Fluid in the abdomen causes. Abdominal ascites in cancer: causes, symptoms, treatment and prognosis. Birch infusion bath

• abdominal percussion;
• palpation of the abdomen;
• laboratory tests;
• ultrasound examination (ultrasound);
• diagnostic laparocentesis (puncture).

Percussion of the abdomen for ascites

Palpation of the abdomen with ascites

By palpation you can detect:

• Enlarged liver. May be a sign of cirrhosis or liver cancer. The liver is dense, its surface is lumpy and uneven.
• Enlarged spleen. In healthy people, the spleen is not palpable. Its increase may be a sign of progressive portal hypertension (with cirrhosis or cancer), tumor metastasis, or hemolytic anemia (in which blood cells are destroyed in the spleen).
• Signs of inflammation of the peritoneum (peritonitis). The main symptom indicating the presence inflammatory process in the abdominal cavity, is the Shchetkin-Blumberg symptom. To identify it, the patient lies on his back and bends his knees, and the doctor slowly presses his fingers on the anterior abdominal wall, after which he sharply removes his hand. The severe acute pain that appears in this case indicates peritonitis.

Symptom of fluctuation in ascites

A symptom of fluctuation can be detected if there is more than 1 liter of fluid in the abdominal cavity. At the same time, with severe ascites it may be uninformative, since it is excessively high pressure in the abdominal cavity will not allow you to correctly conduct the study and evaluate its results.

Tests for ascites

For ascites, the doctor may prescribe:

• general blood analysis ;
• blood chemistry;
• general urine analysis ;
• bacteriological examination;
• liver biopsy.

In infectious and inflammatory diseases of the abdominal organs (in particular with peritonitis and pancreatitis), there may be a marked increase in the concentration of leukocytes (as a response of the immune system in response to the introduction of a foreign infection) and an increase in the erythrocyte sedimentation rate (ESR), which also indicates the presence of an inflammatory process in organism.

Biochemical blood test (BAC)
This study estimates the number various substances in the blood, which allows one to judge the functional activity of certain organs.

With cirrhosis of the liver, there will be an increase in the concentration of bilirubin (due to a decrease in the neutralizing function of the organ). Cirrhosis is also characterized by a decrease in the concentration of proteins in the blood, since they are all formed in the liver.

In case of inflammation of the peritoneum or pancreatitis, BAC allows one to detect an increase in the concentration of proteins in the acute phase of inflammation (C-reactive protein, fibrinogen, ceruloplasmin and others), and their concentration in the blood directly depends on the severity and activity of the inflammatory process. This allows you to recognize peritonitis in a timely manner, as well as monitor the patient’s condition over time during treatment and identify possible complications in a timely manner.

With renal ascites (developing as a result of kidney failure), the concentrations of substances in the blood that are usually excreted by the kidneys will increase. Of particular importance are substances such as urea (normal 2.5 – 8.3 mmol/liter), uric acid (normal 120 – 350 µmol/liter) and creatinine (normal 44 – 100 µmol/liter).

LBC is also important in diagnosing pancreatitis (inflammation of the pancreas). The fact is that as the disease progresses, the gland tissue is destroyed, as a result of which digestive enzymes (pancreatic amylase) enter the blood. Increased concentration pancreatic amylase more than 50 Action Units/liter (U/l) allows you to confirm the diagnosis.

General urinalysis (UCA)
A urine test can reveal abnormalities in the functioning of the urinary system. IN normal conditions More than 180 liters of fluid are filtered through the kidneys daily, but about 99% of this volume is absorbed back into the bloodstream. On initial stage renal failure, the concentration and absorption function of the kidneys may be impaired, resulting in the release of a larger amount of less dense urine (normal specific gravity of urine ranges from 1010 to 1022). In the terminal stage of the disease, the specific gravity of urine may be normal or even slightly increased, but total urine output per day is significantly reduced.

In nephrotic syndrome, there will be urine leakage increased density, in which an increased concentration of proteins will be determined (more than 3.5 grams per day). OAM is also valuable in diagnosing pancreatitis, since with this disease the concentration of amylase increases not only in the blood, but also in the urine (more than 1000 U/l).

Bacteriological research
This study is of particular value for bacterial and tuberculous peritonitis. Its essence is to collect various biological material (blood, ascitic fluid, saliva) and isolate pathogenic microorganisms from it that could cause the development of an infectious-inflammatory process. This allows not only to confirm the diagnosis, but also to determine those antibiotics that are best suited to treat the infection in a given patient (the sensitivity of different bacteria to antibacterial drugs is different, which can be determined in the laboratory).

Liver biopsy
During a biopsy, a small fragment of the patient's liver tissue is removed intravitally for the purpose of examining it in the laboratory under a microscope. This study allows you to confirm the diagnosis of cirrhosis in more than 90% of cases. For liver cancer, a biopsy may be uninformative, since no one can guarantee that cancer cells will end up in exactly the area of ​​liver tissue that will be examined.

Ultrasound for ascites

This study is absolutely harmless and safe; it can be performed many times during the entire treatment period to monitor the patient’s condition and timely identify possible complications.

Ultrasound can reveal:

• Free fluid in the abdominal cavity– even a small amount of it (several hundred milliliters) is determined.
• Fluid in the pleural cavity and pericardial cavity– for systemic inflammatory diseases and tumors.
• Liver enlargement– for cirrhosis, cancer, hepatic vein thrombosis.
• Enlarged spleen– with increased pressure in the portal vein system (portal hypertension) and with hemolytic anemia (accompanied by the destruction of blood cells).
• Dilatation of the portal vein– with portal hypertension.
• Dilatation of the inferior vena cava– with heart failure and stagnation of blood in the veins of the lower body.
• Kidney structure disorder– in case of renal failure.
• Violation of the structure of the pancreas- with pancreatitis.
• Anomalies of fetal development.
• Tumor and its metastases.

MRI for ascites

This study allows us to detect even small amounts of ascitic fluid located in hard to reach places abdominal cavity that cannot be examined using other methods. MRI is also useful in diagnosing liver cirrhosis, benign and malignant tumors of any location, peritonitis, pancreatitis and other diseases that could cause ascites.

