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Ascites

Is called ascites effusion or fluid accumulation in the peritoneal cavity, i.e., inside the membrane lining most of the viscera of the abdomen.

Causes
  • The most common are liver diseases, such as cirrhosis , in which the liver becomes a fibrous organ, thus reducing its functional capacity; and alcoholic hepatitis in which inflammation of the liver appears.
  • The second most frequent cause is constituted by diseases that affect the peritoneum, especially tuberculosis and peritoneal carcinomatosis.
  • Finally, other pathological processes such as acute pancreatitis, in which inflammation of the pancreas appears, generally caused by alcoholism or obstruction of the bile duct; and pericarditis , that is, inflammation of the pericardium generally secondary to AMI, viral infections, or CHF.

Given that the most frequent form is ascites of cirrhotic origin, we are going to refer to the mechanism of its production. There are several factors that favor the appearance of ascites of cirrhotic origin:

  1. Kidney function disorders: one of the functions of the kidney is to regulate the amount of sodium and water in the body. In the case of cirrhotic patients with ascites, excessive sodium retention appears, and since sodium in the body is closely linked to water, there will also be retention of said fluid. However, the most serious kidney disorder that can occur in ascites is hepatorenal syndrome. In this syndrome, the kidney retains toxic substances and is unable to eliminate water, in the absence of known causes that justify this alteration.
  2. Portal hypertension: The existence of cirrhosis hinders the flow of blood to the liver through the portal vein, thus increasing the pressure in the venous circulation of the intestine, thus favoring the passage of fluid to the peritoneum.

Symptoms of ascites

Ascites is clinically manifested by increased abdominal girth. However, this is only observed when the existence of liquid is important (more than 2 or 3 liters).

In this case, we can confirm that the bulging belly is produced by free fluid in the peritoneal cavity through a series of signs: for example, there will be a sensation of a surge when the abdomen is percussed. To check this, the hand is placed flat on one side of the abdomen and played with two fingers on the other side. Checking that we feel this sensation of surge.In addition, since the liquid tends to move to the most declining area due to the effect of gravity, when striking the abdomen on the flanks we will verify the existence of dullness; that is, it will sound as if we were hitting something.

When there is a large amount of fluid in the abdomen, the diaphragm moves upward, making it difficult to breathe.

The increase in intra-abdominal pressure favors the appearance of inguinal and umbilical hernias. Sometimes umbilical hernias are perforated, with the consequent leakage of fluid to the outside.

When ascites is caused by cirrhosis, it is accompanied by other characteristic signs, with frequent edema in the lower extremities, telangiectasias, palmar erythema, increased hardness and size of the liver, gynecomastia and jaundice .

How is it diagnosed?

Ultrasonography may be useful for diagnosis, especially in cases where there is so little free fluid that it cannot be detected clinically.

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Ascites fluid analysis is very important, especially to guide us about the cause of ascites.

Thus, in ascites of cirrhotic origin the protein concentration is low, while in those produced by CHF, peritoneal carcinomatosis, tuberculosis and pancreatitis it is usually high.

In addition, in the case of peritoneal carcinomatosis, ascites usually contains a large number of red blood cells. In tuberculosis there is an increase in the number of cells, especially white blood cells. And in pancreatic ascites there is usually a high concentration of the enzyme amylase.

Treatment of ascites

The treatment of ascites is based on three pillars depending on the severity of the condition:

General measures

These therapeutic actions are indicated both to prevent possible complications and to control the progressive increase of ascites. Bed rest and a diet low in sodium (salt): standing involves a decrease in blood flow to the kidney and, therefore, retention of sodium and fluid; that is why bed rest is useful to reduce the volume of ascites fluid, in the same way as diets low in salt.

Medical treatment

It is the most common treatment along with general measures.

  • Diuretics: diuretics are drugs that promote the elimination of fluid through the kidney. Different types of diuretics are used according to their potency.
  • Evacuating paracentesis: consists of emptying, totally or partially, the free fluid from the peritoneal cavity by puncturing the abdomen with a needle.

Surgical treatment

This type of surgical technique is only used in cases in which ascites cannot be controlled with the diet or drugs described above.

  • Peritoneal-venous anastomosis: in which a valve is placed that allows the passage of ascites fluid into the venous circulation.
  • Porto-caval anastomosis: by means of a surgical intervention, the portal vein is joined with the vena cava, thus favoring the drainage of the portal vein and, therefore, reducing the pressure inside it.
  • Liver transplantation: reserved for patients with very advanced cirrhosis refractory to other treatments.

Avoiding ascites

To avoid the appearance of cirrhosis of alcoholic origin, it is enough to moderate alcohol consumption.

The prevention of chronic hepatitis such as hepatitis C is done by avoiding sharing sharp instruments (razors, needles); and that of hepatitis B, among others, through the use of condoms during sexual intercourse.

In the presence of large amounts of free peritoneal fluid, with a large increase in abdominal volume, generally the patient will have no doubts about the need to see a doctor; however, at first the liquid may go unnoticed.

It is very important to control the weight of these patients because many times the increase in abdominal girth goes unnoticed. In any case, ascites is usually preceded by other symptoms related to the pathology that causes it. For example, in the case of liver diseases, they can be accompanied by abdominal pain, jaundice, cognac-colored urine and other symptoms that highlight the need to see a specialist.

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Hello Readers, I am Nikki Bella a Psychology student. I have always been concerned about human behavior and the mental processes that lead us to act and think the way we do. My collaboration as an editor in the psychology area of ​​Well Being Pole has allowed me to investigate further and expand my knowledge in the field of mental health; I have also acquired great knowledge about physical health and well-being, two fundamental bases that are directly related and are part of all mental health.

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