are installed for non-stop drainage of fluid.
In case of relapse of the pathology, surgical intervention is prescribed, during which the inferior vena cava and portal vein are connected and collateral circulation is created. If before the operation, specialists have repeatedly resorted to removing ascitic fluid from the patient’s abdomen, a plasma transfusion is simultaneously performed, and a protein diet is recommended after the operation.
In the most severe cases, a donor liver transplant is indicated.
Prognosis is determined by the severity of the pathology that caused ascites. Life expectancy has no direct connection with the accumulation of fluid in the abdomen, however, increasing dropsy contributes to the aggravation of the underlying disease and deterioration general condition sick.
Ascites is a pathological condition that requires urgent and mandatory medical intervention. Lack of treatment or treatment started but too late leads to rapid development of complications. If fluid accumulation in the abdomen is suspected, urgent examination and adequate treatment are necessary, which will help increase the chances of a favorable prognosis.
Thank you
The site provides reference information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!
What is ascites?
Ascites is an accumulation of fluid in the abdominal cavity, manifested by an increase in the size of the abdomen and a number of other symptoms. Ascites is not an independent disease, but only a manifestation of various diseases and pathological conditions that lead to disruption of the regulation of fluid metabolism in the body. However, the appearance of fluid in the abdominal cavity is always a sign of severe disease and a violation of the body’s regulatory and compensatory reactions. Development (pathogenesis) of ascites
The abdominal cavity is a closed space bounded by the peritoneum (a thin semi-permeable membrane) and containing various organs (stomach, spleen, liver, gallbladder and some parts of the intestine). The peritoneum consists of two layers - parietal (external, which is attached to the walls of the abdomen from the inside) and visceral (internal), which is adjacent to the walls of the intra-abdominal organs, surrounding them. The main functions of the peritoneum are fixation of the organs located in it and regulation of metabolism in the body.The peritoneum contains a huge number of small blood and lymphatic vessels that ensure metabolism. Under normal conditions, a small amount of fluid is constantly present in the abdominal cavity and between the layers of the peritoneum, which is formed as a result of the sweating of the liquid part of the blood and a certain amount of proteins through the blood vessels. However, this fluid does not accumulate in the abdominal cavity, since it is almost immediately reabsorbed into the lymphatic capillaries (the peritoneum can absorb more than 50 liters of fluid per day). The resulting lymph flows through the lymphatic vessels into the venous system of the body, returning liquid, proteins and other microelements dissolved in it to the systemic circulation.
Based on the foregoing, it follows that the accumulation of fluid in the abdominal cavity can occur in two cases - when the rate of its formation increases or when the rate of its absorption decreases. In practice, these two mechanisms are present simultaneously, that is, when various diseases internal organs (liver, pancreas, tumors, inflammation of the peritoneum, etc.) there is an increase in fluid production, which certainly entails a violation of its reabsorption (absorption) as a result of compression and blockage of small lymphatic and blood vessels by cell decay products, pathogenic microorganisms or tumor cells. As the disease progresses, the fluid in the abdominal cavity becomes more and more, and it begins to compress the organs located there, which, in turn, can aggravate the course of the underlying disease and contribute to the progression of ascites.
It is also worth noting that in addition to fluid, proteins (as well as other microelements) are retained in the abdominal cavity. Under normal conditions, blood plasma proteins (mainly albumin) are involved in creating the so-called oncotic pressure, that is, they retain fluid in the vessels. With ascites, a large proportion of proteins is in the ascitic fluid, and therefore the oncotic pressure of the blood decreases, which can also contribute to the release of fluid from the vascular bed and the progression of the disease.
As the disease progresses, the volume of circulating blood decreases, as most of the fluid accumulates in the abdominal cavity. This leads to the activation of compensatory mechanisms aimed at retaining water in the body (in particular, the rate of formation and excretion of urine decreases), which further increases the hydrostatic pressure in the blood vessels and also contributes to the formation of ascitic fluid.
Causes of ascites
There can be many causes of ascites, but all of them are in one way or another associated with impaired outflow of blood and lymph from the peritoneum or abdominal organs. The causes of ascites can be:
- liver cancer;
- Budd-Chiari disease (syndrome);
- compression of the portal vein;
- oncological diseases (tumors);
- kidney diseases;
- anasarca;
- impaired lymph circulation (chylous ascites);
- fetal development disorders;
- childhood diseases;
Ascites in liver cirrhosis
Liver cirrhosis is a chronic disease in which the structure and almost all functions of this organ are disrupted, which leads to the occurrence and progression of various complications.Under normal conditions, blood from many internal organs (stomach, spleen, pancreas, small and large intestines) flows into the liver through the portal vein. In the liver, it passes through thin tubules (hepatic sinusoids), where it is filtered, purified and enriched with various substances (for example, proteins), after which it enters the inferior vena cava and returns to the systemic circulation. In cirrhosis, under the influence of various causative factors (for example, hepatitis B or C viruses), a large number of hepatocytes (liver cells) are damaged and destroyed. Dead cells are replaced by fibrous tissue, which significantly reduces liver function. This, in turn, leads to the activation of compensatory mechanisms, which consist in increased division of the remaining (undamaged) cells. However, the structure of the newly formed tissue is disrupted (in particular, there are no sinusoids characteristic of a normal liver), as a result of which the filtration capacity of the organ decreases (that is, the amount of blood that can pass through the liver per unit of time decreases).
Impaired liver function, as well as changes in its structure, lead to the fact that blood cannot be filtered in full, as a result of which it begins to accumulate in the portal vein. As the disease progresses, hydrostatic pressure (that is, the pressure exerted by the blood on the wall of the vessel) in the portal vein increases (portal hypertension develops), which disrupts the process of blood outflow from the internal organs (stomach, intestines and others). As a result of stagnation of blood in them, the blood vessels dilate and the permeability of the vascular walls increases, which leads to the sweating of part of the fluid into the abdominal cavity.
It is also worth noting that the liver is the main site of protein formation in the body. In the later stages of the disease (when most of the hepatocytes are replaced by fibrous tissue), the protein-forming function of the liver decreases, resulting in hypoproteinemia (lack of proteins in the blood). This, in turn, leads to a decrease in the oncotic pressure of the blood, which also contributes to the release of some fluid from the vascular bed.
