If fluid accumulates in the abdomen. Ascites of the abdominal cavity: causes, treatment, prognosis. Course and forecast

Abdominal ascites (known as dropsy of the abdomen) is a pathology that is a complication of other diseases. Ascites of the abdominal cavity is characterized by the formation and subsequent accumulation of fluid inside the abdomen, which impairs the functioning of organs in the peritoneal cavity. Code according to the international classification of diseases ICD-10: R18. Such a disease requires the immediate intervention of specialists who perform paracentesis at a high level and prescribe a special diet. Laparocentesis is often used to treat the disease.

Causes of the disease

Ascites of the abdominal cavity is a pathological process, since the healthy functioning of the human body does not provide for the release of fluid in large quantities. A small amount of fluid is formed in the peritoneal cavity so that the intestinal loops can slide and not stick together. This plasma fluid must be absorbed into the intestinal walls, however, if this mechanism fails, the function of fluid excretion and the opposite role of absorption fail. This causes ascites, suggesting the accumulation of excess fluid. Helps in such cases, laparocentesis, along with the use of other medical treatment methods.

In addition, the causes of ascites are kidney problems, as well as improper functioning of the thyroid gland.

Symptoms

The symptoms of ascites depend on how quickly the ascitic fluid is formed, the causes for the disease, and the amount of release of the plasma variety. Symptoms of ascites may appear gradually, or may occur over the course of one day. The most obvious sign of the development of this disease is a significant increase in the size of the abdomen. This causes an increase in the size of the required clothing as well as an increase in weight. In addition, the patient experiences constant belching, heartburn, flatulence, as well as severe pain in the abdomen. When the patient assumes a vertical position, his stomach hangs down, and when horizontal - hangs in both directions. The presence of a large abdomen causes severe shortness of breath with concomitant swelling of the extremities. Abdominal dropsy is often accompanied by a hernia, hemorrhoids, or prolapse of the rectum.

Common symptoms of the disease include:

• fever
• weight loss of other parts of the body against the background of an enlarged abdomen;
• signs of toxicosis;
• an increase in the veins that are on the abdomen.

The indicator of how much fluid accumulates in the patient's body is from 1.5 to 20 liters. Tense ascites is a type of ailment that involves a large fluid accumulation with a tendency to rapidly increase the fluid content in the peritoneum.

Diagnostics

Dropsy of the abdomen can be diagnosed by a doctor even without the use of special equipment - it is enough to feel the patient's abdominal cavity. If, when probing, the doctor finds dullness in the abdomen from the side, while tympanitis is found in the middle, the patient is sick with ascites. For a deeper diagnosis, it is required to conduct, examine the liver, and also make a puncture of the peritoneum (paracentesis). Taking fluid for analysis allows you to identify the stage of the disease and determine its treatment. Paracentesis is performed to find out the causes of the disease. Also, paracentesis can be done in case of difficulty breathing and pain.

In addition to the above diagnostic methods, the patient must pass urine and blood tests, as well as undergo immunological tests. The possibility of prescribing additional tests and tests depends on how much information the doctor receives from the tests.

Treatment

Treatment of abdominal ascites is performed by qualified surgeons, therapists, as well as doctors of other specializations. It all depends on the type of disease and the cause that caused it. Dropsy of the abdomen is treated using the following methods:

• diet for ascites;
• taking diuretics along with substances that contain potassium;
• the use of medications in order to reduce hypertension in the area of ​​the portal vein;
• paracentesis;
• laparocentesis. A highly efficient technique. Laparocentesis is used by surgeons most often.

Diet for ascites involves reducing the intake of fluids, as well as salt due to the fact that it retains fluid in the body. Doctors advise the Avicenna diet. Such a diet for ascites provides for an almost complete rejection of fatty foods, the use of nuts in large quantities, the rejection of fresh fruits in favor of dry ones. Also, liquid food (borscht, soup) should be replaced with broth with additives in the form of celery, parsley, fennel. The diet for ascites does not regulate how much meat the patient should eat, but all meat should be of a lean type (chicken, turkey, rabbit).

Paracentesis- this is an incision of the abdominal cavity in order to identify the causes of the disease. It can sometimes cause complications (bleeding, damage to structures in the abdomen). However, paracentesis is necessary as a diagnostic and therapeutic measure. Factors that negatively affect the conduct of paracentesis are:

• filled bladder;
• pregnancy;
• the presence of bleeding;
• the presence of infection in the operated area.

Paracentesis involves examining the patient, conducting ultrasound and MRI for him. It is performed under local anesthesia that causes drowsiness.

- this is the removal of excess exudate from the patient's body surgically. In this case, laparocentesis involves the removal of no more than 5 liters of fluid at a time. If it forms too quickly, laparocentesis should be combined with the use of peritoneal catheters. They prevent the occurrence of infections and adhesions of the peritoneum. Laparocentesis is performed under ultrasound guidance and under local anesthesia.