Other instrumental studies for ascites

To identify the cause of ascites, your doctor may prescribe:

• Electrocardiography (ECG). This study allows you to evaluate the electrical activity of the heart, identify signs of enlarged heart muscle, heart rhythm disturbances and other pathologies.
• Echocardiography (EchoCG). This study evaluates the nature of heart contractions during each systole and diastole, and also evaluates structural disorders of the heart muscle.
• X-ray examination. A chest x-ray is prescribed to all patients if ascites is suspected. This simple study allows us to exclude infectious diseases of the lungs and pleurisy. X-ray of the abdominal cavity can reveal an enlarged liver, the presence of intestinal obstruction or perforation (perforation) of the intestine and the release of some gases into the abdominal cavity.
• Dopplerography. This study is based on the principle of ultrasound using the Doppler effect. Its essence lies in the fact that during ultrasound examination, approaching and separating objects (in particular blood in blood vessels) will reflect sound waves differently. Based on the results of this study, it is possible to evaluate the nature of blood flow through the portal vein and other blood vessels, it is possible to identify the presence of blood clots in the hepatic veins and determine other possible disorders.

Laparocentesis (puncture) for ascites

Diagnostic laparocentesis is contraindicated:

• If there is a violation of the blood coagulation system, since this increases the risk of bleeding during the study.
• If the skin in the area of ​​the anterolateral wall of the abdomen is infected, since during a puncture it is possible to introduce infection into the abdominal cavity.
• At intestinal obstruction(there is a high risk of needle perforation of swollen intestinal loops, which will lead to the release of feces into the abdominal cavity and the development of fecal peritonitis).
• If you suspect a tumor near the puncture site (damage to the tumor with a needle can trigger metastasis and spread of tumor cells throughout the body).

Preparing the patient
Preparation for the procedure consists of emptying the bladder (if necessary, a special catheter can be installed in it), stomach (up to rinsing through a probe) and intestines. The procedure itself is performed under local anesthesia (that is, the patient is conscious), so particularly sensitive and emotional patients can be prescribed light sedatives.

Lidocaine and novocaine (local anesthetics injected into soft tissues and suppressing pain and other types of sensitivity for a while) quite often cause allergic reactions(up to anaphylactic shock and death of the patient). That is why an allergy test is required before starting pain relief. On the skin of the patient’s forearm, 2 scratches are made with a sterile needle, anesthetic is applied to one of them, and regular anesthetic is applied to the other. saline. If after 5–10 minutes the color of the skin above them is the same, the reaction is considered negative (no allergy). If there is redness, swelling and swelling of the skin above the scratch with an anesthetic, this indicates that the patient is allergic to this anesthetic, so its use is strictly contraindicated.

Technique of the procedure
The patient takes a semi-sitting or lying (on his back) position. Immediately before the puncture begins, it is covered with sterile sheets so that only the area of ​​the anterior abdominal wall through which the puncture will be performed remains free. This reduces the risk of developing infectious complications in the postoperative period.

The puncture is usually made along the midline of the abdomen, between the navel and pubic bone(this area contains the fewest blood vessels, so the risk of injury to them is minimal). First, the doctor treats the site of the intended puncture with an antiseptic solution (iodine solution, hydrogen peroxide), after which he injects the skin, subcutaneous tissue and muscles of the anterior abdominal wall with an anesthetic solution. After this, a small skin incision is made with a scalpel, through which a trocar (a special instrument that is a tube with a stylet inside) is inserted. The trocar is slowly moved deeper with the help of rotational movements until the doctor decides that it is in the abdominal cavity. After this, the stylet is removed. The leakage of ascitic fluid through the trocar indicates a correctly performed puncture. The required amount of fluid is taken, after which the trocar is removed and the wound is sutured. The test tube with the resulting liquid is sent to the laboratory for further research.

Interpretation of research results
Depending on the nature and composition, two types of ascitic fluid are distinguished - transudate and exudate. This is extremely important for further diagnosis, since the mechanisms of formation of these liquids are different.

Transudate is an ultrafiltrate of plasma formed when fluid sweats through blood or lymphatic vessels. The cause of the accumulation of transudate in the abdominal cavity may be heart failure, nephrotic syndrome and other pathologies accompanied by an increase in hydrostatic pressure and a decrease in oncotic blood pressure. In a laboratory study, transudate is defined as a clear liquid of low density (specific gravity ranges from 1.006 to 1.012). The protein concentration in the transudate does not exceed 25 g/l, which is confirmed by special tests.

Exudate, in contrast to transudate, is a cloudy, shiny liquid, rich in proteins(more than 25 g/l) and other micromolecular substances. The density of the exudate usually ranges from 1.018 to 1.020, and the concentration of leukocytes can exceed 1000 in one microliter of the test fluid. Also, impurities of other substances may be found in the exudate. biological fluids(blood, lymph, bile, pus), which will indicate damage to one or another organ.

Stages of ascites

Ascites can be:

• Transitional. IN in this case no more than 400 ml of fluid accumulates in the abdominal cavity, which can only be detected using special research(ultrasound, MRI). Transient ascites does not impair the function of the abdominal organs or lungs, therefore all existing symptoms are caused by the underlying disease, adequate therapy of which can lead to fluid resorption.
• Moderate. With moderate ascites, up to 4 liters of ascitic fluid can accumulate in the abdominal cavity. The abdomen in such patients will be slightly enlarged, in a standing position there will be a bulging of the lower abdominal wall, and in a lying position shortness of breath (a feeling of lack of air) may appear. The presence of ascitic fluid can be determined by percussion or fluctuation symptom.
• Tense. In this case, the amount of ascitic fluid may exceed 10–15 liters. The pressure in the abdominal cavity increases so much that it can disrupt the functions of vital organs (lungs, heart, intestines). The condition of such patients is assessed as extremely serious, so they must be immediately hospitalized in the intensive care unit for diagnosis and treatment.

Treatment of ascites

In the treatment of ascites the following are used:

• diet therapy;
• physical exercise;
• therapeutic laparocentesis;
• traditional methods of treatment.

Diuretics (diuretics) for ascites

Diuretics for ascites

Other medications used for ascites

Drug treatment for ascites may include:

• Agents that strengthen the vascular wall(diosmin, vitamins C, P). Vasodilation and increased permeability vascular wall are one of the main elements in the development of ascites. The use of drugs that can reduce vascular permeability and increase their resistance in the face of various pathogenic factors (increased intravascular pressure, inflammatory mediators, etc.) can significantly slow down the progression of ascites.
• Drugs affecting the blood system(>polyglucin, rheopolyglucin, gelatinol). The introduction of these drugs into the systemic circulation helps to retain fluid in the vascular bed, preventing its passage into the intercellular space and into the abdominal cavity.
• Albumin (protein). Albumin is the main protein that provides oncotic pressure in the blood (which holds fluid in the vascular bed and prevents it from moving into the intercellular space). With cirrhosis or liver cancer, as well as with nephrotic syndrome, the amount of protein in the blood can be significantly reduced, which needs to be compensated intravenous administration albumin.
• Antibiotics. Prescribed for bacterial or tuberculous peritonitis.