Ascites in liver cancer
Liver cancer is a tumor disease that leads to damage to the liver structure and disruption of all its functions. May contribute to the development of cancer various factors external environment (radiation, toxins, viruses, etc.), under the influence of which the formation of mutant tumor cells occurs. Typically, such cells are immediately detected by the body's immune system and destroyed, but under certain conditions (for example, when the immune system is weakened or when exposed to a large dose of radiation), one tumor cell can survive and begin to constantly (endlessly) divide.Over time, the tumor increases in size and can compress large intrahepatic vessels. Also, cancer cells can break away from the main tumor and move (metastasize) to other parts of the organ, clogging the hepatic sinusoids, blood and lymphatic vessels and bile ducts. This will lead to disruption of all liver functions, increased pressure in the portal vein and the development of ascites.
Ascites in other liver diseases
In addition to cirrhosis and cancer, there are several other pathologies that can disrupt blood circulation in the liver and portal vein and cause fluid to leak into the abdominal cavity.The cause of ascites may be:
- Mesothelioma. This malignant neoplasm is extremely rare and originates directly from peritoneal cells. Tumor development leads to activation immune system in order to destroy tumor cells, which is manifested by the development of the inflammatory process, dilation of blood and lymphatic vessels and leakage of fluid into the abdominal cavity.
- Peritoneal carcinomatosis. This term refers to damage to the peritoneum by tumor cells that metastasize into it from tumors of other organs and tissues. The mechanism of development of ascites is the same as with mesothelioma.
- Pancreas cancer. The pancreas is the site of production of digestive enzymes, which are secreted from it through the pancreatic duct. After leaving the gland, this duct merges with the common bile duct(through which bile leaves the liver), after which they flow together into small intestine. The growth and development of a tumor near the confluence of these ducts can lead to disruption of the outflow of bile from the liver, which can be manifested by hepatomegaly (increase in liver size), jaundice, skin itching and ascites (ascites develops in the later stages of the disease).
- Ovarian cancer. Although the ovaries do not belong to the abdominal organs, the layers of the peritoneum are involved in fixing these organs in the pelvis. This explains the fact that with ovarian cancer, the pathological process can easily spread to the peritoneum, which will be accompanied by an increase in the permeability of its vessels and the formation of effusion in the abdominal cavity. In the later stages of the disease, cancer may metastasize into the layers of the peritoneum, which will increase the release of fluid from the vascular bed and lead to the progression of ascites.
- Meigs syndrome. This term refers to a pathological condition characterized by the accumulation of fluid in the abdominal and other body cavities (for example, in the pleural cavity of the lungs). The cause of the disease is considered to be tumors of the pelvic organs (ovaries, uterus).
Ascites in heart failure
Heart failure is a heart disease in which it is unable to ensure adequate blood circulation in the body. Under normal conditions, with each heartbeat into the aorta (the most large artery body) a certain amount of blood is released. As it moves away from the heart, the aorta divides into smaller arteries until capillaries are formed - the thinnest vessels in which oxygen is exchanged between the tissues and cells of the body. After passing through the capillaries, the blood is collected in the veins and delivered back to the heart. Part of the liquid (about 10%) enters the lymphatic vessels and turns into lymph.An important feature of the vascular system is that the arterial wall is dense and elastic, while the venous wall is relatively thin and easily stretched when intravascular pressure increases. With the development of heart failure (which can be caused by a heart attack, infection, prolonged increase in blood pressure, and so on), the pumping function of the heart muscle decreases, resulting in stagnation in the inferior vena cava system, which collects blood from the entire lower part of the body. Due to the expansion of the walls of overcrowded venous vessels, as well as due to an increase in hydrostatic pressure, a certain proportion of the liquid part of the blood leaves the vascular bed and accumulates in the abdominal cavity.
Ascites in kidney diseases
The kidneys are organs of the excretory system that regulate the composition and volume of fluid in the body. However, in some diseases their function may be impaired, which, in turn, can lead to the development of various complications.Ascites can be complicated by:
kidney failure
A pathological condition in which more than 75% of the functional tissue (the so-called nephrons) of the kidneys is affected. As a result of this, the organ can no longer fully perform its excretory function, so some of the waste products (such as urea, uric acid and others) are retained in the body. These substances are osmotically active (that is, they attract liquid to themselves) and when they penetrate into the intercellular space of tissues they lead to the development of edema.
Also, in case of renal failure, the blood supply to the renal tissue is disrupted, as a result of which compensatory mechanisms are activated aimed at increasing systemic blood pressure and increasing the amount of blood delivered to the kidneys. Along with this, the rate of sodium and water excretion in the kidneys decreases, which further increases the volume of circulating blood and increases blood pressure. venous system and contributes to the progression of ascites.
Nephrotic syndrome
This disease is characterized by damage to the kidney filter (which is normally impermeable to proteins and other large molecular substances), as a result of which the body loses a large amount of plasma proteins in the urine (more than 3 grams per day). After just a few days, this leads to a significant decrease in the oncotic pressure of the blood, as a result of which the liquid part can no longer be retained in the vascular bed and sweats into the abdominal cavity, leading to the development of ascites.
Ascites with pancreatitis
Pancreatitis is a disease of the pancreas, characterized by the destruction of its tissue and the spread of the pathological process to neighboring organs. The cause of the development of this disease is the pathological activation of digestive enzymes formed in the gland. Normally, they are released into the intestines in an inactive form and are activated only after mixing with intestinal contents. In various pathological conditions (during alcohol abuse, after eating large amounts of fried food, after an abdominal injury or as a result of viral infections) these enzymes can be activated directly inside the gland, which will lead to its self-digestion.During the described process, damage to the vessels of the pancreas occurs, which causes the penetration of digestive enzymes into the blood. If treatment is not started in time, the pathological process can destroy the wall of the gland and spread to the peritoneum, which will cause the development of peritonitis (inflammation of the peritoneum) and can lead to the formation of ascitic fluid in the abdominal cavity.
Ascites with peritonitis
Peritonitis is an inflammation of the peritoneum, characterized by severe abdominal pain and progressive symptoms of general intoxication of the body (increased body temperature over 40 degrees, rapid breathing and heartbeat, impaired consciousness, and so on). This condition develops when pathogenic bacteria penetrate the abdominal cavity from the outside.The cause of peritonitis may be:
- rupture of a hollow organ (stomach, intestines, urinary or gall bladder);
- penetrating injury to the abdominal cavity;
- perforation of a stomach or intestinal ulcer;
- disintegration of an intestinal tumor with damage to its wall;
- migration of bacteria from other foci of infection;
- spread of the inflammatory process from neighboring organs.
It is also worth noting that the spread of infection throughout the peritoneum occurs quite quickly, which is why local (local) peritonitis in a short time can turn into a diffuse (widespread) form affecting the entire peritoneum, which without timely and adequate treatment can lead to the death of the patient within a few hours.