Treatment of ascites in cirrhosis of the liver, unfortunately, is often not effective. To treat the disease, the patient must be constantly under the supervision of doctors. Often, it is necessary to cure not only ascites with cirrhosis of the liver, but also another disease, for example, heart problems or a tumor.

Ascites in ovarian cancer is quite expected, as it is provoked by a violation in the functioning of the lymphatic vessels. In addition, ascites in the presence of oncology can provoke rupture of the ovaries.

Ascites peritonitis is provoked by infection in the plasma fluid. This increases the symptoms of the patient, which requires the use of antibacterial drugs. Ascites peritonitis is usually spontaneous and requires close examination of the contaminated fluid.

Chylous ascites develops with accompanying liver diseases and involves the release of fats and lymph into the peritoneal cavity from the intestine. It is necessary to treat chylous ascites with diuretics - drugs that can quickly remove fluid from the body.

Treatment of ascites with folk remedies involves taking baths, body wraps, and taking tinctures. It is suggested to cure the disease at home with the help of birch. From its leaves at home, you can make a bath, tincture of the kidneys can be taken orally, and with the help of a decoction, you can make body wraps. Birch is known for its anti-stagnant properties.

It is worth noting that abdominal dropsy is an exacerbation of any disease, and this worsens the patient's prognosis for a full recovery. The disease can cause bleeding, liver failure, brain damage, and other severe symptoms. The presence of severe ascites, according to statistics, increases the percentage of deaths up to 50%.

Ascites is the accumulation of large amounts of fluid in the abdominal cavity (in the abdomen). Between the loops of the intestine and the organs of the peritoneum there is a serous fluid, thanks to which the organs of the abdominal cavity move freely and return to their place.

As a result of various diseases, fluid absorption is disturbed, it begins to accumulate in the abdomen, and signs of ascites appear. The main manifestation of this disease is a strong increase in the abdomen.

According to statistics, 85% of cases of accumulation of fluid in the abdomen are associated with cirrhosis of the liver, 10% of cases are associated with oncological diseases, 5% are a consequence of heart failure.

Causes of accumulation of fluid in the abdomen, the occurrence of ascites

The causes of ascites can be varied, but the most common cause of fluid accumulation in the abdomen is cirrhosis of the liver.

Ascites cannot be called a disease of the liver, but the accumulation of fluid in the abdominal cavity is often the result of severe liver diseases, such as cirrhosis. According to statistics, 50% of people suffering from cirrhosis of the liver for more than 10 years have liver ascites.

It is worth noting that liver ascites indicates a severe course of cirrhosis and a possible lethal outcome. About half of patients die 2 years after the discovery of ascites, developed against the background of cirrhosis of the liver.

Severe heart failure can also cause accumulation of fluid in the abdomen - the development of ascites.

In some cases, when stomach cancer fluid begins to accumulate in the peritoneum, resulting in the formation of the so-called ascites of the stomach. Tumors spread to the inner lining of the stomach, which leads to an increase in the volume of the abdomen.

So, the causes of ascites or accumulation of fluid in the abdomen are associated with the following diseases and pathologies:

Liver disease;
Heart problems;
Diseases of the peritoneum;
kidney disease;
Diseases of the gastrointestinal tract;
tuberculosis infection

The main symptoms of ascites

Symptoms of ascites vary depending on the stage and nature of the course of the disease.

Moderate ascites is often accompanied by swelling of the lower extremities, an enlarged chest, inguinal and umbilical hernia can be observed. The patient is concerned about heaviness in the abdomen, shortness of breath, heartburn, problems with stool. These symptoms of ascites are observed if the pathology develops gradually over weeks and months.

A characteristic sign of fluid accumulation in the abdominal cavity is an enlarged abdomen. The size and shape of the abdomen depend on the stage of the disease.

With moderate ascites, the abdomen sags, and the veins of the abdominal cavity expand. If the patient assumes a horizontal position, then the abdomen spreads out on the sides, while it is soft, the so-called "frog belly". If you slightly push the stomach from the side, then a response wave is formed in the other side.

Tense abdominal ascites is characterized by the appearance of a round abdomen, with tense, shiny, smooth skin. In this case, the skin of the hernial sac may become thinner, which leads to its rupture and the outpouring of a certain amount of ascitic fluid. The patient may develop severe cardiac and respiratory failure.

Ascitic fluid may spontaneously become infected and peritonitis develops. Peritonitis can lead to the death of the patient, so if you find signs of ascites, you should not delay the visit to the doctor.

Stages of occurrence and development of ascites

There are 3 stages of ascites:

Transient ascites characterized by the accumulation of fluid in the peritoneum with a volume of 400 milliliters, the fluid is not visually determined. At this stage, the treatment of ascites is quite effective, while diet and water-salt regimen are sufficient;

moderate ascites characterized by a soft belly. Abdominal ascites at this stage responds well to treatment with albumin infusions and diuretics. You may need laparocentesis - a puncture and removal of fluid from the peritoneum. But the abuse of this procedure can lead to kidney failure and the development of the next stage of the disease;

Tension or resistant ascites characterized by a large accumulation of fluid - up to 20 liters. In this case, the volume of fluid increases very quickly, the volume of the abdomen and the weight of the patient increases. Treatment of ascites at this stage almost always requires a laparocentesis procedure, as one of the methods of complex therapy.

