Cluster of fluid in the abdominal cavity. What is the abdominal cavity ascites? Causes of the appearance of liquid in the abdomen Liquid in the abdominal cavity in men

Ascites can develop rapidly (within a few days) or for a long period (weeks or months). Clinically, the presence of free fluid in the abdominal cavity is manifested when it is reached quite large volume - from 1.5 liters.

The amount of fluid in the abdominal cavity sometimes reaches significant numbers - 20 liters and more. By origin, the ascitic fluid may be inflammatory nature (exudate) and non-inflammatory, as a consequence of the impaired hydrostatic or colloid-osmotic pressure in the pathologies of the circulatory or lymphatic system (transudate).

More than 80% of cases of ascites are caused by decompensation of chronic disease or acute inflammatory process in the liver

The reasons

Several groups of diseases, in which ascites develops:

• pathologies, accompanied by an increase in pressure in the portal vein of the liver, that is, portal hypertension (liver cirrhosis, badda disease - kiaari, thrombosis in the portal vein system, Stuart - Braz syndrome);
• malignant neoplasms (peritoneal carcinomatosis, primary liver cancer, Maigs Syndrome, Mesothelioma of the peritoneum, Sarcoma of the Bolshoi Salna, pseudomixoma of the peritoneum);
• stagnant phenomena in the system of the lower vein (chronic content pericarditis, right-handed heart failure);
• inflammatory processes in the abdominal cavity (tuberculous peritonitis, bacterial peritonitis, is polyspeed with a systemic red lupus, peritoneum alveococcosis);
• other states (nephrotic syndrome, Upple's disease, intestinal lymphangectasia, Menetry's disease, Myxedema, Chronic pancreatitis, protein swelling during starvation).

In more than 80% of cases, ascites is caused by the decompensation of chronic disease or an acute inflammatory process in the liver. The second frequency is the cause of ascite - neoplastic processes in the abdominal cavity (about 10%). Diseases of the cardiovascular system will attract the development of ascites of approximately 5% of cases, other reasons are rarely found.

The risk of resolution of ascites for 6 months is 43%, within 1 year - 69%, for 2 years - 74%.

Views

Depending on the amount of fluid in the abdominal cavity, there are several degrees of the pathological process:

1. Small ascites (no more than 3 l).
2. Moderate (3-10 l).
3. Significant (massive) (10-20 liters, in rare cases - 30 l or more).

The infection of ascitic content is distinguished:

• sterile (uninfected) ascites;
• infected ascites;
• spontaneous bacterial peritonitis.

According to the response to the therapy, ascites happens:

• transient. Disappears against the background of the conservative treatment carried out in parallel with the improvement of the patient's condition forever or before the period of the next exacerbation of the pathological process;
• stationary. The appearance of fluid in the abdominal cavity is not a random episode, in a minor volume, even despite adequate therapy;
• resistant (torpid, or refractory). Large ascites, which fails not only to stop, but even reduce the larger doses of diuretics.

If the fluid accumulation continues to grow steadily and reaches huge sizes, contrary to the treatment, such ascites is called tense.

Signs

The main signs of ascites are a uniform increase in the volume of the abdomen and the increase in body weight. Often, an increase in the abdomen during ascite patients are mistakenly taken for manifestation of obesity, pregnancy, or intestinal diseases accompanied by increased gas formation.

Ascites can develop rapidly (within a few days) or for a long period (weeks or months).

In position, the stomach looks disproportionately large, dug, in the patient's position lying on his back the side flanks of the abdomen (there is a "frog abdomen"). Front abdominal wall leather stretched, shiny, tense. Possible expansion and protrusion of the umbilical ring due to the increase in intra-abdominal pressure.

If the ascite is provoked by an increase in pressure in the portal vein, the expansion and convolutions of the veins of the anterior abdominal wall are noted ("Medusa's head"). The cirrhosis is characterized by skin "liver signs": palm erythema, vascular stars on the chest and shoulders, brownish brownish pigmentation of the forehead and cheeks, white color of the nail plates, purple.

Diagnostics

For reliable confirmation of ascites, a comprehensive approach to the diagnosis is required:

• collection of anamnesis (information on infectious diseases, possible abuse of alcohol, chronic pathology, previous episodes of ascites);
• objective examination of the patient (inspection, palpation of the abdominal organs, the percussion of the abdomen in the horizontal, vertical position and on the side, as well as the definition of fluid fluctuations);
• Ultrasound examination;
• cT scan;
• diagnostic laparocentsis (puncture of the front abdominal wall followed by the study of ascitic fluid).

Treatment

To eliminate ascites, first of all it is necessary to stop the main disease.

Medical measures:

• diet with a limitation of liquid and salt;
• diuretics (diuretics);
• hemodynamically active neurogormonal modulators - beta blockers, angiotensin-plating enzyme inhibitors (IAPF), angiotensin receptor antagonists (ARA II);
• tools that increase in blood oncotic (blood plasma and albumin) and osmotic (aldosterone antagonists) pressure;
• preparations for improving renal filtering;
• hepatoprotectors;
• antibiotic therapy (if necessary);
• therapeutic laparocentsis to reduce the volume of ascitic liquid;
• surgical treatment, in severe cases - liver transplantation.

In more than 80% of cases, ascites is caused by the decompensation of chronic disease or an acute inflammatory process in the liver.

Prevention

Ascites is a complication of common diseases, therefore the main measure of its prevention is timely and adequate treatment of the underlying disease. In addition, contribute to the prevention of ascites:

• strict following the recommendations of the attending physician;
• refusal of alcohol abuse;
• compliance with diet.

Two-year survival in patients with ascites - 50%. With the appearance of refractive ascites, half patients die over the year.

Consequences and complications

Ascites can lead to the following severe consequences:

• respiratory failure (due to an increase in the volume of the abdominal cavity and limiting the tours of the diaphragm);
• spontaneous bacterial peritonitis;
• refractory ascites;
• hepatic encephalopathy;
• hepatorenal syndrome.

The emergence of spontaneous bacterial peritonitis in patients with cirrhosis of the liver leads to repeated bleeding from the varicose extended veins of the esophagus. Mortality after the first episode of bleeding is 30-50%. In 70% of patients who survived one episode of bleeding from the varicose veins of the esophagus, bleeding occurs. The risk of resolution of ascites for 6 months is 43%, within 1 year - 69%, for 2 years - 74%.

Forecast

Two-year survival in patients with ascites - 50%. With the appearance of refractive ascites, half patients die over the year.

Adverse prognostic factors for patients with ascites:

• elderly age (over 60 years old);
• low blood pressure (systolic pressure of less than 80 mm Hg. Art.);
• reducing the speed of glomerular filtration (less than 500 ml / min);
• reducing the content of serum albumin (less than 28 g / l);
• hepatocellular carcinoma;
• diabetes.

Video from YouTube on the subject of Articles:

The abdominal cavity ascites may occur as a result of the flow of various diseases, often such pathology refers to one of the most common complications of the liver cirrhosis.

Asscite disease - what it is

The stomach water can become a very serious impairment, as it indicates complex diseases of the internal organs or immediately several systems, which carries serious danger to life and human health. Ascites is a cluster of fluid in the abdominal cavity, from the outside of the organs.

Characterized by such pathology:

• Increasing abdomen;
• An increase in intrauterine pressure;
• Violation of the work of the internal organs.

The disease is characterized by the fact that the activities are violated not only by organs located in the abdominal cavity, but also other different systems. This state arises as a result of the presence of many pathologies of various organs and human systems.

A pathological process is detected when conducting physical and instrumental research techniques. Treatment of such a violation is quite complicated, long and is often carried out throughout life.

The ascis of the abdominal organs is a symptomatic manifestation in which liquid (effusion) accumulates in the abdomen. Many believe that such a state is a disease, however, it is only a manifestation of certain health problems.

Abdominal cavity combines:

• Spleen;
• Part of the intestines;
• Gallbladder;
• Liver.

It is limited to a certain shell, which includes two layers adjacent to this organ and abdominal walls. The task of the abdominal cavity is to fix the organs located in it, as well as to participate in metabolic processes. It is equipped with blood vessels providing a full-fledged metabolism. In a healthy person between these shells there is water, which is normally not accumulated, and is absorbed into lymphatic vessels, released space for the new arrival.

In the occurrence of ascites, excessive accumulation of excessive fluid in the peritoneum is observed. In addition, it is very poorly excreted from the body. The progression of the pathological process is gradually aggravated, the excess fluid begins to prescribe the internal organs and the course of the underlying disease is significantly aggravated.

Liquid accumulation can occur when:

• Cirrhosis;
• Tuberculosis;
• Peritonitis;
• Some diseases of children;
• Malignant neoplasms;
• Heart failure.