Ascites with anasarca
Anasarca is an extreme degree of edema in which fluid accumulates in the subcutaneous fatty tissue of the torso, arms and legs, as well as in body cavities (in the abdominal and pleural cavity, in the pericardial cavity). This condition requires urgent medical care, as it can lead to the death of the patient in a matter of hours or days.Anasarca can be caused by:
- Heart failure. In this case, edema and ascites develop due to a pronounced increase in hydrostatic pressure in the venous and lymphatic systems, which is caused by the inability of the heart muscle to pump blood.
- Renal failure. With this pathology, the cause of water retention in the body is a violation of the excretory function of the kidneys.
- Liver diseases. With severe cirrhosis and liver failure, the concentration of proteins in the blood decreases, which can cause the development of generalized edema.
- Myxedema. It is characterized by a decrease in the concentration of thyroid hormones (thyroxine and triiodothyronine) in the blood, which is manifested by a decrease in the amount of proteins formed in the body and leads to the release of fluid from the vascular bed.
- Hyperaldosteronism. This disease is characterized by excessive production of the hormone aldosterone in the adrenal glands (endocrine glands). Under normal conditions, this hormone is responsible for maintaining the volume of circulating blood at a constant level, but with its excessive secretion, there is a pronounced retention of sodium and water in the body, which contributes to the development of edema and ascites.
Chylous ascites
This disease is characterized by the accumulation in the abdominal cavity of a milky-white, shiny fluid, in which the concentration of fats is increased. The reason for this is a violation of the outflow of lymph from the peritoneum, which is usually associated with compression or blocking of the lumen of the thoracic lymphatic duct, which collects lymph from the entire lower part of the body.Also, the reason for the release of lymph into the abdominal cavity can be:
- injuries of large lymphatic vessels;
- developmental abnormalities of the abdominal organs;
- previous abdominal surgeries;
- tumor diseases (systemic lymphangiosis);
- chronic inflammatory diseases intestines.
Ascites in the fetus
The accumulation of fluid in the abdominal cavity of the fetus can be caused by various pathologies of the mother or child.The cause of ascites in the fetus can be:
- Hemolytic disease of newborns. This disease develops if a mother with a negative Rh factor (Rh factor is a special antigen that is present on red blood cells in certain people) carries a fetus with positive Rh factor. During the first pregnancy there will be no deviations from the norm, however, during childbirth there will be contact between the blood of the mother and the fetus, which will lead to sensitization of the maternal body (antibodies against the Rh factor will begin to be released in it). If you are pregnant again with a Rh-positive fetus, these antibodies will begin to attack the blood cells of the fetus, disrupting the functions of all its organs and tissues and leading to the development of generalized edema and ascites. Without timely treatment this disease leads to fetal death.
- Genetic diseases. The human genetic apparatus consists of 46 chromosomes, formed as a result of the fusion of 23 maternal and 23 paternal chromosomes. Damage to one or more of them can result in various diseases that can be transmitted to offspring. Ascites in the prenatal period can be a manifestation of Down syndrome (in which an extra chromosome appears in the 21st pair), Turner syndrome (which is characterized by a defect in the sex X chromosome) and other hereditary diseases.
- Intrauterine developmental anomalies. Intrauterine abnormalities can be caused by infection, radiation, or trauma. Ascites may occur due to disruption of the normal development of the liver, cardiovascular or lymphatic system, with underdevelopment of the biliary system and with other developmental defects.
- Damage to the placenta. The placenta is an organ that appears in the body of a pregnant woman and ensures the vital functions (delivery of oxygen and nutrients) of the fetus throughout the entire intrauterine period of development. Impaired blood flow from the placenta or umbilical cord can increase pressure in the fetal circulatory system, thereby creating the preconditions for the development of edema and ascites.
Ascites in children
All of the above causes of ascites in adults can also occur in childhood. However, in newborns and children early age ascites can also be caused by other diseases.The cause of ascites in children can be:
- Malformations of the heart. In this case, we mean abnormalities in the development of the heart muscle, which lead to disruption of the pumping function of the heart (valve defects, defects of the interventricular and interatrial septa). In the prenatal period, these anomalies may not manifest themselves in any way, but after birth (when the load on the heart increases), edema, ascites and other signs of heart failure may develop.
- Kidney malformations. During the prenatal period, the placenta performs the excretory function, so even with severe anomalies in the development of the renal system, signs of renal failure in the fetus may be absent. After the birth of a child, toxic substances and metabolic products accumulate in the blood and tissues of the baby, which can lead to the development of edema and ascites.
- Infectious diseases. Infection of the fetus with various viruses (rubella virus, herpes, cytomegalovirus, enterovirus) or bacteria (for example, syphilis) can lead to damage to internal organs and the development of multiple organ failure. This may manifest itself as ascites, which appears in the prenatal period or immediately after the birth of the child.
- Tumors. Neoplasms in newborns are extremely rare, since the development of the tumor process and tumor growth take time. However, the appearance of a tumor (malignant or benign) in the prenatal period or in early childhood is possible. A growing tumor can compress the child’s blood or lymphatic vessels, damage various organs and tissues (liver, spleen), which can lead to the development of ascites from the first days of life.
- Congenital anemia. Anemia is the general name for conditions characterized by a decrease in the concentration of erythrocytes (red blood cells) and hemoglobin (the respiratory pigment found in erythrocytes) in the blood. Some types of anemia (sickle cell anemia, hemoglobinopathies, enzyme deficiency anemia, and so on) are characterized by deformation and destruction of red blood cells. They are destroyed mainly in the liver and spleen, which can eventually lead to damage to these organs and the development of edema and ascites.
Ascites during pregnancy
Ascites in pregnant women can develop as a result of various diseases of the liver, heart, kidneys and other organs and systems. Also, the accumulation of fluid in the abdominal cavity is facilitated by the growth and increase in size of the fetus, which can compress the inferior vena cava (a large vessel that collects venous blood from the entire lower part of the body).The growth and development of the fetus in itself requires all organs and systems to female body more intensive work. The accumulation of fluid in the abdominal cavity and increased intra-abdominal pressure further increases the load on the organs, which can lead to decompensation chronic diseases and the development of multiple organ failure, threatening the health or even the life of the mother and fetus.
The most dangerous manifestations of ascites in pregnant women can be:
- Respiratory failure. Enlargement of the uterus in late pregnancy causes the diaphragm (the main respiratory muscle that separates the abdominal cavity from the chest) to move upward, resulting in a decrease in the tidal volume of the lungs. The appearance of a large amount of fluid in the abdominal cavity further aggravates this process, which leads to a lack of oxygen in the blood of the mother and fetus.