Diet for ascites

The main principles of the diet for ascites are:

• Limiting salt intake. Excessive salt consumption promotes the transition of fluid from the vascular bed into the intercellular space, that is, leads to the development of edema and ascites. This is why such patients are advised to exclude salt from their diet. pure form, and take salty foods in limited quantities.
• Limiting fluid intake. Patients with moderate or severe ascites are not recommended to take more than 500–1000 ml of liquid (pure) per day, as this may contribute to the progression of the disease and deterioration of general well-being.
• Adequate protein intake. As already mentioned, protein deficiency can cause the development of edema. That is why the daily diet of a patient with ascites should include proteins of animal origin (found in meat, eggs). However, it is worth remembering that in case of liver cirrhosis, excessive consumption of protein foods can cause intoxication of the body (as the neutralizing function of the liver is impaired), so in this case it is better to coordinate the diet with your doctor.
• Limiting fat intake. This rule is especially important for ascites caused by pancreatitis. The fact is that consuming fatty foods stimulates education digestive enzymes in the pancreas, which can lead to exacerbation of pancreatitis.

Exercise for ascites

The main “limiter” of physical activity during ascites is the state of the heart and respiratory systems. So, for example, with severe heart failure (when shortness of breath occurs at rest), any physical activity contraindicated. At the same time, with a milder course of the disease and transient or moderate ascites, the patient is recommended to take a daily walk in the fresh air (at a light, slow pace), do morning exercises and other light sports. Particular attention should be paid to swimming, since while in the water, blood circulation improves and, at the same time, the load on the heart decreases, which slows down the progression of ascites.

Stressed ascites, in which compression of the lungs and abdominal organs is observed, can also limit the patient’s physical activity. Performing ordinary physical exercises in this case is impossible, since any load can lead to decompensation of the patient’s condition and the development of acute respiratory failure.

Therapeutic laparocentesis (therapeutic puncture) for ascites

The technique and rules for preparing the patient are the same as for diagnostic laparocentesis. After puncture of the anterior abdominal wall, a special drainage tube is installed into the abdominal cavity, through which ascitic fluid will flow. A container with a graduated volume must be attached to the other end of the tube (to control the amount of liquid removed).

It is important to remember that ascitic fluid may contain large amounts of proteins (albumin). Simultaneous removal of a large volume of fluid (more than 5 liters) can not only lead to a drop in blood pressure (due to the expansion of previously compressed blood vessels), but also to severe protein deficiency. That is why the amount of fluid removed should be determined depending on the nature of the ascitic fluid (transudate or exudate) and the general condition of the patient.

Treatment of ascites with traditional methods

In the treatment of ascites you can use:

• Parsley infusion. 40 grams of chopped green grass and parsley roots should be poured into 1 liter of boiling water and left at room temperature for 12 hours. Take 1 tablespoon orally 3-4 times a day (before meals).
• Decoction of bean pods. Pour 2 tablespoons of chopped bean pods into a liter of water, bring to a boil and boil in a water bath for 20 - 30 minutes. After this, cool and take 2 tablespoons orally 4 to 5 times a day before meals.
• A decoction of coltsfoot leaves. Coltsfoot pour 1 cup (200 ml) water, bring to a boil and simmer for 10 minutes. Cool, strain and take 1 tablespoon orally 3 times a day.
• Motherwort tincture. 1 tablespoon of crushed motherwort leaves should be placed in a glass jar and poured with 100 ml of 70% alcohol, then infused in dark place at room temperature for 3 – 5 days. The tincture should be taken three times a day before meals, 30 drops diluted in a small amount of boiled water.
• Apricot compote. It has not only a diuretic, but also a potassium-sparing effect, which is extremely important when long-term use diuretic herbs and drugs. It is better to prepare compote from dried apricots, 300–400 grams of which are poured with 2–3 liters of water and boiled for 15–20 minutes. It is important to remember that with intense ascites, the amount of fluid consumed should be limited, so it is not recommended to take more than 200 - 300 ml of compote per day.

When is surgery needed for ascites?

Surgical treatment can be used:

• For liver cancer. Removing the part of the liver affected by the tumor can stop the progression of the pathological process (in the absence of metastases in distant organs).
• For heart defects. Correction of valvular heart disease (replacement of a damaged valve with an artificial one) can lead to complete recovery of the patient, normalization of heart function and resorption of ascitic fluid.
• For abdominal cancer. Timely removal of a tumor compressing the blood vessels of the portal vein system can lead to complete cure patient.
• With peritonitis. Bacterial peritonitis is an indication for surgical treatment. The abdominal cavity is opened, cleared of purulent masses and washed with antiseptic solutions.
• With chylous ascites. If the penetration of lymph into the abdominal cavity is due to damage to a large lymphatic vessel in this area, its suturing during surgical operation can lead to complete recovery of the patient.

Today, the method of returning ascitic fluid (more precisely the proteins and other trace elements contained in it) into the systemic circulation through intravenous infusions, which reduces the risk of death in such patients.

Treatment of ascites in liver cirrhosis

Treatment for liver cirrhosis includes:

• Hepatoprotectors(allochol, ursodeoxycholic acid) - drugs that improve metabolism in liver cells and protect them from damage by various toxins.
• Essential phospholipids(phosphogliv, essentiale) – restore damaged cells and increase their resistance when exposed to toxic factors.
• Flavonoids(gepabene, karsil) – neutralize free oxygen radicals and other toxic substances formed in the liver during the progression of cirrhosis.
• Amino acid preparations(heptral, hepasol A) - cover the need of the liver and the whole body for amino acids necessary for normal growth and renewal of all tissues and organs.
• Antiviral agents(Pegasys, ribavirin) – prescribed for viral hepatitis B or C.
• Vitamins (A, B12, D, K)– these vitamins are formed or deposited (stored) in the liver, and with the development of cirrhosis, their concentration in the blood can significantly decrease, which will lead to the development of a number of complications.
• Diet therapy– it is recommended to exclude from the diet foods that increase the load on the liver (in particular, fatty and fried foods, any types of alcoholic beverages, tea, coffee).
• Liver transplant– the only method that allows you to radically solve the problem of cirrhosis. However, it is worth remembering that even after a successful transplant, the cause of the disease must be identified and eliminated, since otherwise cirrhosis can affect the new (transplanted) liver.

Treatment of ascites in oncology

The following can be used in the treatment of cancer:

• Chemotherapy. Chemotherapy is the main treatment for peritoneal carcinomatosis, in which tumor cells affect both layers of the serosa of the abdominal cavity. Chemical drugs (methotrexate, azathioprine, cisplatin) are prescribed that disrupt the processes of tumor cell division, thereby leading to the destruction of the tumor. The main problem with this is the fact that these means also violate the division normal cells throughout the body. As a result, during the treatment period, the patient may experience hair loss, stomach and intestinal ulcers may appear, and aplastic anemia may develop (lack of red blood cells due to a disruption in the process of their formation in the red bone marrow).
• Radiation therapy. The essence of this method is the high-precision impact of radiation on tumor tissue, which leads to the death of tumor cells and a decrease in the size of the tumor.
• Surgery. It involves removing the tumor through surgery. This method is especially effective when benign tumors or in the case when the cause of ascites is compression of blood or lymphatic vessels by a growing tumor (its removal can lead to a complete recovery of the patient).