In addition, such a disease is typical of people with narcotic and alcohol addiction, chronic hepatitis. Influenced that the fluid is delayed in the peritoneum can increase cholesterol, obesity, diabetes. Important! Since the ascitic fluid can accumulate in significant quantities, as well as hazardous consequences, it is important to conduct a timely diagnosis to determine the presence of a disease, as well as to cure pathology in time.

Whether the abdominal cavity ascis is possible at oncology

In the presence of oncology, malignant cells multiply very quickly. If during metastasis, they penetrate the liver, then this leads to the transmission of the space between the cells filled with blood, as well as to increase the pressure in the collar vein area and the vessels adjacent to it. As a result, the outflow of lymph and blood from peritoneum, which is assembled in significant quantities. If there is a dropsy, then it is important to know how much you live with a similar disease. Many patients with such a diagnosis live less than 2 years.

A high mortality rate is due to the high probability of occurrence of dangerous complications, in particular, such as:

• Respiratory failure;
• Obstruction in the intestines;
• The formation of the umbilical hernia;
• Peritonitis.

Among all other reasons for the occurrence of malignant neoplasms are defined as: ovarian cancer, pancreatic tumors, abdominal concealer. The forecast is quite disappointing, since when progressing oncological ascites, the life expectancy is a maximum of a couple of years. The condition is significantly worsening in people in old age, with strong metastasis, as well as renal failure. If there are malignant neoplasms in the field of gynecology, it is necessary to undergo a corresponding examination and subsequent complex treatment.

Liquid in the abdominal cavity: symptoms of the disease

It is quite simple to determine the presence of an abdominal cavity ascite, as there are sufficiently characteristic symptoms of the disease. Ascites may occur sharply and suddenly, and can develop for a long time, within a few months. If a minor amount of fluid is recruited, then the signs at this stage will not be observed. They occur only if there is a 1 liter of excessive fluid contained in the abdominal cavity.

There is a similar pathological process with such symptoms as:

• Pain in the stomach;
• Feeling of cutting;
• Weight gain;
• Edema;
• Bloating;
• Difficulties when tilting the body;
• The presence of shortness of breath;
• Heartburn, belching.

From the very beginning of the occurrence of the pathological condition, the stomach becomes quite intense, it has a spherical shape with an unscrewing half down, and if a person falls, it is molded like a frog. The stomach grows all the time, the navel gradually protrudes outward, stretch marks appear on the skin. Extended subcutaneous veins can be seen on the front and side of the abdomen. If there are tuberculosis ascites, fatigue, pulse, weakness, headache are also added to such signs. There is a sharp reduction in weight in the patient. It is difficult to distinguish the presence of the pathological process, so it can be masked for various diseases. In difficult cases, hemorrhagic shock may even occur, which is very dangerous for a person.

Reasons for women: liquid in the abdominal cavity

Many are interested in why the abdominal cavity ascites is formed and how to cope with the existing pathological process. The causes of ascites in women and men are diverse and are connected with serious disorders occurring in the human body.

In adults, such a violation arises for such reasons as:

• Sick liver, kidney, heart;
• Damage defeat;
• Protein failure;
• Power error;
• Problems with digestion.

The abdominal cavity ascis Code on the ICD 10 of which R18 is characteristic mainly for people with chronic pathologies. First of all, these are liver diseases, in particular, such as malignant neoplasms of this organ, cirrhosis. Such a condition may occur against the background of hepatitis, receiving some toxicological drugs, alcohol consumption, as well as many other factors. As a result, liver cells are replaced by scarring.

Provice ascites can serious nutritional disorders, especially pathology arises due to obesity.

Many are interested in where the disease is taken from the child. These can be different kind of congenital pathological processes.

What is ascites and the peculiarity of treatment

Having determined, at what kind of violations, ascites is formed, it is important to know how to diagnose and subsequent treatment.

The diagnosis is made on the basis of:

• Visual inspection;
• Instrumental research;
• Laparaskopy and laparocentsis;
• Angiography;
• Coagulogram.

There are also other research methods, in particular, the chilistic indicator in the blood is estimated. It is necessary to treat a disease immediately after it is detected. When conducting therapy, it is very important to observe the bed and semi-noar regime. Be sure to comply with a certain diet, limiting or completely excluding sodium from food. To do this, it is necessary to eliminate salt and limit the fluid consumption.

If the belly is unpreveloped and small, the clinic implies a medication treatment with various drugs.

If the belly is very large and the accumulation of liquid is significant, then surgery needs to do. When carrying out operation, excessive accumulated liquid pumped out. Laparocentsis involves pumping excessive fluid through the puncture of the abdominal wall. Typically, pumping is carried out through a special drainage tube with a clamp so that you can remove excessive fluid over several days. Obtaining excessive fluid helps only temporarily suspend the pathological process, which is why subsequent comprehensive treatment is required. In difficult cases, liver transplantation is performed.

Cutting fluid in the abdominal cavity

The accumulation of excess fluid in the region of the abdominal cavity is called ascites. It is important to diagnose the diagnosis and subsequent treatment of the pathological process, since otherwise the forecast may be disappointing.

Among the main complications it is necessary to allocate such as:

• Bacterial peritonitis;
• Hepatic encephalopathy;
• Bleeding.

Especially often complications arise in people older than 60 years, in the presence of complex chronic diseases. Basically, patients with such a disease live less than a year and then, subject to comprehensive treatment.

What is an abdominal cavity ascites (video)

Ascites is characterized by the fact that it takes very difficult, provokes violations of many internal organs. It is practically not amenable to therapy.

The reasons for the accumulation of fluid in the abdominal cavity depend on the set of various factors and hazardous states. it abdominal Vodka.which can exercise gastroenterological problems, gynecological disorders, oncology, urology, can even indicate heart pathologies.

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

The factors of the appearance of ascites are diseases that provoked unpleasant symptoms due to the deterioration of the patient's condition:

• Portal Hypertension. This disease is characterized by an increase in pressure in a carrier vein. It ensures the correct blood circulation on the gastrointestinal tract and its pathology happens quite often. This disease is characterized by the fact that the liver functions are not fully executed. The disease is manifested very bright, as disorders are observed in the process of digestion, as well as dangerous manifestations of the disease characterized violation of metabolism.
• Cirrhosis of the liver. Dangerous and difficult to cure a disease from which it is necessary to get rid of the minimum time.
• Alcohol Hepatitis V.A strong inflammation of the liver is manifested, which began due to its poisoning toxic substances that fell as a result of alcohol consumption. First of all, it is necessary to abandon all alcohol-containing drinks, then all the forces will be sent to cure from the disease.
• Carcanicomatosis of peritonean. This is a disease characterized by the presence of malignant cells outside or inside the peritoneum. Various tumors and simply modified cells can cause the stomach water.
• Heart failure. If the blood flow in the heart is broken, all organs suffer, which leads to the bloodstream. As a result, the accumulated fluid increases, which causes a rapid increase in abdomen and inconvenience for the patient.
• Liver failure. Usually ascites in this case occurs not just in the case of a decrease in the liver function, and when chronic inflammation or death of hepatic tissue. If the cells cannot perform their functions for a long time, the process of processing proteins is knocked down. Too small percentage of protein in the blood leads to the fact that the liquid is distinguished from the vessels and enters the abdominal cavity. Liquid delayed insideCauseing unpleasant symptoms.
• Hypoproteinemia. It is manifested in the pathologies of the kidneys, especially dangerous or strong if the person has undergone a bubble diet.
• Pushkin tuberculosis.This is a very rare disease, but it is capable of manifesting with a weakened immunite.
• Patology of the pancreas. In most cases, manifest themselves in the abdomen if strong pancreatitis is characterized by complications.

Symptoms

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

• Increase abdomen. When the patient stands, the pathology is visible especially strongly. The stomach seems to be dispersed, looks burdened. If a person falls around, the stomach looks rolling. Side surfaces never wade, some protruding or strongly stand out.
• Forms a bipoon ring syndrome. The navel is constantly expanding to when it becomes convex, which often provokes The emergence of hernia.
• In some cases, the accumulation of fluid in the abdominal cavity is considered the result. hypertension. The disease at which the increase in the pressure in the portal vein is manifested, according to which the venous blood circulates on the gastrointestinal tract. Also in many cases, the accumulation of fluid inside the abdomen is associated with the problems of the liver. Then the skin on the stomach does not look smooth, but is decorated with bright venous vessels. They do not look asynchronous, as we visually form a web, leaning away from the bunch.
• Patients complain of heavy breathing and incessant shortness of breath. This syndrome is formed due to the fact that the significant part of the abdominal fluid is invariably lifts a diaphragm. Because of this, the breast cavity decreases, which does not allow it to provide sufficient volume so that the air goes and go out without tension.

