By the amount of fluid inside the abdominal cavity, three degrees of ascites can be distinguished. The first degree is diagnosed when the amount of accumulated water does not exceed three liters. In this case, laparoscopy is mandatory. Puncture allows to determine the qualitative composition of the transudate. If there are no blood impurities in it, the prognosis for recovery is almost always high. Development of the first degree is preceded by a minimal ascites, in which the amount of liquid does not exceed 400 ml.
On the second degree of ascites, more than three liters of fluid accumulate inside the abdominal cavity. In this case, the abdomen noticeably increases in size, but the abdominal wall itself does not stretch. The diaphragm does not rise yet, so the patient does not yet have difficulty breathing. But the first signs of hepatic insufficiency appear, they often provoke disorders of brain activity, so hepatic encephalopathy develops.
The third degree of ascites indicates that 10 to 20 liters of transudate accumulate in the abdomen. The abdomen becomes very large in size, the skin becomes thin, so a mesh of venous vessels becomes visible through it. As the volume of the abdomen increases, the abdominal wall strongly stretches and hangs. The navel protrudes outward. A large volume of water raises the diaphragm, the lungs do not open completely, so the patient begins to experience respiratory failure. The absence of oxygen changes the composition of the blood, cardiac activity is disrupted. The person starts to get tired quickly, his whole body swells. The third degree is a dangerous state that can provoke a fatal outcome.
Three degrees of ascites make it possible to form a classification of complications, but physicians pay attention not only to the external signs of hydrocephalus. Depending on the "how the fluid behaves", they distinguish the following types of ascites: intense, pronounced, chylezny, mild, repeated and refractory. What are the characteristics of each type of ascites?
Intensive and pronounced ascites
The diagnosis of strenuous ascites is made when the amount of fluid exceeds 10 liters( dropsy of the third degree).It develops in the third stage. The volume of the accumulating liquid increases rapidly. The abdomen becomes round, the skin stretches out, becomes tense, shiny and smooth to the touch. Over time, with the progression of the complication, the skin of the hernial sac can tear, some liquid in this case pours out.
Physicians pay attention to the fact that pronounced ascites is very dangerous. With this form of complication, the fluid can easily become infected. With a bundle, intense or severe ascites and peritonitis in 50% of cases a lethal outcome occurs. Those who survived in 70% of cases, within a year there is a relapse.
Treated and pronounced types of ascites are treated with complex therapy. The patient is advised to adhere to the pastel regimen, strictly follow the diet, treat the disease, which provoked dropsy. Patients who are diagnosed with a third stage of dropsy, a procedure of laparocentesis is necessarily indicated.
Moderate ascites
Favorable predictions have moderate ascites, it, unlike the strained, flows slowly, the fluid accumulates for several weeks or even months, so the degree of complication is gradually formed. When a moderate appearance is diagnosed, there is not only an increase in the abdomen, but also swelling of the extremities. The thorax increases in size, the patient has an inguinal or umbilical hernia. He complains of a constant weight in the abdomen, a feeling of strong bursting, he is troubled by heartburn and problems with the stool.
To distinguish between moderate ascites from a strenuous visually simple. The described type of the disease is characterized by softness of the abdomen. This stage of the disease is treatable, predictions with proper therapy are almost always positive. A mild edema of the abdominal cavity is treated with albumin infusions and diuretics. If necessary, laparocentesis is prescribed, but you should not abuse this procedure. Repeated removal of fluid from the abdomen can significantly worsen the patient's condition and provoke the development of peritonitis. What happens with a combination of ascites and peritonitis, we already know.
According to the effectiveness of therapeutic measures, doctors allocate another type of hydrocele - the minimum. It precedes the first degree of complication development and indicates that a small amount of transudate accumulated inside the abdominal cavity( up to 400 ml).The initial minimal ascites can be detected only with the help of ultrasound. Other visual methods of the study determine the onset of complications can not. That is why the very first degree of dropsy passes almost imperceptibly.
Chile ascites
This is a rare complication of far-reaching hepatic cirrhosis( last degree) or abdominal obstruction of the lymphatic duct, peritoneal cord or chronic inflammation of the intestine. The ascitic fluid is white to milky. This is because a large number of fat cells enter the transudate, they appear in the liquid for several reasons:
- As a result of the development of hydrostatic hypertension forming in the lymphatic vessels( pressure loss can lead to the rupture of some of them, then the lymphatic contents enter the stomach).
- After a complicated surgical procedure, which is performed in the retroperitoneal space.
- Quite often the chylous form of ascites becomes a complication of pancreatitis and tuberculosis.
- Sometimes the described complication is the result of dangerous injuries of organs located in the abdominal cavity.
Diagnosis of chylous ascites is performed by puncture fluid. In addition to fat cells, proteins are found in it, a high concentration of triglycerides and lymphocytes. If the patient follows a hunger diet, the fluid becomes serous.
Treatment of the described complication is reduced to the appointment of adequate nutrition. The daily diet includes a large amount of protein food and excludes completely those that contribute to the accumulation of internal fat. Laparocentesis is prescribed only at those stages when this type of ascites has a third degree of severity, which causes respiratory insufficiency. If conservative treatment does not help, laparotomy is used, it helps to find and eliminate the outbreak of lymph.
Repeated and refractory ascites
According to the reaction of the body to the applied drug therapy, ascites can be classified as repeated and refractive. Usually, the diagnosis of repeated ascites is made when the transudate in the abdomen appears again after the procedure of the laparocentesis. It can indicate that the cause of hydrocephalus has been incorrectly identified, that the chosen treatment does not give positive results. Conduct laparocentesis once again is very dangerous. It can lead to local inflammation of the peritoneum, to adhesions in the intestinal loops, to the threat of peritonitis. Therefore, it is so important to use all diagnostic tools to identify the source of a formidable complication.
Unlike repeated hydrocele, the refractory appearance of ascites is not a relapse. This type of complication is diagnosed when hydrocortisies are not amenable to drug treatment. Try to eliminate refractory ascites only in an operative way. Laparocentesis gives only temporary relief, after which the liquid again accumulates in the abdominal cavity( a third degree is formed).It can be pumped several times, but this situation does not change the situation.
What can help eliminate this kind of ascites? The therapeutic strategy is built on two components. The patient is shown liver transplantation or transgular intrahepatic portosystemic shunting. Forecasts in this case allow to count on positive results when the first two degrees of complication are revealed.