Treatment of ascites in heart failure

Treatment for heart failure includes:

• Diuretics. They reduce the volume of circulating blood, reducing the load on the heart and the pressure in the veins of the lower body, thereby preventing further development ascites. They should be prescribed carefully and under supervision blood pressure so as not to provoke dehydration of the body.
• Drugs that lower blood pressure(ramipril, losartan). When blood pressure (BP) is high, the heart muscle has to do more work, pumping blood into the aorta during contraction. Normalizing pressure reduces the load on the heart, thereby helping to eliminate venous stagnation and edema.
• Cardiac glycosides(digoxin, digitoxin). These drugs increase the force of heart contractions, which helps eliminate congestion in the veins of the lower body. They should be taken with caution, as in case of overdose, death can occur.
• Salt-free diet. Consuming large amounts of salt leads to fluid retention in the body, which further increases the load on the heart. This is why patients with heart failure are not recommended to take more than 3 to 5 grams of salt per day (including salt used in preparing various dishes).
• Limiting fluid intake(no more than 1 - 1.5 liters per day).
• Maintaining a daily routine. If condition allows of cardio-vascular system, patients are recommended to moderate physical activity (walking, morning exercises, swimming, yoga).

Treatment of ascites in renal failure

Treatment for kidney failure includes:

• Diuretics. In the initial stages of the disease they can have a positive effect, but in end-stage renal failure they are ineffective. This is explained by the fact that the mechanism of action of diuretics is to regulate (that is, enhance) the excretory function of renal tissue. At the last stage of the disease, the amount of functional renal tissue is extremely small, which causes the lack of effect when prescribing diuretics.
• Medicines that lower blood pressure. In renal failure, the blood supply to the remaining functional renal tissue is disrupted, as a result of which a number of compensatory mechanisms are activated aimed at maintaining renal blood flow at an adequate level. One of these mechanisms is an increase in blood pressure. However, an increase in blood pressure does not improve the condition of the kidneys, but, on the contrary, contributes to the progression of the pathological process, the development of edema and ascites. That is why normalization of blood pressure is an important stage of treatment, allowing to slow down the rate of formation of ascitic fluid.
• Hemodialysis. During this procedure, the patient's blood is passed through a special machine, in which it is cleansed of metabolic by-products and other toxins, after which it is returned back to the bloodstream. Hemodialysis and other methods of blood purification (plasmapheresis, peritoneal dialysis, hemosorption) are the latest effective way prolonging the life of patients with chronic renal failure.
• Kidney transplant. Radical method treatment in which a patient is transplanted with a donor kidney. If the operation will take place successfully and the transplant takes root in the host’s body, the new kidney can fully perform the excretory function, ensuring the patient’s normal quality and life expectancy.

Consequences and complications of ascites

Ascites can be complicated by:

• inflammation of the peritoneum (ascites-peritonitis);
• heart failure;
• respiratory failure;
• umbilical hernia;
• intestinal obstruction.

It is important that there is no visible defect of the peritoneum or internal organs that could become a source of infection. It is believed that bacteria leak into the abdominal cavity through the dilated and overstretched walls of the intestinal loops.

Regardless of the mechanism of development, the presence of peritonitis requires hospitalization of the patient and urgent surgical treatment.

Heart failure
The accumulation of a large amount of fluid in the abdominal cavity leads to compression of the organs and blood vessels located there (arteries and veins), disrupting the flow of blood through them. As a result, the heart has to do a lot of work to pump blood through the vessels.

If ascites develops slowly, compensatory mechanisms are activated in the heart, consisting of the proliferation of muscle fibers and an increase in the size of the heart muscle. This allows you to compensate for the increase in load up to a certain point. At further progression Ascites causes the reserves of the heart muscle to become depleted, which will cause the development of heart failure.

If ascites develops quickly (over several days), the heart does not have time to adapt to the increasing load, as a result of which acute heart failure may develop, requiring emergency medical care.

Hydrothorax
This term refers to the accumulation of fluid in the chest. The development of hydrothorax with ascites is facilitated by an increase in the pressure of ascitic fluid, as a result of which fluid from the blood and lymphatic vessels of the abdominal cavity can pass into the vessels of the diaphragm and chest. As the disease progresses, the amount of free fluid in the chest will increase, which will lead to compression of the lung on the affected side (or both lungs in case of bilateral hydrothorax) and respiratory impairment.

Respiratory failure
Development this state may contribute to the rise and limitation of excursion of the diaphragm as a result of increased abdominal pressure, as well as the progression of hydrothorax. In the absence of timely treatment respiratory failure will lead to a pronounced decrease in the concentration of oxygen in the blood, which can be manifested by shortness of breath, cyanosis of the skin and impaired consciousness, up to its loss.

Diaphragmatic hernia
A diaphragmatic hernia is a protrusion of an organ or tissue through a defect in or through the diaphragm. hiatus. The reason for this is a pronounced increase in intra-abdominal pressure.

The stomach, intestinal loops, or serous membrane filled with ascitic fluid may protrude through the hernial opening. This condition manifests itself as pain in the chest and in the heart area, in the upper abdomen. If a sufficiently large section of an organ emerges into the hernial opening, it can compress the lungs and heart, leading to impaired breathing and heartbeat.

Treatment of the disease is mainly surgical, consisting of repositioning the hernial sac and suturing the defect in the diaphragm.

Umbilical hernia
Reason for formation umbilical hernia There is also increased pressure in the abdominal cavity. The anterior abdominal wall is covered with muscles along almost its entire length. The exception is the umbilical region and the midline of the abdomen, where these muscles come together and form the so-called aponeurosis of the anterior abdominal wall. This aponeurosis consists of tendon tissue, which is “ weak point» abdominal wall (this is where protrusion of the hernial sac is most often noted). Treatment of the disease is also surgical (the hernia is reduced and the hernia orifice is sutured).

Intestinal obstruction
It develops as a result of compression of intestinal loops by ascitic fluid, which usually occurs with tense, refractory ascites. Impaired intestinal patency leads to the accumulation of feces above the site of compression and increased peristalsis (motor activity) of the intestine in this area, which is accompanied by severe paroxysmal abdominal pain. If intestinal obstruction does not resolve within a few hours, intestinal paralysis occurs, dilation and increased permeability of the intestinal wall. As a result, numerous bacteria (which are permanent inhabitants of the large intestine) penetrate the blood, causing the development of serious, life-threatening complications for the patient.