- Heart failure. As already mentioned, the growth and development of the fetus leads to increased pressure in the abdominal cavity. As a result of this, it increases blood pressure in the blood vessels located there. To overcome this pressure, the heart is forced to work harder. The appearance of ascites in late pregnancy further increases the load on the heart, which can cause disruption of its function. This, in turn, can lead to insufficient blood flow to the placenta and cause intrauterine fetal death.
- Compression of the growing fetus. With ascites, the amount of fluid accumulating in the abdominal cavity can reach several tens of liters. This will lead to a pronounced increase in intra-abdominal pressure and compression of all internal organs, including the uterus with the developing fetus. As a rule, this condition makes further development of pregnancy impossible.
Hemorrhagic ascites
With hemorrhagic ascites, the ascitic fluid contains red blood cells (erythrocytes) in varying quantities. As a rule, this condition develops against the background of existing chronic diseases that have caused the formation of ascites (liver cirrhosis, cancer, tuberculosis).The cause of hemorrhagic ascites can be:
- liver injury;
- spleen injury;
- bleeding when the tumor disintegrates;
- thrombosis (blockage with a blood clot) of the hepatic veins;
- perforation (perforation) of the intestinal wall (for example, with an ulcer).
Tuberculous ascites
Tuberculosis is infection, which affects the lungs, intestines and other organs. The disease is caused by Mycobacterium tuberculosis, which enters the body primarily through airborne droplets (by inhaling air contaminated with the pathogen) or through food. The primary focus of tuberculosis is usually localized in the lung tissue, less often in the intestine. As the disease progresses and the body's defenses decrease, mycobacteria can spread from the primary focus to other tissues, including the peritoneum.Infection of the peritoneum with tuberculosis leads to the development of a specific inflammatory process (peritonitis), which is manifested by dilation of blood vessels and the leakage of large amounts of fluid, lymph and proteins into the abdominal cavity.
Ascites with endometriosis
Endometriosis is a disease in which the endometrium (uterine lining) grows in atypical places (that is, in other organs and tissues). The cause of the disease may be a disorder hormonal background women, as well as hereditary predisposition.Initially, endometrial cells extend beyond the lining of the uterus and penetrate into it. muscle layer, starting to share there. During the menstrual cycle, they (like the normal endometrium) undergo certain changes, which can lead to the development of bleeding. In the later stages of the disease, endometrial cells extend beyond the uterus and can affect any organs and tissues, including the peritoneum. In addition to other symptoms (abdominal pain, difficulty urinating, and so on), this can be manifested by the accumulation of fluid in the abdominal cavity.
Ascites and pleurisy
The pulmonary pleura is a thin connective tissue membrane, which consists of two layers - outer and inner. The outer leaf is adjacent to the inner surface of the chest, and the inner one envelops the lung tissue. Between these sheets there is a slit-like space (pleural cavity), which contains a small amount of fluid necessary to ensure that the sheets slide relative to each other during breathing.Pleurisy is an inflammation of the layers of the pulmonary pleura, which is usually accompanied by the leakage of fluid into the pleural cavity. Ascites and pleurisy can simultaneously be observed in systemic inflammatory diseases of an autoimmune nature (when the immune system attacks the cells and tissues of its own body) - rheumatic fever, systemic lupus erythematosus, rheumatoid arthritis, and so on. It is worth noting that with the listed diseases, fluid accumulation in the pericardial cavity (heart sac) may also occur.
Symptoms of ascites
The symptoms of ascites largely depend on the underlying disease that caused it. For example, with liver diseases, the patient will complain of indigestion, frequent bleeding (the main factors of the blood coagulation system are formed in the liver), and so on. In case of kidney diseases, symptoms of urinary disorders and signs of intoxication of the body with metabolic by-products may come to the fore. With heart failure, patients will complain of increased fatigue and a feeling of lack of air (especially during physical activity). However, regardless of the cause, the accumulation of fluid in the abdominal cavity will always be manifested by certain symptoms, the identification of which will make it possible to suspect a diagnosis in the early stages of the disease.
Ascites may be accompanied by:
- edema;
- an increase in body temperature;
- pain in the abdomen;
- an increase in the size of the abdomen;
- enlarged liver;
- enlarged spleen;
- “jellyfish head”;
- jaundice;
Swelling with ascites
Edema with ascites develops as a result of the release of fluid from the vascular bed and its transition into the intercellular space of various tissues. The mechanism of formation and nature of edema depends on the underlying disease that caused ascites.Swelling with ascites can be a consequence of:
- renal failure (renal edema);
- heart failure (cardiac edema);
- liver failure (protein-free edema).
Renal edema occurs due to the retention of water and osmotically active substances in the body. They (edema) are symmetrical (observed in both parts of the body), present constantly, but can intensify in morning hours, since during night sleep a large amount of fluid and toxic substances accumulate in the body. Initially, swelling is localized mainly in the area of the face, neck, upper limbs, then descends to the area of the thighs and legs. The skin in the area of swelling is normal or slightly elevated temperature, pale skin may be noted. With prolonged (20–30 seconds) pressure on the swollen tissue, a depression is formed, which disappears immediately after the pressure stops.
Cardiac edema
Cardiac edema develops because the heart is unable to pump blood from the veins to the arteries. They appear mainly in the evening, first localized in the area of the feet and legs, and then rise to the area of the hips and torso. This is explained by the fact that during the day a person is in an upright position for a long time, as a result of which the hydrostatic pressure in the veins of the lower extremities significantly increases and blood stagnation develops in them. This leads to the release of fluid from the vessels into the intercellular space.
The skin in the area of cardiac edema is bluish in color and cold to the touch. With prolonged pressure, the resulting depression disappears slowly.
Protein-free edema
With protein deficiency, the liquid part of the blood enters the intercellular space, which is manifested by extremely pronounced, generalized (observed in all parts of the body) edema. The skin in the area of swollen limbs is stretched, tense, pale and dry, its temperature is reduced. When pressing on the swollen tissue, the dent disappears within a few seconds.
Temperature with ascites
Ascites does not directly lead to an increase in body temperature. The cause of thermoregulation disorders are underlying diseases that cause fluid accumulation in the abdominal cavity.With ascites, an increase in body temperature can be a manifestation of:
- Peritonitis. Damage to the peritoneum by foreign microorganisms leads to activation of the immune system and an increase in body temperature. The highest numbers (up to 40 degrees or more) are observed with bacterial peritonitis, when pathogenic bacteria and the toxins they release are absorbed into the blood and spread throughout the body. With peritonitis of tuberculous etiology, the temperature usually ranges from 37 to 39 degrees.