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

To cure ascites, it is necessary to clearly define the pathology, which led to its formation.

After operation

When conducting an operation on internal organs, one complication is the accumulation of fluid in the abdominal cavity. In most cases, doctors warn about it in advance, as well as carry out the necessary research in order to eliminate the likelihood of this disease.

If the inflammation of the internal organs is observed, the probability of the accumulation of fluid inside the abdomen increases. To remove it, there is no need for a re-operation. Doctors easily solve this problem, Having a simple puncture procedure with the subsequent conclusion of the fluid under local anesthesia.

Treatment

To cure the accumulation of fluid inside the abdomen, it is necessary to resort to complex measures by applying the main medical techniques:

• Relief from the main disease. In most cases, ascites is caused by chronic pathologies. They are quite difficult to treat, since it is necessary to bring a state to long-term remission, as a result, to achieve in order to hurt completely left the person. If you spend constantly adequate treatment The risk of ascites is reduced.
• Diet. It is necessary to constantly monitor your diet, take food, which contains a large number of proteins.
• Do not neglect the reception of diureticsEspecially in the event that they are needed for your body.
• Laparing. Weak anesthetic is used, since the process takes the minimum amount of time. The wall is pierced by a specialized medical device designed to carry out this surgical intervention. Thanks to the commissioning of the puncture, the liquid is completely allocated. This method is used quite often, however, is not effective enough, if not combining it with a competent course of therapy. If the main disease does not leave the patient, there is a high probability that the liquid is formed again and even more than before.
• Conducting an operationwhich led to the accumulation of liquid in the stomach. Especially often the operation is shown in hypertension. Requires vascular operations under which measures that serve for improvement of blood flow.This will allow not only to reduce the likelihood of recurrence of the accumulation of fluid in the stomach, but also ensure good blood circulation on the gastrointestinal tract, save a person from hepatic pathologies.

The accumulation of fluid in the abdominal cavity is a dangerous disease, but it is possible to get rid of it using standard medical methods. If cured the main disease, the recurrence of ascites will not appear.

If you leave it without attention, as a result of multiple violations of the functions of the internal organs deteriorates forecast of the main diseaseand also aggravated the patient's condition.

Ascites - This is a secondary state at which the transudate or exudate in the abdominal cavity occurs. Symptoms of pathology are manifested by an increase in the size of the abdomen, pain, shortness of breath, sensation of gravity and other signs.

Ascitis in medicine is called abdominal water, which can accompany the set of diseases from the field of gynecology, gastroenterology, urology, cardiology, lymphology, oncology, etc. Ascitis is not an independent disease, but acts as a symptom of a severe violation in the body. The abdominal cavity ascites does not occur with light pathologies, it always accompanies diseases threatening a person's life.

Ascites statistics indicate that it is more than 70% of adults developing as a result of liver disease. The tumors of the internal organs lead to the development of ascites in 10% of cases, another 5% accounted for heart failure and other diseases. While in children, the development of ascites is most often indicating about.

It has been established that the maximum amount of liquid accumulating in the abdominal cavity during patient's ascites can reach 25 liters.

Causes of Ascita

The causes of the abdominal cavity ascites are diverse and always associated with some serious impairment in the human body. The abdominal cavity is a closed space in which unnecessary fluid should not be formed. This place is intended for internal organs - there is a stomach, liver, gallbladder, part of the intestines, spleen, pancreas.

The peritonean is lined with two layers: the outer, which is attached to the wall of the abdomen, and the inner, which is adjacent to the authorities and surrounds them. Normally between these sheets there is always a minor amount of fluid, which is the result of the work of blood and lymphatic vessels in the cavity of the peritoneum. But this liquid does not accumulate, as practically immediately after the selection, it is absorbed by lymphatic capillaries. The remaining insignificant part is necessary in order for intestinal loops and internal organs to move freely in the abdominal cavity and did not glue with each other.

When a violation of the barrier, excretory and resorbative function occurs, the exudate ceases to be absorbed normally and accumulates in the abdomen, as a result of which the ascites develop.

The reasons for ascites are as follows:

Liver disease. First of all, this, as well as Badda Kiari syndrome. Cirrosis can develop on the background, steatosis, intake of toxic drugs, and other factors, but always accompanied by the death of hepatocytes. As a result, normal liver cells are replaced by a scar tissue, the organ increases in size, it displays a portable vein and therefore ascites develops. Also contributes to the exit of an extra liquid decrease in oncotic pressure, because the liver itself is no longer able to synthesize plasma proteins and albumin. Exacerbates the pathological process a number of reflex reactions started by the body in response to hepatic failure;

Heart diseases. Ascites can develop due to, or due to the resistance pericarditis. Heart failure can be a consequence of almost all cardiac diseases. The mechanism of development of ascites in this case will be associated with the fact that the hypertrophied heart muscle is not able to pump the necessary volumes of blood, which begins to accumulate in blood vessels, including in the system of the lower hollow vein. As a result of high pressure, the liquid will be out of the vascular bed, forming ascites. The mechanism for the development of ascites with pericade is approximately the same, but in this case the outer sheath of the heart is inflated, which leads to the impossibility of its normal blood filling. In the future, this affects the work of the venous system;

Diseases of the kidneys. The chronic ascites, which arises as a result of a wide variety of diseases (, glomerulonephritis, etc.). The kidney diseases lead to the fact that the blood pressure increases, sodium together with the liquid is delayed in the body, ascites are assessed. Reducing the oncotic pressure of plasma, leading to ascitis, can also occur against the background of nephrotic syndrome;

Ascites May develop during damage to lymphatic vessels. This happens due to injury, due to the presence in the body of a tumor, which gives, due to infection with filiaries (laying eggs in large lymphatic vessels);

Various defeat of the peritoneum Create ascites, among them spilled, tuberculosis and fungal peritonitis, peritoneal carcinosis, stomach, breast, ovarian, endometrial. This also includes pseudomixoma and mesothelioma peritoneum;

Polyesorozit is a disease in which the ascites performs in a complex with other symptoms, among which pleurisy and pericarditis;

Systemic diseases Capably lead to the accumulation of fluid in the peritoneum. This is rheumatism, etc.;

Ascites in newborn children Also occurs and most often is the result of the hemolytic disease of the fetus. It, in turn, develops with intrauterine immunological conflict when the blood of the fetus and mother is not combined by a number of antigens;

Protein deficiency - one of the factors predisposing to the formation of ascites;

Diseases of digestive organs Could provoke excessive accumulation of fluid in the abdominal cavity. It may be chronic, Crohn's disease. This can also include any processes occurring in the peritoneum and prevent lymphatic outflows;

Miksedma is capable of leading to Ascita. This disease is accompanied by an edema of soft tissues and mucous membranes, manifests in violation of thyroxine synthesis and triiodothyronine (thyroid hormones);

Serious errors in nutrition Cauls can cause abdominal ascites. Fasting and strict diets are especially dangerous in this regard. They lead to the fact that protein stocks are drying in the body, the protein concentration in the blood drops, which implies a pronounced decrease in oncotic pressure. As a result, the liquid part of blood comes out of the vascular channel and ascites is formed;

At an early age, ascites accompanies exudative enteropathy, hypotrophy and congenital nephrotic syndrome.

So, the basis of ascites can contain a wide variety of inflammatory, hydrostatic, metabolic, hemodynamic and other violations. They entail a number of pathological reactions of the body, as a result of which the interstitial fluid prohibits through the veins and accumulates in the peritoneum.

The first symptom of ascites is an unprecedented increase in the abdomen, or rather, his bloating. The main reason for this is that a huge amount of fluid accumulates there, and it practically does not come out. A person discovers ascites usually when it can not get into the usual clothes, which has recently approached him in size.

If you have an abdominal asbit of the abdominal, then in the body there are probably at least two serious functional disorders that need to be cured. Most often it is an incorrect intestinal work, stomach disorder or liver pathology.

The rate of increase of symptoms is directly related to what caused ascite. The process can develop quickly, and may take several months.

The symptoms of the abdominal cavity ascites are the following clinical signs:

A feeling of cutting in the abdominal cavity;

The occurrence of pain in the abdomen and pelvis (abdominal pain);

Problems with digestion and urination;

Nausea attacks;

Gravity in the stomach;

Increase abdomen in volume. If the patient is in a horizontal position, then the belly sputs around and reminds the appearance of the abdomen of the frog. When a person stands, the stomach hangs;

Navel protrusion;

Symptom of abdominal oscillations or fluctuation. It always occurs when the abdominal cavity is filling;

The greater the fluid accumulates in the abdominal cavity, the stronger the shortness of breath becomes, the swelling of the lower extremities becomes, movement becomes slow motion. Especially difficult to lean forward;

Due to the increase in intra-abdominal pressure, it is possible to protrude the femoral or umbilical hernia. Varicocele can develop on the same background. The loss of the rectum is not excluded.

