There are several methods for determining ascites: visual examination of the patient, instrumental diagnostics and laboratory tests. The first two areas of research help to identify the presence of excess fluid in the abdomen, the third is designed to find the causes of the disease. Normally, in a healthy person between the visceral and parietal peritoneum there is only 75 ml of ultrafiltrate. It helps to eliminate the process of friction between two organs that are in close contact with each other( the small and large intestine, for example).Today, the diagnosis of ascites is made when the volume of fluid increases to 1.5 liters.
When a patient means ascites, the diagnosis begins with the collection of an anamnesis of the pathological condition. First of all, existing complaints are identified and recorded. It is important to find out when the first symptoms of ascites appeared, what binds them to the patient, whether there are any chronic diseases. The doctor necessarily asks about the previous illnesses, and about the presence of operations, infections.
The visual inspection is then carried out. The abdomen volume is measured, the skin condition is studied. Answering the question how to determine ascites, any experienced physician will pay attention to the roundness of the abdomen, to the strained transparent skin, which is very smooth to the touch. At a palpation the diffusive soreness of a skin is revealed. When fluid in the peritoneum accumulates gradually, the lower ribs rise, and the lower part of the chest widens. In the act of breathing, the diaphragm gradually turns on, and this too becomes visually visible, which means that it confirms the diagnosis.
If ascites are suspected, further diagnosis is performed using percussion. The patient is laid in a prone position, the liquid all leaves in the rear lower divisions, the intestine filled with air, on the contrary, floats up. Tapping on the upper wall of the peritoneum allows us to reveal the tympanic sound, strokes on the lower sections give rise to a dead wave. The presence of tympanic sound indicates that at least half or two liters of water has accumulated in the stomach. The presence of a smaller volume of percussion does not allow to identify, in this case the diagnosis is confirmed differently.
Instrumental Diagnosis of Ascites
Today, the diagnosis of ascites in earlier stages is performed using X-rays. It can show the presence of any amount of fluid. But to determine its volume is possible only with the help of ultrasound and tomography, ascites on ultrasound looks anechogenic with rare echogenic inclusions. Using ultrasound, you can find out the cause of ascites( liver cirrhosis, alcoholic hepatitis, kidney failure, Budd syndrome, pancreas disease, gallbladder or bile ducts).
The same ultrasound will show if there is inflammation of the pelvic organs, tumors of the abdominal cavity. To clarify the diagnosis of ascites, computed tomography also helps. A three-phase contrast study, as well as magnetic resonance imaging, is suitable when the diagnosis of ascites can be a consequence of oncology.
If the doctor suspects any particular cause of ascites development, he can prescribe additional methods for instrumental ascites determination:
- Dopplerography can detect cardiac venous blood flow disturbances.
- Hepatoscytigraphy is used for suspected kidney disease.
- Ezofogastroscopy confirms the presence of varicose veins of the stomach and esophagus.
Laboratory diagnostics of ascites
Laboratory diagnostics is actively used to detect etiology of hydrocele. The patient is assigned:
- General analysis of blood and urine.
- Biochemical blood test.
- Analysis of HBsAg and anti-HBs( confirms the presence of viral hepatitis).
- Rivolta test.
Speaking about how to determine ascites, experts pay attention to the procedure of laparocentesis. With the help of it, the fluid accumulated in the abdomen is collected. Its composition is also carefully studied. Specialists identify:
- The number of inflammatory cells.
- Number of neutrophils.
- The amount of protein in the blood.
- Presence or absence of a tuberculosis pathogen.
- The level of glucose and the qualitative composition of enzymes.
- The presence or absence of malignant cells.
In addition, using a liquid, experts make bacterial seeding and identify the possibility of infection. Such a diagnosis helps to prevent worse forecasts.
Differential diagnosis of ascites
The visual signs that the disease manifests can be similar to the symptoms of ovarian cysts, mesentery or retroperitoneal cyst. Education sometimes fill the entire cavity of the peritoneum, so a large rounded abdomen appears. To exclude a similar pathology, differential diagnostics helps, in this case the methods for determining ascites are based on the principle of exclusion of symptoms that do not fit into the anamnesis or etymology of hydrocephalus. Today, differential diagnosis of ascites is used quite actively where it is possible to apply all the methods of diagnosing described above.