Treatment consists of opening the abdominal cavity and eliminating intestinal obstruction. If the damaged intestinal loops are not viable, they are removed, and the resulting ends of the digestive canal are connected to each other.

Prognosis for ascites

How long do people with ascites live?

The life expectancy of a patient with ascites is determined by:

• 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.
• 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 main disease. This is perhaps the main factor determining the survival of patients with ascites. The fact is that even with the most modern treatment, a favorable outcome is unlikely if the patient has failure of several organs at once. 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.

Prevention of ascites

Prevention of ascites includes:

• Timely treatment of liver diseases. The development of liver cirrhosis is always preceded by prolonged inflammation of the liver tissue (hepatitis). It is extremely important to establish the cause of this disease in time and eliminate it (carry out antiviral treatment, stop drinking alcohol, start taking healthy food and so on). This will stop the progression of the pathological process and keep most of the liver tissue viable, which will provide the patient full life for many years.

• Timely treatment of congenital heart defects. On modern stage development, surgery to replace a damaged heart valve or close a defect in the heart muscle wall can be performed early childhood, which will allow the child to grow and develop normally and save him from heart failure in the future.
• Timely treatment of kidney diseases. Although hemodialysis can compensate for the excretory function of the kidney, it is not able to provide a number of other functions of this organ. That is why it is much easier to promptly and fully treat various infectious diseases of the urinary system, such as cystitis (inflammation of the bladder), glomerulonephritis (inflammation of the kidney tissue), pyelonephritis (inflammation of the renal pelvis), than then undergoing hemodialysis for 2 - 3 hours twice a week for the rest of your life.
• Diet for pancreatitis. At chronic pancreatitis Ingestion of large amounts of alcohol, sweets, spicy, smoked or fried foods can provoke an exacerbation of the disease and destruction of pancreatic tissue. However, it should be understood that such patients should not completely exclude the above foods from their diet. 1 candy or 1 piece of smoked sausage eaten per day will not provoke an exacerbation of pancreatitis, so it is extremely important for patients to eat moderately and not overeat (especially before bedtime).
• Performing routine ultrasounds during pregnancy. Pregnant women are recommended to undergo at least three ultrasound scans during pregnancy. The first of them is carried out between 10 and 14 weeks of pregnancy. By this time, all the organs and tissues of the fetus are formed, which makes it possible to identify gross developmental anomalies. The second ultrasound is performed at 18–22 weeks of pregnancy. It also makes it possible to identify various developmental anomalies and, if necessary, raise the issue of termination of pregnancy. The third study is performed at 30–34 weeks to identify abnormalities in the development or position of the fetus. Terminating a pregnancy at this stage is impossible, but doctors can identify this or that pathology and begin treating it immediately after the birth of the child, which will significantly increase his chances of survival.

The causes of fluid accumulation in the abdominal cavity depend on many various factors and dangerous conditions. This abdominal dropsy, which can manifest gastroenterological problems, gynecological disorders, oncology, urology, and may even indicate cardiac pathologies.

This condition is accompanied by an increase in intra-abdominal pressure, the diaphragm rises closer to the chest, which makes breathing difficult. This is an aesthetic and physiological problem that significantly worsens the prognosis of the existing disease.

Factors in the appearance of ascites are considered to be diseases that provoked unpleasant symptoms due to deterioration of the patient's condition:

• Portal hypertension. This disease is characterized by increased pressure in the portal vein. It ensures proper blood circulation throughout the gastrointestinal tract and its pathologies occur quite often. This disease is characterized by the fact that liver functions are not fully performed. The disease manifests itself very clearly, as there are disturbances in the digestive process, as well as dangerous manifestations diseases characterized metabolic disorders.
• Cirrhosis of the liver. A dangerous and difficult to cure disease, which must be eliminated in the shortest possible time.
• Alcoholic hepatitis B. Manifests severe inflammation liver, which began due to its poisoning with toxic substances acquired as a result of alcohol consumption. First of all, you need to give up all alcohol-containing drinks, then focus all your efforts on curing the disease.
• Peritoneal carcinomatosis. This is a disease characterized by the presence of malignant cells outside or inside the peritoneum. Various tumors and simply changed cells can cause abdominal dropsy.
• Heart failure. If blood flow in the heart is disrupted, all organs suffer, which leads to blood stagnation. As a result, the accumulated fluid increases, which causes a rapid increase in the abdomen and discomfort for the patient.
• Liver failure. Typically, ascites in this case occurs not just in case of decreased liver function, but when chronic inflammation or death of liver tissue. If cells cannot perform their functions for a long time, the protein processing process is disrupted. Too small a percentage of protein in the blood leads to fluid being released from the vessels and entering the abdominal cavity. Liquid gets trapped inside, causing unpleasant symptoms.
• Hypoproteinemia. It manifests itself in kidney pathologies; it is especially dangerous or strong if a person has been subjected to a grueling diet.
• Peritoneal tuberculosis. This is very rare disease, however, it can manifest itself in weakened immunity.
• Pathologies of the pancreas. In most cases, they appear in the abdomen if severe pancreatitis is characterized by complications.

Symptoms

There are a number of dangerous situations that need to be noticed as quickly as possible:

• Abdominal enlargement. When the patient is standing, the pathology is especially visible. The stomach seems to sag and looks weighed down. If a person lies down, the stomach looks spread out. The side surfaces never sink, protrude slightly or stand out strongly.
• Umbilical ring syndrome develops. The navel constantly expands to the point where it becomes convex, which often provokes the occurrence of a hernia.
• In some cases, the accumulation of fluid in the abdominal cavity is considered to be the result of hypertension. A disease in which there is an increase in pressure in the portal vein, through which venous blood circulates through the gastrointestinal tract. Also, in many cases, the accumulation of fluid inside the abdomen is associated with liver problems. Then the skin on the stomach does not look smooth, but is decorated with bright colors. venous vessels. They do not look asynchronous, since they visually form a web, radiating away from the fart.
• Patients complain of heavy breathing and persistent shortness of breath. This syndrome occurs due to the fact that significant part fluid in the abdomen is constant raises the diaphragm. This causes the chest cavity to become smaller, preventing it from providing enough volume for air to move in and out without strain.

The accumulation of fluid inside the abdomen is never an independent disease, but is only a symptom of other, underlying pathologies that require immediate investigation.

To cure ascites, it is necessary to clearly identify the pathology that led to its formation.