Symptoms of ascites will be somewhat different depending on the etiological factor, which provoked it:

Symptoms of ascites with tuberculous peritonitis.In this case, ascites is a consequence of tuberculous lesion of the sexual system, or intestines. The patient begins to rapidly lose weight, he is growing symptoms of intoxication of the body. The lymph nodes are increasing, which pass along the bow / intestinal mesentery. In the drafts taken using the exudate puncture, in addition to lymphocytes and erythrocytes, mycobacteria will be allocated;

Symptoms of ascites with peritoneal carcinosa.If the ascite is formed due to the presence of a tumor in the peritoneum, then the symptoms of the disease will primarily depend on which organ it struck. Nevertheless, there is always an increase in lymph nodes on the ascite of oncological etiology, which can be adopted through the abdominal wall. Atpic cells will be present in the precipitation;

Symptoms of ascites against heart failure.The patient has a blue sinking of skin. The lower limbs, especially the foot and lower legs, will be very sweetered. At the same time, the liver increases in size, pain occurs, localized in the right hypochondrium. The accumulation of transudate in pleural cavities is not excluded;

Symptoms of ascites against the background of the thrombosis of the carrier vein.The patient will make complaints of severe pain, the liver increases in size, but not much. There is a high risk of developing massive bleeding from hemorrhoidal nodes, or from the veins of the esophagus, which were subjected to varicose expansion. In addition to increasing the liver, an increase in the size of the spleen is observed.

Other ascites symptoms:

If the cause of pathology is portal hypertension, then the patient is much losing weight in weight, it is sick and tear. Skin covers are yellowing, an venous drawing appears on the stomach by the type of "Head of Jellyfish";

On protein deficiency, as the cause of ascite, indicate strong edema extremities, accumulation of fluid in the pleural cavity;

With chilse ascite (at the terminal stage of the liver cirrhosis), the liquid arrives very quickly, which affects the size of the abdomen;

Skin symptoms come to the fore with ascite developing against rheumatic pathologies.

Stage Ascita

There are three stages of ascites, which are determined by the amount of fluid in the cavity of the peritoneum:

The first stage is an ascite transient. In this case, the volume of fluid does not exceed 400 ml. It is practically impossible to notice the symptoms of ascites. Unnecessary fluid can be seen during instrumental examinations (during MRI or ultrasound research). The work of the abdominal organs due to the accumulation of such volumes of fluid is not violated. If a person notices some pathological symptoms, they will be associated with the main disease provoking ascites.

The second stage is a moderate ascite. Liquid volumes that are simultaneously located in the abdominal cavity can reach 4 liters. In this case, the patient already notices the alarming symptoms, the stomach increases and during standing begins to hang. Enhanced shortness of breath, especially in the lying position. The doctor is able to determine ascites based on the examination of the patient and palpation of its abdominal cavity.

The third stage - ascis is stressful. Liquid volumes will exceed 10 liters. At the same time, the pressure is strongly rising in the abdominal cavity, which leads to problems with the functioning of the internal organs. The state of a person worsens and requires immediate medical care.

Separately release refractory ascites. In this case, pathology is most often not amenable to treatment, and the fluid, despite the therapy, continues to arrive in the abdominal cavity. The forecast of the development of the disease unfavorable to the patient's life.

Treatment methods

The methods of treatment of ascites will be effective only if they started to be implemented in a timely manner. For a start, the doctor should appreciate the stage of pathology and find out what caused its development.

Therapy is conducted in the following areas:

The main drugs that help remove excess fluid from the body are diuretics. Due to their reception, it is possible to achieve the transition of an extra liquid from the abdominal cavity in the bloodstream, which helps to reduce the symptoms of ascites. To begin with, patients are prescribed the smallest dose of diuretics to minimize the risk of side effects. An important principle of treatment with diuretic drugs is a slow increasing diurea that will not lead to significant losses of potassium and other major metabolites. Most often we recommend the reception of the preparations of aldakton, Veroshpiron, triamtenen, amyloride. In parallel, potassium preparations are prescribed. At the same time, hepatoprotectors are introduced into the treatment scheme.

At the same time, doctors carry out daily control of the diurea of \u200b\u200bthe patient and with the ineffectiveness of treatment with the dose of drugs, or replace them with stronger means, for example, triampur or dichlorotiazide.

In addition to diuretic patients, drugs are prescribed to strengthen the walls of the vessels (vitamin C, vitamin P, diosmin), as well as preparations that prevent the fluid outlet beyond the limits of the vascular channel (REOPOLIGULUKIN).

Improves the exchange of hepatic cells. Introduction of protein substrates. Most often, a concentrated plasma is used for this purpose, or an albumin solution in a 20% concentration.

Antibacterial drugs are prescribed if the disease caused by ascites has a bacterial nature.

Diet

The patient's nutrition should be balanced and high-calorie, which will ensure the needs of the body in all the trace elements you need. It is important to limit the consumption of salt, and in its pure form, it is prohibited in its menu at all.

The volume of fluid consumed must also be adjusted to a smaller side. Patients are not recommended per day drink more than 1 liter of liquid without taking into account soups.

It is important that the daily diet of the patient is enriched with protein food, but its amount should not be redundant. Fat consumption should be reduced, this is especially true of patients who have ascites provoked by pancreatitis.

Surgical intervention

Laparocentesis in the abdominal cavity ascite is performed if the patient remains resistant to drug correction. For fluid outflow, it is possible to form a peritonenevous shunt with partial deperitonization of the walls of the abdominal cavity.

Operations aimed at reducing pressure in the portal system are indirect interventions. These include protocavative shunting, the reduction of spley blood flow, the impregnated portoysystemic shunting.

As for the liver transplantation, this is a very complex operation that can be performed with a stable ascite. But, as a rule, to find a donor to transfers the organ is a difficult task.

Laparocentsis of the abdominal cavity during ascite

The laparocentsis of the abdominal cavity during ascite is surgical manipulation, in which the liquid from the abdominal cavity is deleted puncture. It is not possible to pump out more than 4 liters of exudate, as it threatens the development of a collapse.

The more often the puncture is carried out during ascite, the higher the risk of developing inflammation of the peritoneum. In addition, the likelihood of adhesion formation and complications from the procedure increases. Therefore, with massive ascites, the installation of the catheter is preferable.

Indications for the conduct of a laparcenosis is a voltage and refractory ascite. The fluid can be daded using a catheter, or it simply flows freely into pre-prepared dishes after installation in the abdominal cavity of the trocar.

Answers to popular questions:

How quickly is fluid in ascite?The speed of a set of fluid in the abdominal cavity directly depends on which disease is the cause of ascite. The slower of all this process occurs in heart pathologies, and faster everything - with malignant tumors and chilse ascite.

How many of the abdominal cavity ascites live with oncology?Ascite itself does not directly affect the life expectancy of the patient. However, its development due to oncological diseases impairs the forecast for survival. The patient's life depends on the effectiveness of the treatment. It has been established that with frequent recurrences of ascite, resistant to therapy, more than 50% of patients die during the year.

Is it possible to do the enema during ascite?As a rule, the enema during ascite is performed only in the conditions of a medical institution as a preparatory event before surgical intervention.

Can there be a watermelon during ascite? When ascites can be included in the menu, as it has a diuretic effect and helps to eliminate excess fluid from the body.

Education: Moscow State Medical and Dental University (1996). In 2003, he received a diploma of the Educational and Scientific Medical Center for the Office of the President of the Russian Federation.

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What is ascites?

Ascites - This is a cluster of fluid in the abdominal cavity, manifested by an increase in the size of the abdomen and a number of other symptoms. Ascites is not an independent disease, but only the manifestation of various diseases and pathological conditions, which led to a violation of the regulation of fluid exchange in the body. However, the appearance of fluid in the abdominal cavity is always a sign of difficult the course of the disease and violation of the regulatory and compensatory reactions of the body.

Development (pathogenesis) ascis

The abdominal cavity is a closed space bounded by the peritoneous (thin semi-permeable shell) and containing various organs (stomach, spleen, liver, gallbladder and some intestinal deposits). The peritoneum consists of two sheets - parietal (outdoor, which is attached to the walls of the abdomen from the inside) and visceral (internal), which adjacent to the walls of intra-abdominal organs, surrounding them. The main functions of the peritoneum are fixation of the organs located in it and regulation of metabolism in the body.

