When a large amount of liquid accumulates in the abdominal cavity, and the stomach becomes inflated and becomes like a ball, when the abdominal wall dilates provokes protrusion of the navel outward, the ascites of the abdominal cavity( abdominal edema) is diagnosed. Such a condition is not a disease, but a consequence, a complication of other diseases. At the first signs of fluid accumulation( especially when it occurs rapidly), it is necessary to immediately seek help from specialists. And all because the dropsy of the abdominal cavity puts pressure on all internal organs located in the peritoneum, disrupting their normal functioning.
Why does fluid accumulate in the abdomen?
In an adult, abdominal dropsy develops for various reasons. It can become a consequence:
- Increased pressure inside the portal vein. It drains blood from all internal organs located in the described area. Sometimes the outflow of blood is blocked. When cirrhosis develops, it overlaps at the level of the liver, with thrombosis of the hepatic veins, above it, with thrombosis of the portal vein - under the liver. Any compression leads to an increase in hydraulic pressure, so the plasma in the stomach, in the intestine, in the spleen gradually through the walls of the organs begins to ooze and accumulate in the abdomen. This is how ascites is formed in most cases.
- Alcoholic hepatitis, developing against a background of permanent inflammation of the liver, caused by toxic effects.
- Chronic heart failure. The principle of fluid formation is the same as in the first described case. Because of a pressure disorder, stagnation occurs in the large circle of the circulation. There is edematous syndrome, which provokes the release of plasma.
- Alimentary dystrophy.
- Appearance of any obstruction to lymph drainage in the thoracic region.
- Peripheral carcinomatosis( metastasis of malignant tumors).
- Ascites peritonitis( involvement of the peritoneum in the tuberculosis process).
- Pathologies of the pancreas.
The indicated reasons can be combined with each other, making the patient's condition particularly difficult. For example, cirrhosis of the liver is often accompanied by a decrease in the level of protein in the blood. It, in turn, provokes a decrease in oncotic pressure, the plasma begins to stagnate, so it easily seeps through the walls of the vein and accumulates in the abdomen. Still ascites of the stomach can develop due to a violation of the water-salt balance.
Causes of ascites in children
Often abdominal dropsy occurs in children. It can be a consequence of congenital, hereditary and acquired factors. Congenital pathologies are three:
- Rhesus is a conflict between the blood of the mother and the fetus.
- Swelling, provoked by hidden blood loss.
- The presence of nephrotic syndrome.
An hereditary factor occurs when an infant is diagnosed with exudative enteropathy. Sometimes ascites in children is formed as a result of lesions of the bile ducts or against the background of a chronic disturbance of the gastrointestinal tract, when a severe form of dystrophy develops due to a lack of proteins in the daily diet of the infant.
It should be noted that ascites in older children develops for the same reasons as in adults.
How does hydrocurrents appear?
Symptoms that have a dropsy of the abdominal cavity in humans are obvious. In some cases, gradually, in others rapidly, the stomach of the patient noticeably increases in size and becomes like a maximally inflated ball. It can protrude, or hanging in its lower half. If the patient lies on his back, the rounded abdomen is flattened.
When the abdominal dropsy develops in people, the peritoneal wall tightens, the skin tightens and becomes thinner than usual, so all the veins become visible through it. The navel begins to bulge outward, white stretches gradually form around it.
In addition, to the general symptoms are added those that may indicate the cause of the development of ascites syndrome. So, for example, if portal hypertension became the culprit in the development of pathology, there are no swelling. But clearly visible expansion of the subcutaneous veins, located on the side of the navel or around it. It has a form that looks like the head of the Gorgon. If the syndrome of ascites is accompanied by severe edema, it is very likely that the patient is diagnosed with hydropericardia or hydrothorax.
Basic forms of edema of the abdominal cavity
In the international disease classification, the disease of ascites( abdominal edema) is not a separate disease. In fact, this is a complication of other pathologies that has arisen in the last stages. But ascites also has its own code for ICD 10. There it appears in section R00-R99( Symptoms, signs, abnormalities revealed in laboratory tests that do not appear in other illnesses), ICD code R10-R19( Symptoms and signs related to diseasesdigestion and abdominal cavity).The code for the ICD is 10 R18( Ascites).
The brightness of the manifestation of edema of the abdomen can be of several kinds:
- The initial ascites of the abdominal cavity with a small amount of fluid inside the stomach( up to one and a half liters).
- Ascites with a moderate amount of water. It manifests itself in the form of edema of the lower extremities and a noticeable increase in the size of the thorax. The patient is constantly disturbed by shortness of breath, severe heartburn, he feels a heaviness in his stomach. The condition worsens the appearance of constipation.
- Massive dropsy( large amount of water, more than 5 liters) is a dangerous disease. The skin on the abdomen becomes smooth and transparent, the peritoneal wall is strained as much as possible. At this stage, the patient develops respiratory and heart failure, the fluid can become infected and provoke peritonitis, which in most cases ends in a fatal outcome.
For liquid quality:
- Sterile hydrocele( analysis of fluid intake shows the absence of pathogens).
- Infected hydrops( analysis of fluid intake shows the presence of pathogenic bacteria in it).
According to the expected prognosis:
- Abdominal cramp, amenable to drug therapy.
- Persistent ascites( re-dropsy, or ascites, not amenable to drug treatment).
Diagnosis of ascites
Increased abdominal volume can trigger not only ascites. Sometimes an ovarian cyst or a mesentery cyst can fill the entire space of the peritoneum, so it is so important to make an accurate diagnosis. How can hydrocystitis be diagnosed? Confirm the fears helps visual inspection of the patient, instrumental examination methods and laboratory tests.