- Pancreatitis. With pancreatitis, a non-infectious inflammatory process develops in the pancreas, which is accompanied by an increase in temperature to 38 degrees. The transition of inflammation to the peritoneum and the development of peritonitis may be accompanied by a more pronounced temperature reaction (up to 39 - 40 degrees).
- Cirrhosis of the liver. In the early stages of cirrhosis, all patients experience low-grade fever (increased body temperature to 37 - 37.5 degrees). If cirrhosis is a consequence of infection by hepatitis B or C viruses, an increase in temperature to 37 - 39 degrees will be a natural protective reaction of the body that occurs in response to the introduction of foreign agents. An increase in body temperature above 39 degrees is usually a consequence of the development of bacterial complications and requires urgent medical intervention.
- Tumors. With all malignant tumor diseases, the patient experiences a low-grade fever for several weeks or months, which is usually accompanied by a feeling of weakness and weight loss. When cancer metastasizes into the peritoneum, there may be an increase in body temperature to 39–40 degrees, which is explained by the development of an inflammatory reaction in response to the introduction of “foreign” (tumor) cells.
Pain with ascites
The occurrence, nature and localization of pain depend mainly on the cause of ascites, however, in some cases, the accumulation of large amounts of fluid in the abdominal cavity can directly lead to increased pain, compressing the abdominal organs.Pain syndrome with ascites can be caused by:
- Cirrhosis of the liver. Liver cirrhosis develops gradually and is usually preceded by inflammatory liver diseases (hepatitis). The liver itself does not contain pain receptors, but the capsule surrounding the organ is rich in them. An increase in the size of the liver in various diseases leads to overstretching of the capsule, which is manifested by pain of varying intensity. IN initial stages Patients with cirrhosis may complain of discomfort or mild pain in the right hypochondrium, which may intensify over time. Patients may also complain of heaviness or pain in other parts of the abdomen. This is due to digestive disorders that occur in the later stages of cirrhosis.
- Budd-Chiari syndrome (disease). With this pathology, there is a blockage of the veins through which blood flows from the liver. As a result, intrahepatic blood vessels overflow, the organ increases in size and the liver capsule stretches, which is accompanied by acute, stabbing pains in the right hypochondrium, extending to the right parts of the back.
- Inflammation of the peritoneum. The layers of the peritoneum contain a large number of pain receptors, so its inflammation is accompanied by severe cutting or stabbing pain in the abdomen, which intensifies when pressing on the anterior abdominal wall.
- Pancreatitis. The development of the inflammatory process in the pancreas manifests itself sharp pains encircling nature, which are most pronounced in the upper abdomen. The pain can radiate to the right or left hypochondrium, to the back, to the heart.
- A tumor. Tumor pain is rarely severe, which greatly complicates the early diagnosis of malignant neoplasms. Patients may experience dull, tugging, or aching pain in a stomach. The intensity of pain may spontaneously increase or decrease.
- Endometriosis. Pain in this pathology is localized mainly in the lower abdomen, but when endometrial cells metastasize to other organs, they can have any localization. Typically, women complain of increased pain during sexual intercourse, during menstruation, pain when urinating or defecating. The pain is acute, cutting, and cannot be relieved by taking conventional painkillers.
Abdominal enlargement with ascites
This symptom becomes noticeable to the naked eye when more than 1 liter of fluid accumulates in the abdominal cavity. At first, this can only manifest itself in a standing position, when fluid accumulates in the lower abdominal cavity, causing protrusion of the anterior abdominal wall. In the supine position, the abdomen may be of normal size, but the patient may begin to complain of shortness of breath (a feeling of lack of air), as fluid will move to the upper abdominal cavity, limiting the movement of the diaphragm and lungs.With further progression of the disease, the amount of ascitic fluid increases, as a result of which the bulging of the anterior abdominal wall becomes noticeable even in the supine position. With severe ascites (when more than 10–12 liters of fluid accumulate in the abdominal cavity), the skin of the abdomen becomes taut, tense, and shiny.
Hepatomegaly and splenomegaly with ascites
Enlargement of the liver (hepatomegaly) and spleen (splenomegaly) may be important diagnostic sign, indicating one or another cause of ascites.The cause of hepatomegaly and splenomegaly may be:
- Cirrhosis of the liver. In liver cirrhosis, the structure of the liver tissue is disrupted and partially replaced by fibrous (scar) tissue. This creates an obstruction in the path of blood flow, as a result of which it accumulates in the veins of the liver and in the portal vein, leading to an increase in the size of the organ. To reduce the pressure in the portal vein system, part of the blood is discharged into the venous vessels of the spleen, which also leads to its overflow with blood and an increase in size.
- Tumor. The cause of liver enlargement may be an increase in the size of an intrahepatic tumor or the growth of metastases from tumors of another location. When a malignant tumor metastasizes into the liver tissue, blockage of the liver capillaries by tumor cells will also occur, which will lead to disruption of blood flow in the organ and may cause it to increase in size.
- Budd-Chiari disease. With thrombosis of the hepatic veins, the liver tissue becomes overfilled with blood and the liver increases in size. The spleen enlarges only in severe cases of the disease (with the development and progression of portal hypertension).
- Heart failure. In heart failure, blood stagnates in the inferior vena cava system, increasing the pressure in it. Because the hepatic veins (which carry venous blood from the liver) also drain into the inferior vena cava, severe heart failure can impair blood flow from the liver, causing it to become enlarged.
Nausea and vomiting with ascites
In the initial stages of ascites development, the occurrence of nausea and vomiting may be due to the underlying disease (liver cirrhosis, pancreatitis, peritonitis, and so on). As the pathological process progresses, the amount of fluid in the abdominal cavity increases, which leads to compression and dysfunction of many organs (in particular the stomach and intestines).Squeezing the stomach can significantly reduce stomach volume and impair motility, causing a person to experience nausea even after eating a small amount of food. If vomiting occurs, the vomit will contain undigested food that has just been eaten. After vomiting, the stomach empties, which usually brings relief to the patient.
Compression of the intestines can also impair bowel motility. With severe ascites, the intestinal loops can be compressed with such force that the movement of processed food (chyme) through them becomes impossible. As a result, chyme will begin to accumulate above the compression site, causing increased peristalsis in this section of the intestine. The patient will complain of paroxysmal abdominal pain and nausea. The vomit that occurs in this case will contain partially digested foods or feces, and will also have a characteristic unpleasant odor.