In the peritoneum there is a huge amount of small blood and lymphatic vessels that provide metabolism. Under normal conditions in the abdominal cavity and between leaflets of peritoneum constantly there is a small amount of fluid, which is formed as a result of the heating of the liquid part of the blood and a certain number of proteins through blood vessels. However, this fluid does not accumulate in the abdominal cavity, since it almost immediately its reverse absorption in the lymphatic capillaries (per day the peritoneum can absorb more than 50 liters of fluid). The resulting lymph in the lymphatic vessels enters the venous system of the body, returning into systemic bloodstream fluid, proteins and others dissolved in it, microelements.

Based on the foregoing, it follows that the accumulation of the liquid in the abdominal cavity can occur in two cases - with an increase in the rate of its formation or with a decrease in the speed of its suction. In practice, these two mechanisms are present at the same time, that is, with various diseases of the internal organs (liver, pancreatic gland, with tumors, with inflammation of the peritoneum, and so on) an increase in fluid products arises, which will certainly entail a violation of its reabsorption (suction) as a result of squeezing and blockage of small lymphatic and blood vessels with products of cell decay, pathogenic microorganisms or tumor cells. As the diseases of the liquid develop in the abdominal cavity, it becomes more and more, and it begins to squeeze the organs there, which, in turn, can aggravate the course of the main disease and contribute to the progression of ascites.

It is also worth noting that in addition to fluid in the abdominal cavity, proteins (as well as other trace elements) are delayed. Under normal conditions, blood plasma proteins (predominantly albumin) are involved in the creation of the so-called oncotic pressure, that is, they hold the liquid in the vessels. During ascite, the large proportion of proteins is in ascitic fluid, and therefore the oncotic blood pressure decreases, which can also contribute to the exit of the liquid from the vascular channel and the progression of the disease.

When progressing the disease, there is a decrease in the volume of circulating blood, since most of the liquid accumulates in the abdominal cavity. This leads to the activation of compensatory mechanisms aimed at the water delay in the body (in particular, the rate of formation and separation of urine decreases), which further increases the hydrostatic pressure in blood vessels and also contributes to the formation of ascitic fluid.

Causes of Ascita

The causes of ascites can be much, but they all are somehow connected with a violation of blood outflow and lymphs from peritoneum or abdominal organs.

The causes of ascites can be:

• liver cancer;
• disease (syndrome) Badda Kiaari;
• squeezing portal veins;

• oncological diseases (tumors);
• kidney disease;
• anasarka;
• violation of the circulation of lymph (chilse ascites);
• disorders of the fetus;
• childhood diseases;

Ascites with liver cirrhosis

Cirrhosis of the liver is a chronic disease in which the structure is disturbed and almost all functions of this organ, which leads to the emergence and progression of various complications.

In normal conditions, blood flops from many internal organs (from the stomach, spleen, pancreas, a thin and large intestines) in the liver on a barny (portal) vein (from the stomach, spleen, pancreas, thin and large intestines). In the liver, it passes through thin tubules (liver sinusoids), where filtered, cleaned and enriched with various substances (for example, proteins), after which it enters the lower hollow vein and returns to systemic blood flow. In cirrhosis under the action of various causal factors (for example, hepatitis V viruses in or c), damage and destruction of a large number of hepatocytes (liver cells) occurs. The dead cells are replaced by a fibrous fabric, which significantly reduces the function of the liver. This, in turn, leads to the activation of compensatory mechanisms consisting in the enhanced division of the remaining (intact) cells. However, the structure of the newly formed tissue is broken (in particular, there are no sinusoids characteristic of normal liver), as a result of which the filtration capacity of the organ decreases (that is, the amount of blood is reduced, which can pass through the liver per unit of time).

The violation of the liver function, as well as the change in its structure leads to the fact that blood cannot be filtered in full, as a result of which it begins to accumulate in a portal vein. As the disease progresses, the hydrostatic pressure (that is, the pressure rendered on the wall of the vessel) in the carrier vein increases (portal hypertension develops), which disrupts the process of blood outflow from the internal organs (stomach, intestines and others). As a result of stagnation of blood in them, there is an expansion of blood vessels and an increase in the permeability of vascular walls, which leads to the rising part of the liquid into the abdominal cavity.

It is also worth noting that the liver is the main place of the formation of proteins in the body. In the later stages of the disease (when most of the hepatocytes are replaced by a fibrous cloth), the protein-forming function of the liver decreases, resulting in hypoproteinemia (lack of proteins in the blood). This, in turn, leads to a decrease in the oncotic pressure of blood, which also contributes to the output of a part of the liquid from the vascular bed.

Ascites with liver cancer

Liver cancer is a tumor disease that causes damage to the structure of the liver and disruption of all its functions. Various environmental factors (radiation, toxins, viruses, and so on) can contribute to the development of cancer (radiation, toxins, viruses, and under the action of mutant tumor cells. Typically, such cells are immediately detected by the immune system of the body and are destroyed, however, under certain conditions (for example, when weakening immunity or when irradiated with a large dose of radiation), one tumor cell can survive and start constantly (infinitely) to share.

Over time, the tumor increases in size and can squeeze large intrahepatic vessels. Also, cancer cells can be broken from the main tumor and move (metastasis) to other organs of the organ, blocking hepatic sinusoids, blood and lymphatic vessels and bile ducts. This will lead to a violation of all the functions of the liver, an increase in pressure in the carrier vein and the development of ascites.

Ascites with other liver diseases

In addition to cirrhosis and cancer, there are several other pathologies that can disrupt blood circulation in the liver and a portal vein and cause the fluid yield into the abdominal cavity.

The cause of ascites can be:

• Mesothelioma. This malignant neoplasm meets extremely rarely and occurs directly from the cells of the peritoneum. The development of the tumor leads to the activation of the immune system in order to destroy the tumor cells, which is manifested by the development of the inflammatory process, the expansion of blood and lymphatic vessels and the peashing of the liquid into the abdominal cavity.
• Crachercomatosis of peritoneum. This term is denoted by the damage of the peritoneum with tumor cells, which are metastasized into it from tumors of other organs and tissues. The mechanism for the development of ascites at the same time is the same as during the mesothelome.
• Pancreas cancer. Pancreas is the place of formation of digestive enzymes, which are allocated from it in the pancreatic duct. After leaving the gland, this duct merges with a common bile duct (according to which he moves bile from the liver), after which they together fall into the delicate intestine. The growth and development of the tumor near the velocity of these ducts can lead to a violation of the outflow of bile from the liver, which can manifest itself with hepatomegaly (increasing liver size), jaundice, skin itching and ascites (ascites develops in late stages of the disease).
• Ovarian cancer. Although the ovaries do not belong to the abdominal organs, the leaflets of the peritoneum participate in fixing these organs in a small pelvis. This explains the fact that with the ovarian cancer, the pathological process can easily spread to the peritoneum, which will be accompanied by an increase in the permeability of its vessels and the formation of traffic in the abdominal cavity. In the later stages of the disease, cancer metastasis can be noted in the peritoness leaves, which will increase the yield of the liquid from the vascular bed and will lead to the progression of ascites.
• Maigs syndrome. This term is denoted by the pathological condition characterized by accumulating fluid in the abdominal and in other cavities of the body (for example, in the pleural cavity of the lungs). The cause of the disease is tumors of small pelvis organs (ovaries, uterus).

Ascites in heart failure

Heart failure - heart disease in which it is not able to ensure adequate blood circulation in the body. Under normal conditions, with each cardiac reduction in the aorta (the largest artery of the organism), a certain amount of blood is ejected. As the aorta is removed from the heart to smaller artery, until the capillaries are formed - the thinnest vessels in which oxygen exchanges between the tissues and cells of the body occurs. After passing through the capillaries, the blood is going to the veins and delivered back to the heart. Part of the fluid (about 10%) is entered into lymphatic vessels and turns into lymph.

An important feature of the vascular system is that the wall of the arteries is dense and elastic, while the venous wall is relatively thin and easily stretched with increasing intravascular pressure. When developing heart failure (the cause of which can be a heart attack, infection, a long-term increase in blood pressure and so on) the pump function of the heart muscle is reduced, as a result of which it develops stagnation in the system of the lower hollow vein, which collects blood from the entire bottom of the body. Due to the expansion of the walls of crowded venous vessels, as well as due to the increase in the hydrostatic pressure, a certain proportion of the liquid blood flows from the vascular channel and accumulates in the abdominal cavity.

Ascites for kidney disease

The kidneys are organs of excretory system that regulate the composition and volume of fluid in the body. However, in some diseases, their function may violate that, in turn, can lead to the development of various complications.

