Ascites

Ascites is called the accumulation of abdominal fluid.

Most often ascites occurs when kidney disease, heart failure, malnutrition, cirrhosis of the liver, due to the thoracic duct lymph, peritoneal (tuberculosis, cancer seeding and so on), resulting in compression of the trunk of the portal vein of the liver or thrombosis its branches. Newborns ascites develops with hidden blood loss or in the presence of fetal hemolytic disease. In children up to three years ascites is usually associated with liver disease, but may be the result of exudative enteropathy, chronic eating disorders, as well as a manifestation of nephrotic syndrome. The occurrence of ascites contribute to violations of water-salt metabolism.

Accumulating in the abdominal cavity large quantities of liquid (sometimes more than 20 liters) causes deformation in the chest cavity of the diaphragm and increasing intra-abdominal pressure. The result is to limit the movement of the lungs (up to respiratory failure), broken heart function, develop protein malnutrition. To determine ascites clinically possible only in the presence of at least one litre of fluid in the abdominal cavity. When viewed from the increasing belly, his sagging, bulging navel. The patient in the supine position will webwhat lateral abdomen, he spread ("frog belly"). The skin of the abdomen is well marked venous network. Twisted, swollen and dilated veins are concentrated around the navel and in the form of rays depart from it, forming a so-called "Medusa's head". Percussion of the abdomen on its side or sloping part heard a dull sound. When the position of the body is changing, and border of dullness. Palm, attached to the side with one side of the abdomen, you can feel the tremors that occur when tapping the fingers of the other hand on the opposite side (so-called symptom fluctuations). Chest x-ray and percussion determine limiting the mobility of the diaphragm. In patients with ascites complicated by cardiac failure often see hydrothorax (fluid in the pleura).

The main diagnostic task is to establish the underlying disease, which resulted in ascites. Cirrhosis often ascites combined with bleeding from veins in the esophagus and is accompanied by development under the skin of the abdomen collaterals. In heart failure, complicated by ascites, see swelling of the feet and legs, acrocyanosis. In renal failure disseminated subcutaneous edema and skin.

For diagnosis is of great importance puncture of the abdominal cavity with further study of the fluid. In patients with heart failure and cirrhosis of the liver transparent liquid, contains mainly endothelium cells, the protein concentration of not more than 2.5%. Cancer of the peritoneum in the fluid of cancer. In children up to three years ascites should be differentiated from pseudoacacia, which can be observed in cystic fibrosis and coeliac disease.

Aimed at addressing the underlying disease. To reduce the amount of fluid used by the aldosterone antagonists, diuretics, normalizes water-salt metabolism. If drug ineffective methods shown puncture of the abdominal cavity. Surgical treatment of ascites use to reduce portal hypertension and create the necessary conditions for fluid intake adjacent tissues. The prognosis of the underlying disease complications ascites is deteriorating.

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