After operation

When performing surgery on internal organs, one of the complications is the accumulation of fluid in the abdominal cavity. In most cases, doctors warn about this in advance and also carry out necessary research in order to eliminate the likelihood of this disease.

If there is inflammation of the internal organs, the likelihood of fluid accumulation inside the abdomen increases. To remove it, there is no need for a second operation. Doctors easily solve this problem, by performing a simple puncture procedure followed by removal of fluid under local anesthesia.

Treatment

To cure the accumulation of fluid inside the abdomen, it is necessary to resort to complex measures using basic treatment methods:

• Getting rid of the underlying disease. In most cases, ascites is caused by chronic pathologies. They are quite difficult to treat, since it is necessary to bring the condition to a long-term remission, as a result, to ensure that the disease completely leaves the person. If you constantly carry out adequate treatment, the risk of ascites is reduced.
• Diet. You should constantly monitor your diet and eat foods that contain large amounts of protein.
• Don't neglect taking diuretics, especially if they are necessary for your body.
• Carrying out laparocentesis. A mild painkiller is used, as the process takes a minimal amount of time. The wall is pierced with a specialized medical device intended for this surgical procedure. Thanks to the puncture, the liquid is completely released. This method is used quite often, but is not effective enough if it is not combined with a competent course of therapy. If main disease does not leave the patient, there is a high probability that the fluid will form again and even to a greater extent than before.
• Carrying out the operation which led to fluid accumulation in the abdomen. Surgery is especially often indicated for hypertension. Vascular operations are required, in which measures are provided that serve to improving blood flow. This will not only reduce the likelihood of recurrence of fluid accumulation in the abdomen, but also ensure good blood circulation throughout the gastrointestinal tract and save a person from liver pathologies.

The accumulation of fluid in the abdominal cavity is a dangerous disease, but you can get rid of it using standard medical methods. If the underlying disease is treated, ascites will not recur.

If left unattended, it worsens as a result of multiple dysfunctions of internal organs. prognosis of the underlying disease, and the patient’s condition worsens.

Ascites is considered to be the most significant symptoms many diseases, in particular cancer and cirrhosis of the liver.

The accumulation of fluid in the abdominal cavity is observed in many diseases. The development of symptoms may be gradual or rapid. The patient begins to complain about an increase in the size of the abdomen, a feeling of fullness and flatulence.

Symptom development

The composition of the liquid sweating into the abdominal space is an ultrafiltrate of blood plasma. Its composition is in dynamic equilibrium with plasma components. In one hour, 40–60% of the fluid is exchanged with the blood plasma, and intravenously injected labeled albumin enters the effusion within 30 minutes.
Ascites in liver cirrhosis depends in its pathogenesis on several factors:

1. Increased pressure in the portal vein system (portal hypertension);
2. Hormonal factor;
3. Neurohumoral factor.

The most serious factors are congestion in the portal vein system and associated portal hypertension. Intrahepatic portal hypertension leads to an increase in hydrostatic pressure in the sinuses, which increases the extravasation of filtrate from high content squirrel.
When the intrahepatic outflow is blocked, the patient's lymph production increases. Ascites in liver cirrhosis provokes the formation of lymphatic vessels (discharge, intrahepatic, subcapsular). Lymph flows out of the thoracic duct at a much faster rate. Normal outflow lymph fluid from the liver is 8 to 9 liters per day, with ascites and cirrhosis it reaches 20 liters. So hard work lymphatic system At first, it unloads the venous network, but then lymph circulation insufficiency increases, and a large amount of fluid begins to sweat from the surface of the liver.

Sweating of exudate leads to a decrease in the effective volume of plasma that participates in blood circulation. In response to this, the synthesis of the hormone renin in the kidneys, angiotensin 1 and 2, increases, therefore ascites in liver cirrhosis is accompanied by a decrease in renal filtration and blood flow, an increase in synthesis antidiuretic hormone and aldosterone.
Activation of the renin-angiotensin system ultimately leads to secondary renal retention of sodium ions. Sodium ions, in turn, attract water, which only worsens ascites.

Other ways of developing abdominal dropsy with malignant diseases and with infectious lesions of the peritoneum.

In such cases, ascites is associated with metastasis of carcinomatosis and the onset of secondary inflammatory exudation.
A significant role is played by compression of the lymphatic drainage pathways and their germination by the tumor itself, involvement of blood vessels in the process and the presence of metastases in the liver parenchyma.

Clinical manifestations

Every day at healthy person the peritoneum secretes and absorbs about 1.5 liters of free fluid. Small volumes of effusion do not manifest themselves in any way, so at the initial stage patients usually do not present characteristic complaints. An auxiliary diagnostic method at this stage will be ultrasonography abdominal organs.

As the volume of effusion increases, the patient becomes symptomatic. First of all, they are associated with unpleasant sensations: pressure, fullness, heaviness in the abdomen, then dull constant pain occurs in the lower abdomen. An increase in intra-abdominal pressure causes compression of the chest organs, it becomes harder for the patient to breathe, and digestive disorders appear. Dyspeptic symptoms: nausea and frequent belching. The stool is broken. The urinary system also suffers.

Significant effusion greatly worsens your health. After eating, the patient experiences a feeling of early satiety, heaviness, and belching occurs. As a result, constantly increased pressure in the abdominal space leads to the development of an umbilical hernia if treatment is not taken in time.

Externally, a patient with dropsy is visible only when the amount of effusion is more than 1 liter. An examination will reveal other symptoms: a deformed abdomen, its sagging when standing. When the patient lies down, the abdomen is shaped like a frog's: it is flattened, its sides are convex.

If there is a history of congestive heart failure and long-term ascites, one should also expect the presence of effusion in the pleural cavity - hydrothorax.

The accumulation of effusion in the abdominal cavity leads to compression of all organs, the level of pressure in the abdominal cavity increases, this pushes the diaphragm upward. In such patients, the volume of respiratory movements is significantly limited, which is why respiratory failure increases. In the vessels of intra-abdominal organs, peripheral resistance increases, aggravating circulatory failure.

Long-term ascites disrupts lymphatic drainage, so at the junction of lymphatic vessels lower limbs and the abdominal cavity, a disorder of lymph outflow occurs. Outwardly, it looks like swelling of the lower extremities. A retrograde flow of lymph from the thoracic duct occurs into the internal organs.

Such a pathological flow of lymphatic fluid leads to a massive discharge of malignant cells from the main focus, seeding of tissues and internal organs occurs at a rapid speed.

A pronounced venous network appears on the skin of the abdomen. This symptom is called “jellyfish head”. This is a common sign of dropsy, the causes of which are increased portal pressure. At the same time, the patient looks emaciated, since the disease is accompanied by muscular dystrophy, and the liver is moderately enlarged. Post-hepatic portal hypertension leads to persistent ascites, the development of jaundice, dyspeptic symptoms (nausea, vomiting), and a sharp increase in liver size.