Ascites may complicate:
Renal failure
The pathological condition in which more than 75% of the functional tissue is affected (so-called nephrons) of the kidneys. As a result, the body can no longer fully perform its excretory function, therefore, part of by-products of vital activity (such as urea, uric acid and others) are delayed in the body. These substances are osmotically active (that is, they attract fluid to themselves) and when penetrating into the intercellular space of tissues leads to the development of edema.

Also, with renal failure, the blood supply to the renal tissue is disturbed, as a result of which compensatory mechanisms are activated, aimed at increasing the systemic blood pressure and an increase in the amount of blood delivered to the kidneys. Along with this, the rate of sodium and water is reduced in the kidneys, which further increases the volume of circulating blood, increases the pressure in the venous system and contributes to the progression of ascites.

Nephrotic syndrome
This disease is characterized by damage to the renal filter (which is normally impenetrable for proteins and other large-molecular weight substances), as a result of which the body loses with urine a large number of plasma proteins (more than 3 grams per day). After a few days, this leads to a significant decrease in the oncotic pressure of the blood, as a result of which it is no longer able to hold it into the vascular bed and hesitates in the abdominal cavity, leading to the development of ascites.

Ascites with pancreatitis

Pancreatitis is a disease of the pancreas, characterized by the destruction of its tissue and the spread of the pathological process to neighboring organs. The reason for the development of this disease is the pathological activation of the digestive enzymes generated in the gland. Normally, they are allocated to the intestine in inactive form and are activated only after mixing with intestinal content. With different pathological conditions (with alcohol abuse, after receiving a large amount of fried food, after the abdomen injury or as a result of viral infections), these enzymes can be activated directly inside the gland, which will lead to its self-extinguishing.

During the described process, damage to the vessels of the pancreas occurs, which causes the penetration of digestive enzymes into the blood. If it does not start treatment in time, the pathological process can destroy the wall of the gland and go to the peritoneum, which will cause the development of peritonitis (peritoneal inflammation) and can lead to the formation of ascitic fluid in the abdominal cavity.

Ascites at Peritonitte

Peritonitis is inflammation of the peritoneum, characterized by pronounced pain in the abdomen and progressive symptoms of general intoxication of the body (increasing body temperature of more than 40 degrees, rapid breathing and heartbeat, violation of consciousness, and so on). This condition develops when penetrating pathogenic bacteria in the abdominal cavity from the outside.

The cause of peritonitis can be:

• breaking the hollow organ (stomach, intestines, urinary or gallbladder);
• penetrating injury of the abdominal cavity;
• spinning ulcers of the stomach or intestines;
• disintegration of the intestinal tumor with damage to its wall;
• migration of bacteria from other foci of infection;
• distribution of the inflammatory process from neighboring organs.

As mentioned earlier, the peritone contains a large number of blood and lymphatic vessels. With the development of an infectious or other inflammatory process, migration is noted to the hearth inflammation of a large number of leukocytes, which causes the extension of the vessels and the yield of fluid into the abdominal cavity.

It is also worth noting that the spread of infection on peritoneum occurs quite quickly, in view of which the local (local) peritonitis in a short time can move to the diffuse (common) form affecting all the peritoneum, which without timely and adequate treatment can lead to the patient's death for several hours.

Ascit on Anasarke

Anasarka is the extreme degree of edema in which the liquid accumulates in the subcutaneous fat transshipment of the body, hands and feet, as well as in the cavities of the body (in the abdominal and in the pleural cavity, in the pericardial cavity). This state requires urgent medical care, as it can lead to a patient's death in a matter of hours or days.

The cause of the anasarch can be:

• Heart failure. In this case, swelling and ascites are developing due to a pronounced increase in hydrostatic pressure in venous and lymphatic systems, which is due to the inability of the heart muscle to pump blood.
• Renal failure. With this pathology, the cause of the water delay in the body is a violation of the excretory function of the kidneys.
• Liver diseases. With severe cirrhosis and liver failure, the concentration of proteins in the blood decreases, which may cause the development of generalized edema.
• Myxedema. It is characterized by a decrease in the blood concentration of thyroid hormones (thyroxine and triiodothyronine), which is manifested by a decrease in the amount of proteins generated in the body and leads to the exit of the liquid from the vascular bed.
• Hyperldosteroneism. This disease is characterized by excessive formation in adrenal glands (endocrine glands) Hormone aldosterone. Under normal conditions, this hormone is responsible for maintaining the volume of circulating blood at a constant level, however, with its redundant secretion, a pronounced sodium and water delay occurs in the body, which contributes to the development of edema and ascites.

Hilse ascites

This disease is characterized by an accumulation in the abdominal cavity of a milky white, shiny fluid, in which the concentration of fats is elevated. The reason for this is the violation of the outflow of lymphs from peritoneum, which is usually associated with squeezing or overlapping the lumen of the breast lymphatic duct collecting lymph from the entire bottom of the body.

Also the cause of the exit of lymph in the abdominal cavity can be:

• injuries of large lymphatic vessels;
• abnormalities of the abdominal organs;
• previously transferred operations on the abdominal cavity;
• tumor diseases (systemic lymphangiosis);
• chronic inflammatory bowel diseases.

Ascites in fruit

The accumulation of the liquid in the abdominal cavity of the fetus may be due to various pathologies of the mother or child.

The cause of ascites in the fetus can be:

• Hemolytic disease of newborns. This disease develops if the mother with a negative rhesus factor (Rhow factor is a special antigen, which is present on red blood cells in certain people) will enter the fetus with a positive rear factor. During the first pregnancy, no deviations from the norm would not, however, during the childbirth, the blood of the mother and the fetus will occur, which will lead to the sensitization of the parent organism (antibodies against the rhesv factor will begin to be released). When re-pregnancy, the reserves-positive fruit of antibodies will begin to hit the blood cells of the fetus, disturbing the functions of all its organs and tissues and leading to the development of generalized edema and ascites. Without timely treatment, this disease leads to the death of the fetus.
• Genetic diseases. The human genetic apparatus consists of 46 chromosomes resulting from a fusion of 23 maternal and 23 paternal chromosomes. Damage to one or more of them can manifest themselves with various diseases that can be transmitted to offspring. The ascites in the intrauterine period may be a manifestation of Down syndrome (in which the extra chromosome in 21 pairs appears), the Turner syndrome (which is characterized by the defect of the sexual X chromosome) and other hereditary diseases.
• Interene development abnormalities. The cause of intrauterine developmental anomalies may be infection, radiation or injury. Ascites may arise due to the violation of the normal liver development, the cardiovascular or lymphatic system, with the underdevelopment of the biliary system and with other defects.
• Damage to the placenta. The placenta is an organ that appears in the body of a pregnant woman and provides livelihoods (delivery of oxygen and nutrients) of the fetus during the entire intrauterine period of development. The disturbance of blood outflow from the placenta or the umbilical cord can be increased in the blood pressure of the fetus, thereby creating the prerequisites for the development of edema and ascites.

Ascites in children

All listed causes of ascites in adults may also meet in childhood. However, in newborns and young children, ascites may be due to other diseases.

The cause of ascites in children can be:

• Digures of heart development. In this case, the abnormalities of the development of the heart muscle are meant, which lead to a violation of the pumping function of the heart (defects of valves, defects of interventricular and interpresenting partitions). In the intrauterine period, the data of the anomalies may not be exercised in any way, but after birth (when the load on the heart increases) edema, ascites and other signs of heart failure can develop.
• Digures of the kidneys. In the intrauterine period, the excretory function is carried out by the placenta, therefore, even with severe anomalies for the development of the renal system, the signs of renal failure in the fetus may be absent. After the birth of the child, toxic substances and the exchange products accumulate in the blood and in the tissues of the baby, which can lead to the development of edema and ascites.
• Infectious diseases. Fetal infection with various viruses (rubella, herpes virus, cytomegalovirus, enterovirus) or bacteria (for example, during syphilis) can lead to the affix of the internal organs and the development of polyorgan deficiency. This can manifest itself ascite, which will appear in the intrauterine period or immediately after the birth of the child.
• Tumors. Neon-formations in newborns are extremely rare, as time is necessary for the development of the tumor process and the tumor growth. Nevertheless, the appearance of a tumor (malignant or benign) in the intrauterine period or in early childhood is possible. A growing tumor can squeeze the blood or lymphatic blood vessels, damage various organs and fabrics (liver, spleen), which can lead to the development of ascites from the first days of life.
• Congenital anemia. Anemia is the general name of states characterized by a decrease in the concentration of erythrocytes (red blood cells) and hemoglobin (in the red blood cells of the respiratory pigment) in the blood. Some types of anemia (sickle-cell anemia, hemoglobinopathy, anemia with a shortage of enzymes and so on) are characterized by deformation and destruction of red blood cells. They are destroyed mainly in the liver and spleen, which can over time lead to damage to these organs and the development of edema and ascites.