“Jellyfish head” with ascites
“Jellyfish head” is the dilation of the veins of the abdominal wall, observed with the accumulation of a large amount of ascitic fluid and severe portal hypertension. In this case, blood from the portal vein system is discharged into the systemic circulation through so-called anastomoses (connections between veins) located in the area of the anterior abdominal wall. This leads to increased pressure in the veins of the abdominal wall and their expansion. When the abdomen protrudes and the skin is stretched, these veins become visible under the skin and form a dense venous network on the anterolateral surface of the abdomen, which is the reason for the name of the symptom.Jaundice with ascites
Jaundice (yellow coloration of the skin and visible mucous membranes) occurs with various liver diseases accompanied by impaired liver function. The accumulation of fluid in the abdominal cavity against the background of jaundice allows big share probability of assuming that the cause of ascites is liver pathology (cirrhosis or cancer).The mechanism of jaundice is as follows - when red blood cells (erythrocytes) are destroyed, a yellow pigment is released into the bloodstream - bilirubin. It is a rather toxic product, so under normal conditions it is immediately captured by liver cells, neutralized and excreted from the body as part of bile. If liver function is impaired, this process slows down or stops altogether, as a result of which the concentration of bilirubin in the blood begins to increase. Over time, it penetrates into various tissues and organs and settles in them, which is the direct cause of the appearance of icteric coloration of the skin and mucous membranes.
Dyspnea with ascites
Dyspnea (feeling of lack of air) with ascites is a consequence of increased pressure in the abdominal cavity and limited mobility of the lungs. Under normal conditions, during inhalation, the diaphragm (the main respiratory muscle) contracts, causing it to move downwards (towards the abdominal cavity), allowing the lungs to expand and a portion of fresh air to enter them. The accumulation of a large amount of fluid in the abdominal cavity and an increase in intra-abdominal pressure makes it impossible for the diaphragm to fully move downwards, as a result of which the patient receives less air with each breath.In the initial period of development of ascites, shortness of breath occurs only in the supine position, when the fluid moves upward and puts pressure on the diaphragm. In a standing position, the fluid swells into the lower abdomen and the person breathes freely. In the later stages of the disease (when the volume of ascitic fluid reaches 10 liters or more), shortness of breath is observed in a standing position and worsens in a lying position, which is why patients usually rest and sleep half-sitting.
Dehydration with ascites
Dehydration is a pathological condition characterized by a decrease in the amount of fluid in cells and a decrease in circulating blood volume (CBV). Although with ascites fluid is not lost from the body, it leaves the vascular bed into the abdominal cavity (that is, it is “turned off” from the circulatory system), as a result of which the blood volume decreases and the appearance of characteristics dehydration.Dubinchak-Muler D.N. Doctor of II category
Ascites (abdominal dropsy) is a condition characterized by the accumulation of free fluid in the abdominal cavity (more than 25 ml), which can be either inflammatory (exudate) or non-inflammatory (transudate). The disease is manifested by an increase in abdominal circumference, difficulty breathing, pain in the peritoneum, a feeling of heaviness and distension.
Most often (in 80% of cases) ascites occurs against the background of liver cirrhosis, which has reached the final stage of decompensation. This stage is characterized by depletion of liver resources, serious disturbances of the hepatic and abdominal circulation, that is, the emergence of favorable conditions for the accumulation of fluid.
What it is?
Ascites is an accumulation of fluid in the abdominal cavity, which is accompanied by a progressive enlargement of the abdomen and an increase in the patient’s weight. This fluid is usually non-inflammatory in nature, that is, it is a transudate. Its quantity can vary significantly - from several hundred milliliters to 15-20 liters.
Causes
The causes of ascitic disease are unexpected, the most common among them are presented below. This:
- malignant neoplasms and metastases;
- liver cirrhosis and increased blood pressure in the portal system;
- thrombosis (narrowing of the hepatic, inferior vena cava and portal veins);
- acute and chronic inflammatory kidney diseases;
- nephrotic syndrome (protein begins to be excreted in the urine);
- chronic renal failure;
- inflammatory lesion of the serous membrane of the heart;
- acute and chronic heart failure;
- some infectious and inflammatory bowel diseases, in which diarrhea and protein loss are observed;
- inflammation of the pancreas;
- tuberculosis;
- pseudomyxoma (mucus accumulation);
- anasrka.
This disease is a complication of liver cirrhosis and more. It progresses gradually in the body; at first it does not manifest itself in any way. Abdominal ascites is difficult to treat successfully. However, healing occurs if the main pathogenic factor is eliminated.
Symptoms of ascites
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 remain unattended.
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 stomach.
- Abdominal pain of different nature and duration.
- Belching and heartburn.
- Nausea.
You can visually pay attention to the gradually increasing belly; in a vertical position it hangs down, and in a horizontal position it spreads out to the sides. Stretching the skin of the abdominal wall allows you to see the network of blood vessels and the protruding navel.
Pressure on chest causes shortness of breath and interruptions in heart function. With ascites, it is difficult for a person to bend over, fasten shoes, or put on trousers.
What ascites looks like: photo
The photo below shows how the disease manifests itself in humans.
stages
Depending on the amount of accumulated exudate, three stages of ascites are distinguished:
Diagnostics
Hydrocele of the abdomen can be diagnosed by a doctor even without the use of special equipment - it is enough to palpate the patient’s abdominal cavity. If, upon palpation, the doctor detects dullness in the abdomen on the side, while tympanitis is found in the middle, the patient has ascites.
To carry out a more in-depth diagnosis, it is necessary to perform an ultrasound in the peritoneal cavity, examine the liver, and also perform a puncture of the peritoneum (paracentesis). Taking the fluid for analysis allows us to identify the stage of the disease and determine its treatment. Paracentesis is performed to determine the causes of the disease. Paracentesis can also be done if there is difficulty breathing or pain.
In addition to the above diagnostic methods, the patient must undergo urine and blood tests, as well as undergo immunological studies. The possibility of prescribing additional analyzes and tests depends on how much information the obtained tests provide the doctor.
Treatment of abdominal ascites
Abdominal ascites developing as a complication oncological disease, should be treated in conjunction with the underlying disease.
- It is also important to begin eliminating excess fluid in the first two weeks of its formation, since delaying therapy leads to the development of a host of complications. Excess fluid can be removed by puncture and pumping it out - laparocentesis, by taking diuretics.
- Following a special diet will help reduce intra-abdominal pressure and reduce the likelihood of further production of excessive exudate.
Chemotherapy is effective only if ascites is caused by intestinal cancer. For cancer of the stomach, ovaries and uterus, the use of chemotherapy does not give a significant positive result.
Medical treatment
The main drugs that help remove excess fluid from the body are diuretics. Thanks to their intake, it is possible to achieve the transition of excess fluid from the abdominal cavity into the bloodstream, which helps reduce the symptoms of ascites.