A small volume of fluid in the abdominal cavity is observed in persons with protein deficiency; it is combined with peripheral edema and the appearance of pleural effusion.

Rheumatic diseases are characterized by polyserositis: the presence of fluid is detected in several cavities (thoracic cavity, pericardial cavity, joints, abdominal cavity), while the clinic is complemented by a typical rash and other skin manifestations, pathology of the glomerular apparatus of the kidneys, joint pain.

Chylous ascites is distinguished. Its causes are diseases that lead to disruption of lymph outflow. In this case, the effusion has a milky color, its consistency is pasty, and upon analysis it reveals great content lipids and fat.

With portal vein thrombosis, ascites is persistent, the pain syndrome is severe, the liver is slightly changed in size, and the spleen is enlarged. The development of collateral circulation networks leads to frequent bleeding, mainly from varicose veins of the esophagus and hemorrhoidal lymph nodes. A peripheral blood test will show anemia, a decrease in the number of platelets and leukocytes.

Ascites differs in people with heart failure. It is accompanied by swelling of the lower extremities, cyanosis of the distal parts of the body, a sharp enlargement of the liver and its pain on palpation. In such patients, effusion also accumulates in the chest cavity.

Causes diffuse edema subcutaneous fat and skin - renal failure. Free fluid in the abdominal cavity is determined.

In women with Meigs syndrome, ultrasound examination will detect ovarian tumors, possibly malignant, which are combined with hydrops of the abdominal cavity and hydrothorax.

Peritoneal carcinosis and fluid in the abdominal cavity are accompanied by other manifestations: the doctor is able to palpate multiple The lymph nodes, increased in size, with a changed consistency. The main complaints in this case are due to the primary location of the tumor. Analysis of the fluid shows the presence of atypical cells; in appearance it resembles a hemorrhagic effusion.

Genital tuberculosis or intestinal damage by mycobacteria causes secondary tuberculous ascites. It is characterized by the following symptoms: weight loss, fever, general intoxication. Enlarged lymph nodes are found along the intestinal mesentery. The exudate itself is also different: its density exceeds 1016, it contains a lot of protein (from 40 to 60 g per liter), the Rivalt reaction is positive, and the sediment contains erythrocytes, lymphocytes, endothelial cells, and tuberculosis bacteria.

Treatment

Treatment of dropsy is reduced to removing pathological exudate. In most clinical cases, its excess is removed through a surgical operation - laparocentesis (pumping out using a trocar).

It is performed in a hospital setting, under the supervision of an anesthesiologist and surgeon.

Classically, laparocentesis is performed on an empty bladder, the patient is in a sitting position; seriously ill patients can be placed on the right side. The staff must comply with all rules of asepsis and antisepsis.

By injection they provide local anesthesia. Then a puncture is made along the midline of the abdomen with a trocar instrument, after which pumping begins. It is important to gradually remove the effusion, no more than 5-6 liters at a time. Rapid removal of fluid threatens a sharp drop in blood pressure and the development of collapse.

After completing the procedure, the patient remains in a lying position for several hours on the side that is free from the puncture.

During this time, the patient is closely monitored. If effusion continues to flow from the wound, after 24–48 hours it is allowed to apply some kind of reservoir to the puncture hole.

The number of repeated punctures is limited. The reasons for this are:

1. Possible deformation of internal organs as a result sharp fall intra-abdominal pressure. In addition, rapid unloading leads to disruption of the structure (architectonics) of organs, the development of ischemia and fibrosis.
2. It is worth remembering that the fluid in the abdominal cavity is similar to plasma, which means it contains a large amount of protein and salts. Significant losses lead to protein deficiency, so it is necessary to alternate aspiration of the effusion and administration of an albumin solution.

To date, treatment using this technique has been improved. A catheter located peritoneally is used. At the same time, replacement of protein and salt losses is carried out using plasma-substituting solutions. The most successfully used is albumin solution (10 or 20%).

Traditional methods

Treatment of ascites folk remedies mainly ensures the removal of excess fluid. Therefore, diuretics and various decoctions have found widespread use.

Therapy with folk remedies should be accompanied by replenishment of potassium losses with the help of decoctions, dried fruits, and vegetables.

Treatment with folk remedies based on bean pods gives an excellent effect. For 12–15 pods, take a liter of purified water. The raw materials are immersed in it and boiled for 10 minutes. You will have to insist for 20 minutes, after which you need to strain the broth. The first portion is taken early, at 5 am in a volume of 200 ml, before breakfast you need to drink another 200 ml, the third before lunch in the same volume, drink the rest before 10 pm. Successful treatment within three days indicates the correct selection of herbs.

Diuretic teas are also folk remedies. This vitamin drinks, which are considered to be a complement to herbal medicine. For preparation you will need dry crushed ingredients in equal quantities: currant leaves, rose hips, raspberry and lingonberry leaves. Boil for 10 minutes in 250 ml of water, leave for another 20 minutes. The infusion can be drunk instead of regular tea.

Birch leaves in combination with horsetail are excellent folk remedies. Dry plant leaves are mixed in equal quantities. The volume of raw materials in half a glass is poured with half a liter of boiling water. And after 15 minutes it can be taken as a diuretic.

Folk remedies can also restore the loss of potassium that accompanies treatment with diuretics. This is done using apricot decoction. Fresh or dry fruits are suitable, in the amount of one glass. They are poured with a liter of water and boiled for 40 minutes. The finished decoction can be drunk in a volume of 250 to 400 ml per day.

A patient receiving treatment with folk remedies should remember that this is not a reason to abandon traditional medicine. Any decision regarding the treatment of the disease must be agreed with the attending physician.

Ascites develops as a result of various kinds of pathological processes in the pelvic organs. Initially, the accumulated transudate is not inflammatory in nature; its amount can range from 30 ml to 10–12 liters.

The most common reasons for its development are a violation of the secretion of proteins, which ensure the impermeability of tissues and pathways conducting lymph and circulating blood.

This condition can be caused congenital anomalies or development in the body:

• liver cirrhosis;
• chronic heart or kidney failure;
• portal hypertension;
• protein starvation;
• lymphostasis;
• tuberculous or malignant lesions of the peritoneum;
• diabetes mellitus;
• systemic lupus erythematosus.

Causes of ascites

Serosocele in gynecology occurs mainly in women before menopause. The most common reasons for its development:

• Inflammatory diseases in the pelvic organs

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.
• Hepatitis B chronic course(including alcoholic).
• obstruction of the hepatic vein.

9-10% of cases of ascites are associated with oncological pathologies abdominal organs, metastases in the stomach. The causes in women often lie in oncological pathologies of the pelvic organs.