Ascites during pregnancy

Ascites in pregnant women can develop as a result of various diseases of the liver, heart, kidney and other organs and systems. Also, the increase in the liquid in the abdominal cavity contributes to the increase and increase in the size of the fetus, which can squeeze the lower venu (large vessel collecting venous blood from the entire bottom of the body).

The growth and development of the fetus in itself requires all the organs of the female organism more intensive work. The accumulation of fluid in the abdominal cavity and an increase in intra-abdominal pressure further increases the load on the organs, which can lead to decompensation of chronic diseases and the development of polyorgan deficiency, threatening health or even the lives of mother and fetus.

The most terrible manifestations of ascites in pregnant women can be:

• Respiratory failure. The increase in the uterus in the late period of pregnancy leads to a displacement of the diaphragm (the main respiratory muscle separating the abdominal cavity from the chest) upwards, leading to a decrease in the respiratory volume of the lungs. The appearance of a large amount of fluid in the abdominal cavity further aggravates this process, which leads to a lack of oxygen in the blood of the mother and the fetus.
• Heart failure. As already mentioned, the growth and development of the fetus leads to an increase in pressure in the abdominal cavity. As a result, blood pressure is rising in blood vessels located there. To overcome this pressure, the heart is forced to work in reinforced mode. The appearance of ascites in the late period of pregnancy further increases the load on the heart, which can cause a violation of its function. This, in turn, can lead to insufficient blood flow to the placenta and cause the intrauterine death of the fetus.
• Squeezing the growing fetus. With ascite, the number of liquid accumulating in the abdominal cavity can reach several tens of liters. This will lead to a pronounced increase in intra-abdominal pressure and comprehension of all internal organs, including uterus with developing fruit. As a rule, this state makes it impossible to further develop pregnancy.

Hemorrhagic ascites

With hemorrhagic ascite in the ascitic fluid, there are red blood cells (erythrocytes) in one or another quantity. As a rule, such a state develops against the background of already existing chronic diseases that caused the formation of ascites (liver cirrhosis, cancer, tuberculosis).

The cause of hemorrhagic ascis can be:

• liver injury;
• searen injury;
• bleeding during tumor decay;
• thrombosis (blood clutch blocking) hepatic veins;
• perforation (bodybag) of the intestinal wall (for example, with ulcers).

The appearance of blood in the ascitic fluid is an unfavorable prognostic feature and requires urgent diagnostic and medical events.

Tuberculosis ascites

Tuberculosis is an infectious disease that affects the lungs, intestines and other organs. The disease is caused by mycobacteriums of tuberculosis, which fall into the body mainly by air-droplet (when inhaling air contaminated by the pathogen) or with food. The primary focus of tuberculosis is usually localized in the pulmonary fabric, less often - in the intestine. As the disease progressing and with a decrease in the protective forces of the body, mycobacteria can be distributed from the primary hearth to other fabrics, including in the peritoneum.

The lesion of the tuberculosis peritoneum leads to the development of a specific inflammatory process (peritonitis), which is manifested by the expansion of blood vessels and the heating of a large amount of liquid, lymph and proteins in the abdominal cavity.

Ascites with endometriosis

Endometriosis is a disease in which the growth of endometrial (mucosa of the uterus) is occurring in atypical places for it (that is, in other organs and tissues). The cause of the disease can be a violation of the hormonal background of a woman, as well as hereditary predisposition.

Initially, endometrial cells go beyond the uterus mucosa and penetrate into its muscular layer, starting there to share. During the menstrual cycle, they (as well as the usual endometrium) are subject to certain changes, which can lead to the development of bleeding. In the later stages of the disease, the endometrium cells go beyond the uterus and can affect any organs and fabrics, including peritoneum. In addition to other symptoms (abdominal pain, urination disorders, and so on) this can manifest liquid accumulation in the abdominal cavity.

Ascites and Purrites

Pulmonary Pleverra is called a thin connective tissue sheath, which consists of two sheets - external and internal. The outer leaf is adjacent to the inner surface of the chest, and the inner envelops the pulmonary tissue. There is a sliding space between these sheets (pleural cavity), which contains a small amount of fluid necessary to provide a slip of the sheets relative to each other during breathing.

Purritite is the inflammation of the leaflets of the pulmonary pleura, which is usually accompanied by the heating of the fluid into the pleural cavity. Ascites and pleurisy can be observed at the same time in systemic inflammatory diseases of autoimmune (when the immune system attacks cells and tissues of their own organism) - with rheumatic fever, systemic red lupus, rheumatoid arthritis, and so on. It is worth noting that the listed diseases may also occur to accumulate liquid in the pericardial cavity (cardiac bag).

Symptoms of ascites

The symptoms of ascites largely depend on the underlying disease that caused its occurrence. For example, in the diseases of the liver, the patient will complain about disruption of digestion, frequent bleeding (the main factors of the blood coagulation system) are formed in the liver) and so on. In case of kidney diseases, symptoms of urination disorders and signs of intocication of the organism by side products of metabolism may occur. In case of heart failure, patients will complain about increased fatigue and a sense of light shortage (especially during exercise).

However, regardless of the cause of the occurrence, the accumulation of fluid in the abdominal cavity will always be manifested by certain symptoms, the identification of which will allow to suspect the diagnosis in the early stages of the disease.

Ascites may be accompanied by:

• edema;
• increasing body temperature;
• poles in the stomach;
• an increase in the size of the abdomen;
• increasing liver;
• increasing the spleen;
• "Head of Medusa";
• jaundice;

Evenkers under ascite

Evenkers under ascite are developing as a result of fluid output from the vascular bed and transition to the intercellular space of various tissues. The mechanism of education and the nature of edema depends on the underlying disease that caused ascitus.

Evenkers during ascites may be a consequence:

• renal failure (renal swelling);
• heart failure (heart swelling);
• hepatic insufficiency (Showless swelling).

Renal swelling
Renal edema arise due to water delay and osmotically active substances in the body. They (swelling) are symmetrical (observed in both parts of the body), are present constantly, however, they can increase in the morning hours, as a large amount of liquid and toxic substances accumulate in the body in the body. At first, edema is localized mainly in the field of face, neck, upper extremities, then descend into the hips and the legs. The skin in the field of edema has a normal or slightly increased temperature, the skin's pallor may be occurred. With prolonged (for 20 to 30 seconds), a depression is formed, which disappears immediately after the pressure stops.

Cardiac swelling
Cardiac edema develops due to the fact that the heart cannot pump blood from the veins in the artery. They arise mainly in the evening, first localized in the field of stop and legs, and then rise to the hips and torso area. This is explained by the fact that the day of a person for a long time is in a vertical position, as a result of which the hydrostatic pressure in the lines of the lower extremities is significantly increased and the blood is developing in them. This leads to the exit of the fluid from the vessels in the intercellular space.

The skin in the field of heart swelling of the blue shine, cold to the touch. With prolonged pressure, the resulting deepening disappears slowly.

Shopless swelling
With protein deficiency, the liquid part of the blood goes into the intercellular space, which is manifested by extremely pronounced, generalized (observed in all parts of the body) edema. The skin in the field of edema extremities is stretched, tense, pale and dry, its temperature is reduced. When pressing on the ebony, the dent disappears within a few seconds.

Temperature under ascite

Directly ascites to an increase in body temperature does not lead. The cause of the violation of thermoregulation is the main diseases that caused liquid accumulation in the abdominal cavity.

When ascite, an increase in body temperature may be manifestation:

• Peritonitis. The damage to the peritoneum is alien microorganisms leading to the activation of the immune system and an increase in body temperature. The highest digits (up to 40 or more degrees) are marked with bacterial peritonitis, when pathogenic bacteria and toxins allocated toxins are absorbed into the blood and are spread throughout the body. With peritonitis of tuberculosis etiology, the temperature usually holds within 37 - 39 degrees.
• Pancreatitis. In case of pancreatitis, the noncommunicable inflammatory process in the pancreas is developed, which is accompanied by an increase in temperature to 38 degrees. The transition of inflammation on the peritoneum and the development of peritonitis can be accompanied by a more pronounced temperature reaction (up to 39 - 40 degrees).
• Liver cirrhosis. In the early stages of the development of the cirrhosis, all patients have a subfebilitation (an increase in body temperature to 37 - 37.5 degrees). If cirrhosis is a consequence of damage to the hepatitis B or C viruses, an increase in temperature to 37 - 39 degrees will be a natural protective reaction of the body that occurs in response to the introduction of alien agents. Increased body temperature above 39 degrees is usually a consequence of the development of bacterial complications and requires urgent medical intervention.
• Tumors. With all malignant tumor diseases, the patient has a subfebelitis for several weeks or months, which is usually accompanied by a sense of weakness and a decrease in body weight. When metastasizing cancer in the peritoneum, an increase in body temperature of up to 39 is 40 degrees may be occurring, which is explained by the development of an inflammatory response in response to the introduction of "foreign" (tumor) cells.