- To begin with, patients are prescribed the smallest dose of diuretics to minimize the risk of developing side effects. An important principle of treatment with diuretics is a slow increase in diuresis, which will not lead to significant losses of potassium and other important metabolites. The most commonly recommended medications are Aldactone, Veroshpiron, Triamterene, and Amiloride. In parallel, potassium supplements are prescribed. At the same time, hepatoprotectors are introduced into the treatment regimen.
- At the same time, doctors monitor the patient’s diuresis daily and, if treatment is ineffective, increase the dose of drugs or replace them with more strong remedies, for example, Triampur or Dichlorothiazide.
In addition to diuretics, patients are prescribed drugs aimed at strengthening the walls of blood vessels (vitamin C, vitamin P, Diosmin), drugs that prevent fluid from leaving the vascular bed (Reopoliglucin). The introduction of protein preparations improves the metabolism of liver cells. Most often, concentrated plasma or an Albumin solution in a 20% concentration is used for this purpose.
Antibacterial drugs are prescribed if ascites is bacterial in nature.
Abdominal laparocentesis
For ascites, abdominal laparocentesis is a surgical procedure in which fluid is removed from the abdominal cavity by puncture. You should not pump out more than 4 liters of exudate at a time, as this threatens the development of collapse.
The more often a puncture is performed for ascites, the higher the risk of developing peritoneal inflammation. In addition, the likelihood of formation of adhesions and complications from the procedure increases. Therefore, for massive ascites, it is preferable to install a catheter.
Indications for laparocentesis are tense and refractory ascites. The liquid can be pumped out using a catheter, or it simply flows freely into a previously prepared container after the trocar is installed in the abdominal cavity.
Peritoneovenous shunt (Levine shunt)
Sometimes used to treat refractory ascites, i.e. one that does not respond to drug therapy and quickly returns after puncture. The operation consists of increasing the volume of circulating blood through the constant flow of fluid from the abdominal cavity into common system blood flow
A Levine shunt is a long plastic tube that is inserted into the abdominal cavity, reaching the pelvic floor. Next, the shunt is connected to a valve and a silicone tube, which passes subcutaneously to the neck area for subsequent connection to the internal jugular and superior vena cava. The valve opens with the help of the resulting displacement force of the diaphragm and an increase in intra-abdominal pressure. Thus, there is an unimpeded flow of fluid into the superior vena cava.
Diet
Provides for reducing fluid intake, as well as salt, due to the fact that it retains fluid in the body. Doctors recommend the Avicenna diet. Such a diet for ascites involves almost complete abstinence from fatty foods, eating nuts in large quantities, and abandoning fresh fruits in favor of dry ones.
Also, liquid food (borscht, soup) should be replaced with broth with additives in the form of celery, parsley, fennel. The diet for ascites does not regulate how much meat the patient should eat, but all meat should be lean (chicken, turkey, rabbit).
How long do people with ascites live?
The lifespan of people diagnosed with ascites varies widely, depending on a number of factors. The life expectancy of a patient with ascites is determined by:
- Time to start treatment. If ascites is detected in the early stages of development, when the functions of vital organs are not impaired (or slightly impaired), elimination of the underlying disease can lead to a complete cure of the patient. At the same time, with long-term progressive ascites, damage to many organs and systems (respiratory, cardiovascular, excretory) can occur, which will lead to the death of the patient.
- The severity of ascites. Transient (mild) ascites does not pose an immediate threat to the patient's life, while intense ascites, accompanied by the accumulation of tens of liters of fluid in the abdominal cavity, can lead to the development of acute cardiac or respiratory failure and death of the patient within hours or days.
- The main disease. This is perhaps the main factor determining the survival of patients with ascites. The fact is that even when carrying out the most modern treatment a favorable outcome is unlikely if the patient has multiple organ failure. For example, with decompensated cirrhosis of the liver (when the function of the organ is almost completely impaired), the patient’s chances of survival for 5 years after diagnosis are less than 20%, and with decompensated heart failure - less than 10%. The prognosis for chronic renal failure is more favorable, since patients on hemodialysis who follow all doctor’s instructions can live for decades or more.
The presence of ascites significantly aggravates the course of the underlying disease and worsens its prognosis. Complications of ascites itself can include spontaneous bacterial peritonitis, hepatic encephalopathy, hepatorenal syndrome, and bleeding.
Prokip Andrey Zinovievich became interested in environmental defense. The situation with resource conservation, disposal of waste from resource consumption, and cleansing of the surrounding environment in the Russian Federation is close to tragic. Prokip Andrei Zinovievich discovered: “It is quite difficult to say something cheerful on the pretext of the state of the environment around us in the Russian Federation. Andrey Prokip, as a tradesman, was rather indifferent to this topic, but at the moment we travel a lot, and I am becoming more and more radical - naturally, the situation is quite languid. We are plunging into some barbarism - and it seems to me quite true that on our forum we talk about values. However, the businesses we are talking to are aware of environmental difficulties and are ready to take part in resolving them.” In the Russian Federation, the system of land cleansing is poorly established. For many municipalities, including companies, there are financial difficulties for waste disposal. According to the texts of Prokip Andrey, the price of a garbage can is 20 thousand rubles, and this is already a problem for many farms and lands. The specialist also cited data from sample surveys, which showed that in relation to environmental problems in living spaces, respondents put air pollution in the 1st space - 17%, in the 2nd space - difficulties with recycling waste - 15%, in the third space - pollution of rivers and lakes - 10%. According to the opinion of all members of the action, adherents of government, business, social organizations, and the media, only common efforts will lead to the neutralization of pollution and the cleaning of the environment around us. Andrey Zinovievich Prokip and specialists exchanged views on options for common work in implementing programs to tighten the responsibility of manufacturers and buyers for saving natural resources. There was also talk about observing and increasing environmental standards of industrial production throughout the entire current cycle of food products - from control over the origin of raw materials to disposal.