At malignant neoplasms There is a deterioration in lymph circulation and blockage of lymph 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 of the 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.
• pancreatic diseases.
• 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 liver and bile ducts.
• exudative enteropathy acquired hereditarily.
• protein deficiency leading to severe dystrophy.

In the first section, a huge number of reasons for this condition were given. To suggest a diseased organ and determine the most likely disease a person has, a comprehensive examination is necessary.

It should begin with a thorough clarification of all complaints and possible harmful factors, and end with specialized diagnostics. Below, we will describe the principles of this diagnosis and methods for determining the real reason ascites.

Analysis of all complaints and harmful factors

IN normal conditions the fluid in the pelvis is serous, as in other serous membranes. Its formation is explained by the processes of secretion and resorption.

Types of abdominal hydrops by ultrasound

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:

1. transient - up to 400 ml.
2. moderate - from 500 ml to 5 l.
3. 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 conservative methods treatment.
• refractory ascites - resistant to drug therapy.

The international classification of diseases does not identify ascites as a separate disease - this condition is a complication of the last stages of other pathological processes. By brightness clinical symptoms differentiate following forms ascites:

• initial – the amount of water accumulated inside the abdomen reaches 1.5 liters;
• with moderate amount of liquid– manifested by swelling of the legs, a noticeable increase in the size of the chest, shortness of breath, heartburn, constipation, a feeling of heaviness in the abdomen;
• massive (exudate volume more than five liters) – dangerous condition, characterized by tension in the walls of the abdominal cavity, the development of insufficiency of the function of the cardiac and respiratory systems, and infection of the transudate.

Water in the stomach is alarming symptom, which the doctor diagnoses by ultrasound. It is recommended to undergo such an examination if the patient notices an enlargement of the abdominal cavity. Such a complaint should not be ignored by a specialist, since the oncological disease can progress with a fatal outcome.

This is a dangerous disease in which a large amount of fluid accumulates in the abdominal cavity. Other organs can also suffer from this: heart, lungs. The pathology is not inflammatory. In the abdominal area, with this disease, which is popularly called “frog belly,” up to 20 liters of fluid can accumulate.

In more than 75% of cases, this problem is a consequence of progressive cirrhosis. The main task of the doctor is to remove symptoms and prolong the period of remission.

Let's figure out what the problem is and why liquid accumulates. The peritoneum, which lines the walls of the organ, secretes a small amount of fluid - its composition is similar to blood plasma and is necessary for the normal functioning of the organs, otherwise they will simply stick together.

Liquid is secreted and absorbed throughout the day, however, when exposed to pathological factors, this process can be disrupted. Due to the imbalance, it begins to increase intra-abdominal pressure, the stomach increases in size, fluid appears.

Why can fluid accumulate in the abdominal cavity?

One of the reasons is liver cirrhosis, but this is not the only provoking factor. So, it should be remembered that the pathology develops slowly and may not manifest itself in any way for the first few months. Moreover, the problem is that this disease is quite difficult to treat; the main thing is to eliminate the factor that causes this disease.

The most common causes of fluid in the abdominal cavity are:

• heart diseases;
• the presence of malignant tumors;
• abdominal tuberculosis;
• problems in the functioning of the endocrine system;
• gynecological diseases.

It is important to note that not only adults, but also children suffer from ascites.

Moreover pathological processes may occur while the fetus is still in the womb, which is associated with birth defects liver. Most often this happens when the mother has infectious diseases: rubella, herpes, measles, etc. Also at risk are those children whose mothers smoke or abuse drugs or strong medications during pregnancy.

Ascites may appear when diabetes mellitus as a result of blood transfusion. To avoid such a problem in infants, it is advisable for pregnant women to avoid going to tattoo artists.

Manifestation and symptoms

The main symptom that you should pay attention to is the appearance of free fluid that is not excreted from the body naturally. As a result, the stomach increases in size, and over time this problem only gets worse.

From the very beginning, you may not notice this, but as the disease progresses, the ability to tense your stomach or relax it disappears.

Additional symptoms include:

• stomach ache;
• weight gain;
• the appearance of shortness of breath;
• heartburn;
• general discomfort;
• swelling of the legs.

Diagnosis of the disease

It is quite difficult to determine this disease only by examining the patient. A description of the symptoms is required by the doctor to collect information, but this is not enough to make a final analysis. You need to undergo an examination that will help determine the nature and stage of the disease.

Diagnostics includes the following:

Treatment of ascites using traditional medicine methods

After the diagnosis, doctors can make a preliminary prognosis and determine a suitable treatment regimen. The approach to this disease should be comprehensive, and in advanced cases, surgery cannot be ruled out. It all depends on the symptoms and stage of the disease.

At first, doctors try to remove the fluid conservatively, but if it continues to accumulate and previous methods have not helped, they will have to prepare for surgery. But let's talk in more detail.

The main goal of drug treatment is to remove fluid non-invasively. Treatment will be effective only at an early stage, when the cavity is partially filled. In this case, diuretics (Diacarb or Torasemide) and drugs with a high calcium content (Asparkam) are usually prescribed. Additionally, they may prescribe taking multivitamin complexes.

If treatment with pills does not help, surgery is prescribed.

It should be noted that the operation performed will remove the fluid, but not the cause itself, so it will be necessary to eliminate the provoking factor.

Surgical intervention involves:

1. Laparocentesis. In this case, a puncture is performed in the abdominal cavity to drain the fluid. The procedure may take 2-3 days and hospitalization is not necessary.
2. Shunting. In this case, doctors form a duct to ensure fluid exchange and stabilize pressure.
3. Liver transplantation. This method is usually used in oncology or late stages cirrhosis.

In addition, it is worth adhering to a therapeutic diet, which will reduce fluid accumulation, prolong the period of remission, and eliminate the main symptoms. During this period, you need to include raisins, dried apricots, and spinach in your diet.

Unconventional methods of treatment

Some try alternative medicine, but it can only be useful if the disease is at an early stage and there is little fluid in the cavity and there are no complications.

Pumpkin acts as an excellent preventive remedy, which improves liver function. That’s why it’s so important to include porridge and other dishes with this product in your diet.

A good diuretic is parsley decoction. Take 2 tbsp. herbs, soak in 200 ml of boiling water. Cover the container with the mixture and leave to infuse for two hours. Drink the drink 5 times a day, 100 ml. You can replace water with milk.

Diuretics can be prepared from beans: take 2 tbsp. beans, make a decoction, boil for 15-20 minutes in 2 liters of water. Drink 100 ml three times a day.

Finally, it must be said that timely treatment and compliance with all doctor’s recommendations will avoid serious problems with health.