It is also worth noting that for ascites, the mixedma is characterized by a decrease in temperature to 35 degrees. This is explained by a disadvantage of thyroid hormones, which normally regulate (increase) the rate of metabolic processes in the body and body temperature.

Pain with ascite

The occurrence, nature and localization of pain depend mainly on the cause of ascite, but in some cases the accumulation of a large amount of fluid in the abdominal cavity can directly lead to an increase in pain, squeezing the abdominal organs.

The pain syndrome during ascite may be due to:

• Cirrhosis of the liver. The cirrhosis of the liver develops gradually and the inflammatory diseases of the liver (hepatitis) are usually preceded by him. The liver does not contain pain receptors, but the surrounding body of the capsule is rich in them. An increase in the size of the liver under various diseases leads to an abstraction of the capsule, which is manifested by pain of different intensity. In the initial stages of cirrhosis, patients may complain about discomfort or light pain in the field of right hypochondrium, which over time may increase. Also, patients may complain about gravity or pain in other belly departments. This is due to a disorder of digestion, which has a place in the later stages of the cirrhosis.
• Syndrome (illness) Badda Kiari. With this pathology, there is a blockage of veins, for which blood flows from the liver. As a result, there is an overflow of intrahepatic blood vessels, an increase in the organ in size and stretching the hepatic capsule, which is accompanied by sharp, with stinging pains in the right hypochondrium, reaching the right spins.
• Inflammation of the peritoneum. The peritoness leaves contain a large number of pain receptors, so its inflammation is accompanied by severe cutting or stabbing pains, which are enhanced by pressing on the front abdominal wall.
• Pancreatitis. The development of the inflammatory process in the pancreas is manifested by sharp obstacle pains that are maximally expressed in the field of the top of the abdomen. Pains can be given to the region of the right or left hypochondrium, in the back, in the heart.
• Tumor. Pains for tumors are rarely strongly pronounced, which greatly complicates the early diagnosis of malignant neoplasms. Patients can feel stupid, pulling or stomach pains for several weeks or months. The intensity of pain can spontaneously increase or decrease.
• Endometriosis. Pains for this pathology are localized mainly at the bottom of the abdomen, however, when metastasizing endometrial cells to other organs can have any localization. Usually women complain to enhance pain during sexual intercourse during menstruation, pain when urination or defecation. The pain at the same time is acute, cutting, not borne by the reception of ordinary painkillers.

Increase the abdomen during ascite

This symptom becomes not equipped with an embarrassed eye when accumulating in the abdominal cavity of more than 1 liter of fluid. Initially, this can only appear in the standing position when the liquid accumulates in the lower vessels of the abdominal cavity, causing the protrusion of the front wall of the abdomen. In the position of lying the belly can be normal size, however, the patient can begin to complain about shortness of breath (feeling of air shortage), as the liquid will move to the upper brush cavity departments, limiting the motion of the diaphragm and the lungs.

With the further progression of the disease, the number of ascitic fluid increases, as a result of which the filling of the anterior abdominal wall becomes noticeable and in the lying position. With pronounced ascite (when more than 10 - 12 liters of liquid accumulates in the abdominal cavity), the skin of the abdomen becomes stretched, stressful, shiny.

Hepatomegaly and splenomegalia during ascite

The increase in liver (hepatomegaly) and spleen (splenomegaly) can be an important diagnostic sign indicating a certain cause of ascites.

The cause of hepatomegaly and splenomegaly can be:

• Cirrhosis of the liver. In the cirrhosis of the liver, there is a violation of the structure of the hepatic tissue and its partial substitution of fibrous (scar) cloth. This creates an obstacle to the blood current path, as a result of which it accumulates in the veins of the liver and in the carrier vein, leading to an increase in the body in size. In order to reduce the pressure in the system of the portal vein, part of the blood is reset into the venous vessels of the spleen, which also leads to overflowing it with blood and increase in size.
• Tumor. The cause of the increase in the liver can be an increase in the size of the intrahepatic tumor or the growth of metastases from tumors of another localization. When metastasizing a malignant tumor in the liver cloth, there will also be blockage of hepatic capillaries with tumor cells, which will lead to a violation of blood flow in the body and may cause an increase in it in size.
• Disease Badda Kiaari. With hepatic veins thrombosis, there is a hepatic tissue overflow with blood and an increase in the size of the liver. The spleen increases only in severe cases of the disease (with the development and progression of portal hypertension).
• Heart failure. In case of heart failure, blood is stirred in the system of the lower hollow vein, increasing the pressure in it. Since hepatic veins (enduring venous blood from the liver) also flow into the lower hollow vein, severe heart failure can break the blood outflow from the liver, which will increase its size.

Nausea and vomiting during ascite

At the initial stages of the development of ascites, nausea and vomiting may be due to the main disease (cirrhosis of the liver, pancreatitis, peritonitis, and so on). As the pathological process progresses, the amount of fluid in the abdominal cavity increases, which leads to comprehension and violation of the functions of many organs (in particular the stomach and intestines).

Squeezing the stomach can significantly reduce its volume and disrupt motility, as a result of which a person may experience nausea even after receiving a small amount of food. In the event of vomiting, vomiting masses will contain just eaten, undigested food. After vomiting the stomach devastated, which usually brings relief to the patient.

Squeezing the intestines can also disrupt his motor skills. With pronounced ascite, intestinal loops can be squeezed with such a force that the advancement of processed food (chimus) will be impossible. As a result, the chimus will begin to accumulate above the squeezing position, causing the enhancement of peristaltics in this intestinal department. The patient will complain about the bogged pain in the stomach, nausea. The vomiting that occurs in this case will contain partially digested foods or carte masses, and will also have a characteristic unpleasant odor.

"Head of Medusa" during ascite

"Headband" is called the expansion of the veins of the abdominal wall, observed when acciding for a large number of ascitic fluid and pronounced portal hypertension. In this case, the blood from the portal vein system is reset into the systemic bloodstream by means of so-called anastomoses (connections between veins) located in the field of the front wall of the abdomen. This leads to an increase in pressure in the veins of the abdominal wall and their expansion. When stretching the belly and tension of the skin, the data of the vein is shouted under the skin and form a thick venous network on the front surface of the abdomen, which caused the symptom name to such a name.

Jaundice with ascite

Jaundice (coloring of the skin and visible mucous membranes in yellow) occurs in various liver diseases, accompanied by a violation of its function. The accumulation of the liquid in the abdominal cavity against the background of the jaundice makes it possible with a large share of the likelihood to assume that the cause of ascite is the pathology of the liver (cirrhosis or cancer).

The jaundice mechanism is as follows - in the destruction of red blood cells (erythrocytes) in the bloodstream, a yellow-colored pigment is highlighted - bilirubin. It is a rather toxic product, therefore, in normal conditions, it is immediately captured by cells of the liver, neutralized and derived from the body in the composition of bile. In case of violation of the functions of the bouncing, this process slows down or is terminated at all, as a result of which the bilirubin concentration in the blood begins to grow. Over time, he penetrates into various fabrics and organs and settles in them, which is the immediate cause of the appearance of jaundice color of the skin and mucous membranes.

Dyspnea with ascite

Dyspnea (sense of lack of air) during ascites is a consequence of the increase in pressure in the abdominal cavity and limiting the mobility of the lungs. Under normal conditions, a diaphragm (main respiratory muscle) is reduced, with the result that it shifts down (towards the abdominal cavity), ensuring the expansion of the lungs and entering the portions of fresh air. The accumulation of a large amount of fluid in the abdominal cavity and an increase in intra-abdominal pressure makes it impossible to the full displacement of the diaphragm down, as a result of which, with each breath, the patient receives a smaller amount of air.

In the initial period of development of ascites, shortness of breath occurs only in the position lying when the liquid is shifted up and presses on the diaphragm. In the standing position, the liquid swells into the lower departments of the abdomen and the man breathes freely. In the late stages of the disease (when the volume of ascitic fluid reaches 10 liters and more) shortness of breath is observed in the standing position and enhanced in the lying position, in view of which patients usually rest and sleep seviy.

Dehydration at ascite

Dehydration is a pathological condition characterized by a decrease in the amount of fluid in cells and a decrease in the volume of circulating blood (BCC). Although during ascite, the liquid from the body is not lost, it comes out of the vascular bed into the abdominal cavity (that is, "turns off" from the circulatory system) as a result of which the BCC decreases and characteristic signs of dehydration appear.

Dubilek-Moiler D.N. Category II