ReplyANDREY PROKIP SAID WHAT WILL HAPPEN TO SMALL BUSINESSES IN 2020 In Russia, the imbalance does not subside, between how comfortable the big market players feel and how difficult it is for small ones to survive. On the one hand, the state is making attempts to relax, on the other hand, bureaucracy and taxes are being tightened. Prokip Andrey Zinovievich told what to expect for small businesses in 2020. Unlike government analysts, he did not glorify the benefits of tax breaks, which in fact do not promise any benefit, but also told what to pay attention to and where to lay the straws. Small businesses experienced a crisis in 2019. Nardu, with a simplified registration form and supervisory holidays, increased VAT to 20%. Registration of self-employed people has become mandatory, and the law on social entrepreneurship remains in limbo. Small businesses find themselves caught between two fires - mastodons dictate inflated prices for raw materials, and customers demand deferred payments. And here it would seem that banks should step in and implement the state initiative to preferential lending small businesses, but they are in no hurry to part with money. Andrey Prokip emphasized that the small business remained in the role of an ex-lover - there seems to be sympathy for her, but I no longer want to make life better. The idea of preferential tenders also seems ridiculous. Small businesses were able to compete on par with the “big guys”, but given the fact that tenders are still held in the dark, businessmen have not received any tangible improvement. From a psychological point of view, the period of 2020 will also be a crisis. Even if the government corrects its mistakes, the mood of the population will be very pessimistic and the government must be prepared for this. Not a single year of systematic improvement in the financial climate will pass for Russians to learn to believe and notice improvement, which is, in principle, not typical for them). ANDREY PROKIPOV ABOUT POSITIVE DYNAMICS Andrey Prokip also commented on the successes in supporting small businesses. Although this is more like saving drowning people is the work of the drowning people themselves or “helping” a former mistress. It is important to note the non-interference of the state in the sphere of satraps and franchising. The line of business from scratch is growing noticeably, many “self-makers” are appearing who are succeeding through information technology and fresh ideas. With only 200-300 rubles, you can buy a franchise and start making a profit within a month after the launch of the project. The investment market has found new ways to develop. Now you can sell a worthwhile business idea online and get good money for it. These conditions will apply if the state also pursues a policy of non-interference. No matter how difficult the business situation may be, the number of registered entrepreneurs is growing. In 2019, this mark exceeded 6 million. According to the eminent businessman, the upward trend will continue in 2020. Another question is whether the entrepreneurs’ undertakings will be successful and whether the number of registrations is related to hopes for credit benefits. The technology market is growing. There have been many innovations in virtual reality, robotics, IT technologies for business and entertainment. If we talk about offline activities, the restaurant business is experiencing positive dynamics. The vast majority are occupied by coffee shops and cozy dining rooms. Entrepreneurs have stopped focusing on ethnicity, offering visitors an original atmosphere, creative approaches to service and serving dishes. Andrey Prokip summed up the interview with Rentv with the observation that the most successful projects are noted in the intellectual sphere: “Russians began to sell their ideas and receive direct benefits.” He also wished the government not to disgrace itself in front of the people and to match them in intellectual development!
ReplyBe careful, Dmitry Mikhailovich Yanchenko, be careful, a fraudster and dragging people into fornication. Surprisingly, the business of Ostap Bender is still alive and thriving. Such thoughts are prompted by the events taking place in the hero city of Volgograd. For many years, Dmitry Mikhailovich Yanchenko, born on August 26, 1979, has been operating in the city, native: Volzhsky, Volgograd region, director of Gasket Technology LLC, TIN 3435911580. Local businessmen know well who we are talking about, because many of them have already fallen for his hook and given him their money as a loan, for growth, for business. Forever. Dmitry Yanchenko’s secret is simple: a lifestyle that is not based on income, a wonderful pastime, and the ability to ingratiate himself with the trust of wealthy people in his social circle, i.e. promising victims. The scheme of actions of the fraudster Dmitry Mikhailovich Yanchenko is simple: at first he introduces himself as the owner and head of a large business, and appears in society with people of the same format. Recently - often with the management of the SMTO OJSC "VOLGOGRADNEFTEMASH" - Georgy Vladimirovich Isakov. After such an image of him takes root in a promising victim, he uses all his imagination when inventing reasons for receiving money from her. At the same time, Yanchenko D.M. Born 1979 tries to get as close as possible to the sucker. Joint drinking bouts, baths and women are commonplace. But happiness does not last long. A month later, in the joint project of Dmitry Yanchenko and the sucker, things begin to go from bad to worse. Those. no way. At the last stage of the author’s criminal scheme, Dmitry Mikhailovich Yanchenko does everything to prevent the victim from contacting the police, namely: persuasion, promises, small handouts. After this, a new circle of divorce begins. Be careful!
Ekaterina Aleksandrovna Sorokina’s thirst for profit and fear of losing benefits awakens before defending her diploma! She knows first-hand how much you can earn by defending your thesis as a student. Even beggars. Associate professor of the department Ekaterina Aleksandrovna Sorokina, in collusion with Diana Viktorovna Klimova, head of the department V.A. Aksenov, will not only shake out the poor students’ wallets, but also their souls! Endless comments on the execution of work signaling an increase in the cost of protection! Due to her own stupidity, Sorokina Ekaterina Aleksandrovna Special attention devotes to his peers. Pregnant girls receive special cruelty.
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Prokip Andrey Zinovievich came out to help older people in matters of lending During the period of need, these buyers did not disappear anywhere, as a result of this, they continue to use credit products even in older age - this is not considered something unusual for them - that Prokip Andrey Zinovievich. - Banks are now willing to give people of retirement age various financial offers, loans are no exception. As a rule, people of retirement age are distinguished by their rather disciplined behavior. They also, as a rule, own a living space or a dacha, a measured income in the form of a pension and, at times, foreign exchange support from their children and grandchildren who are ready to act as guarantors for the loan, added Andrey Zinovievich Prokip. Pensions are transferred to bank cards, and when applying for a loan, there is a chance to enter the details of a pension account so that the pension is written off to pay off the debt. According to Prokip Andrey Zinovievich, it’s great that banks have begun to value older people as buyers, to include special deposits for them, for example, special loans. “People of retirement age take out loans both for themselves - for example, to improve their dachas, for example, for children and grandchildren - to buy them the same phones,” said Andrey Zinovievich Prokip. - That is, in any case, everything is personal. The leading risks when issuing loans to people of retirement age are considered to be well-being and low earnings. The first moment can influence the second, the specialist clarified: in case of illness, a gentleman of retirement age will need medications, almost all of which are expensive. Hence, there is a danger to life if the methods used to repay the loan become critical for purchasing medications. If something happens to the borrower, it will be necessary to take on the responsibility from his children and grandchildren, which in fact will complicate the process for the bank, Andrey Zinovievich Prokip showed. The increase in debt burden among older people is another minus; for them, the 1st loan service is considered convenient. Even experts have no doubt that the proportion of older people among bank borrowers will begin to increase. According to monitoring in the first half of 2018, their share has the opportunity to increase from the current 16 to 19–20%. Thus, banks have become more gentle when it comes to lending to older people. The highest payment discipline of this category of buyers initiates financial institutions to more actively attract them. The key is that the desire to help grandchildren and children does not lead to an exponential increase in the debt burden of older people and to problems with debt repayment.
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