At visual inspection the doctor preliminary hears complaints of the patient, carefully collects the anamnesis, and then starts studying of a pathological site. The fact that abdominal edema develops indicates two phenomena: a dull sound when tapping the swollen areas of the abdomen, and transfer wounds from the opposite side, which are formed after a steep hand stroke from one side. The presence of a cyst is indicated by an asymmetric form of the swollen abdomen, with ascites the belly swells evenly, which is why the peritoneum looks like an even ball.
As an instrumental diagnosis, ultrasound and computed tomography of the abdominal cavity are used. Both methods allow to reveal any, even insignificant accumulation of water, to estimate its volume, and even to see the cause of the development of the described complication.
Mandatory and puncture - drawing fluid from the inside of the abdomen. The extracted liquid is sent to the laboratory after sampling. Biochemical and microbiological analysis of extracted water is performed, as well as cytology. Such studies help determine the specific gravity of the plasma, the total number of cellular elements that are present in it, deduce the leukocyte formula, identify the presence of malignant processes, determine the total amount of protein. Due to the availability of modern endoscopic equipment, abdominal puncture allows simultaneous elimination of a small amount of liquid( up to five liters), simultaneously with diagnostic procedures, that is, to treat ascites even at the stage of setting the right diagnosis.
Assays for ascites of the abdominal cavity
If the abdominal swelling is visually observed, the doctor will prescribe the following laboratory tests to confirm the diagnosis and ascertain the causes of ascites:
- A general blood test helps to determine the presence of liver cirrhosis. It is indirectly indicated by the presence of anemia and increased content of ESR.
- The general analysis of urine, confirms the presence of cirrhosis. On the dropsy of the abdomen indicates protein in the blood, the presence of cylinders and red blood cells. Urinalysis can also show signs of kidney disease. Violation of their functions leads to the appearance in the urine of massive proteinuria, cylindruria. Similarly, with kidney diseases, the density of urine increases severalfold.
- Biochemical blood test is done to detect the level of protein in the blood.
- Investigation of fluid obtained from abdominal puncture: general analysis( transparency test, presence of blood impurities, alkaline reaction, protein content), cytological examination( helps to determine the absence of a dropsy of tumor origin), bacteriological examination( helps to determine absence of tuberculosisabdominal cavity).
- Rivolta test - a reaction to protein, allows you to distinguish between exudate and transudate. Such an analysis is used to reveal the nature of the fluid accumulated in the abdominal cavity.
Additionally, chest X-ray and esophagoscopy of the esophagus can be prescribed.
Ascites during pregnancy
If ascites is diagnosed, the condition of the expectant mother is assessed as extremely dangerous. The accumulated fluid exerts pressure on all internal organs, and on the fetus as well. And to apply medicamentous treatment in the period is impossible. You can not pump out water with a puncture. Therefore, ascites during pregnancy casts doubt on the full bearing of the fetus. Those women who are at risk should undergo a comprehensive preventive examination in advance and at the initial stage receive a course of treatment at the first signs of ascites. Since the dropsy of the abdomen in pregnant women most often arises from the presence of liver diseases, it is useful to pay great attention to their diets and try to exclude from it those foods whose digestion increases the burden on the diseased organ. It is also important to maintain and work the heart. Try to protect yourself from psycho-emotional stress. Then, perhaps, the disease will not develop rapidly.
Features of therapy of ascites of the stomach
How is the complication that is called hydrocele? Therapy is carried out in two ways. The patient is prescribed medication with surgical techniques. The main thing in the entire process is to correctly identify the cause of the disease and eliminate it. Extra fluid from the abdomen is pumped out. Manipulation is carried out under stationary conditions under local anesthesia( a 0.5% injection of novocaine is made, 20 ml is injected into soft tissues into a place located exactly in the middle between the navel and the pubis).The patient assumes sitting position. After anesthesia, the surgeon makes a scalpel cut, then a trocar is inserted into the wound, similar to a stylet inserted into the sleeve. It's hollow. It is through the sleeve that drainage is introduced, which helps pump excess fluid out of the abdominal cavity.
If the cause of ascites is not eliminated, the fluid accumulates again in the peritoneum. And this is an unfavorable sign. And all because the described phenomenon can be complicated by peritonitis, heavy bleeding, failure of some liver functions and brain failure due to the development of edema. In addition, a large volume of fluid begins to gradually squeeze the diaphragm, lifting it. This leads to the appearance of a strong sniff at walking, to suffocation, to the appearance of signs of a chronic lack of oxygen in the body.
Ascites do not go away with itself, it constantly progresses, and this is the danger of dropsy of the abdominal cavity.
Possible prevention of ascites
Of course, pathology is easier to prevent than treat. Prophylaxis of ascites is possible. That it is necessary to do:
- To timely treat diseases that can provoke the development of dropsy. All of them are listed above, in the section "Reasons".
- If you have any swelling, you should immediately stop using excess fluid. It is necessary to refuse carbonated drinks and coffee.
- It is useful to eat less salt.
- It is necessary to try to avoid excessive physical and psychoemotional loads.
At the first signs of ascites, it is important to consult a doctor and not engage in self-medication. Very dangerous can be an edema of the abdominal cavity, it develops rapidly, it takes a long time to reveal the reasons, so it is important not to miss the moment of the "point of no return".The prognosis is determined by the development of the underlying disease - the culprit of dropsy. A severe form is diagnosed when, in the presence of a drug treatment, the water in the stomach continues to accumulate and is constantly increasing. Accumulation of the amount of water necessarily leads to aggravation of the severity of the underlying disease.