The detailed etiology of hydrocephalopathy tells about the causes of its origin, the pathogenesis of ascites allows to understand how a dangerous complication develops and what happens in the body with a large accumulation of fluid in the abdomen. Correctly assembled clinic contributes to the development of an effective treatment strategy, which allows to significantly alleviate the patient's condition and achieve, in some cases, his recovery. That is why it is so important to describe in detail the mechanism of formation of abdominal dropsy.
In a patient, dropsy of the abdomen can occur for various reasons, but, as practice shows, in 75% of cases it develops against a cirrhosis of the liver, it is the dropsy of the abdomen that often becomes a source of liver failure and early portal hypertension. In the hepatic veins, normal blood circulation is disturbed, it forms an increase in pressure in both the inferior vena cava and in the portal vessels. Almost always the clinic of such ascites shows a deficiency anemia, constant inflammatory processes provoke hyperleukocytosis( change in the rate of proliferation of leukocytes) and protein starvation.
Further, the pathogenesis of ascites provokes a permanent deterioration in the patient's condition and signals that the patient has lived no more than five years. The accumulation of fluid occurs rapidly, sometimes up to 20 liters of transudate accumulates in the abdomen. In this situation, the abdominal circumference greatly increases in size, in the vertical position the peritoneum looks saggy, the navel protrudes outward, a blue mesh of venous vessels emerges around it.
The boundaries of fluid accumulation are easily determined by percussion. The patient is placed on the couch first in a lying position. This position allows you to see the flattening of the abdomen. Water under the influence of gravitation goes to the lower divisions, the belly becomes like a belly of a frog. Moving the patient to the side, the doctor makes a sharp clap with the palm of his hand, it echoes instantly in the opposite direction, and the echo produces a wavy effect. Fluctuation is an important part of the ascites clinic. When the etiology of complication is associated with cirrhosis of the liver, bleeding of the esophagus and porto system collaterals becomes possible.
Increased pressure inside the abdominal cavity provokes squeezing of the inferior vena cava, the pathogenesis of ascites leads to the development of kavo-worm collaterals, after pumping out the liquid, they instantly disappear.
When the etiology of ascites is associated with heart failure, pathogenesis indicates the presence of fluid in the pleura, the clinic notices the state of the hydrothorax. When the disease progresses, the diaphragm is pushed up and enters the chest cavity. The patient becomes difficult to breathe, signs of panic and suffocation are instantly reflected on the face in the form of cyanotic puffiness. This is because the movement of the lungs becomes limited, so the pathogenesis of ascites often causes pulmonary insufficiency.
Secondary manifestations of ascites
When ascitic stress is diagnosed, the clinic and pathogenesis show the following secondary manifestations:
- Right-sided pleural effusion( left-sided pleural effusion is a sign of tuberculosis).
- Hypoproteinemic edema.
- The apical impulse of the heart.
- Swelling of the cervical veins.
What can be added to the pathogenesis of ascites?
The expanded clinic and pathogenesis of complications is formed after puncture of ascites fluid. It is always produced, even when the etiology of the complication is obvious. If a large amount of protein is detected in the fluid, this fact indicates either infection of the transudate, or the presence of Badda-Cairo syndrome, or that the disease is taking place against the background of pancreatitis.
The increase in the difference between serum and ascites albumin indicates the existence of portal hypertension.
The very color of the liquid can also tell a lot. Good predictions can be made when a puncture allows you to see clear water or a transudate of a green, straw-colored hue. Admixtures of blood, as a rule, almost always indicate that the etiology of dropsy has a cancer rationale.
Detailed pathogenesis, clinic and etiology of ascites are the three components that allow you to make accurate diagnoses and build the right treatment strategy.