Diagnosis of ascites

Diagnosis of ascites allows you to determine the causes and stages of the disease and prescribe effective treatment.

Diagnosis of ascites is carried out using the following procedures:

General examination, during which the doctor performs palpation (palpation) and auscultation (listening) of the abdomen;

Ultrasound of the abdominal cavity;

X-ray of the abdomen;

CT scan;

Puncture and study of ascitic fluid.

Modern treatment of ascites

Treatment of ascites should begin with restriction of sodium intake: the patient should consume no more than 1 gram of salt per day.

A patient with a large accumulation of fluid in the abdomen is indicated for bed rest. If bed rest and sodium restriction do not help, then liver ascites is treated with diuretics. Preference is usually given to triamterene, spironolactone, amiloride and others. These drugs are quite mild and do not cause side effects.

Most often, treatment with diuretics is effective, so surgery can be avoided.

Surgical treatment of abdominal ascites is indicated in 5-10% of patients refractory to drug therapy. During surgery, peritoneovenous shunting is performed. Such an intervention can cause serious complications, such as fever, intravascular coagulation, and shunt occlusion.

Shunting is not performed in patients with infected ascites, high serum bilirubin levels, hemorrhoidal bleeding and hepatorenal syndrome.

What is the diet for ascites (accumulation of fluid in the abdomen)?

During the treatment of ascites, a special diet must be observed. The patient is limited in taking salt, fried and flour.

Fats should be reduced or moderate in the diet, preference should be given to fats of vegetable origin. Carbohydrates should be limited.

Also, fluid intake is limited to 0.75-1 liters per day.

The diet for ascites includes the use of the following products:

Lean meat;
Fish;
Cereals;
Fruits and vegetables;
Cottage cheese;
Greens

Dishes are boiled or steamed without adding salt. Fruits are consumed in the form of compotes and jelly. Vegetables can be boiled, baked and stewed.

With the accumulation of fluid in the abdomen, it is strictly forbidden to drink alcohol, spices, marinades, seasonings, coffee and strong tea.

How to get rid of fluid in the stomach folk remedies

Treatment of ascites with folk remedies only helps to get rid of excess fluid, but it is possible to completely get rid of the accumulation of water in the abdomen only when the disease that caused it is eliminated. Therefore, the treatment of ascites with folk remedies can only be an addition to medical treatment.

Here are some folk recipes to reduce the accumulation of fluid in the abdomen:

Bean pods are used as a diuretic to remove excess fluid. To prepare a decoction, use the husks of 20-30 bean pods, which is poured with 1 liter of water and boiled for 10 minutes. Then the broth is insisted for 20 minutes and filtered. Take the infusion in portions of 200 milliliters: 1st serving - at 5 o'clock in the morning, 2nd - 30 minutes before breakfast, 3rd - 30 minutes before lunch, the remaining volume - no later than 20 pm;

Apricot decoction helps to replace potassium lost during the use of diuretics. A decoction is prepared from fresh or dried apricots, for this, 1 glass of fruit is poured into 1 liter of water and boiled for 40 minutes. 250-400 milliliters of decoction should be consumed per day;

A decoction of parsley helps to remove excess fluid from the tissues. To prepare a decoction, 300 grams of parsley is boiled for 30 minutes in 1 liter of water. The broth is filtered and taken 0.5 cups every hour in the morning.

The content of the article:

Ascites of the abdominal cavity is a pathological condition in which fluid enters it and lingers there in excess. This process can develop rapidly or proceed in a chronic form. It is never independent and always accompanies severe concomitant diseases, such as cirrhosis, tuberculosis, or cancer with metastasis.

How Olga, 62 years old, treated ascites with medication

My mother developed ascites at age 62. Health problems began about three years ago, when her legs began to swell, and a couple of years ago she was admitted to the hospital for the first time, where they eliminated excess fluid with the help of diuretics. Then he was diagnosed with cirrhosis of the liver. After the diagnosis was made, she was sent to a hepatologist, but after a superficial examination, he did not find any serious pathologies and advised her to continue drinking diuretics.

My mother also went to see a cardiologist. He also said everything was fine. And diuretics eventually helped less and less. A few months later, her ascites burst and more than 20 liters of water leaked out. She was hospitalized and had a detailed examination, analyzed the leaked fluid for the presence of cancerous and atypical cells. They were not found.

A laparocentesis procedure was performed and a few more liters of fluid were pumped out. An MRI of the pelvic organs was also performed. As a result of this examination, symptoms of involutive changes in the uterus and appendages were found. Then an additional magnetic resonance imaging of the abdominal cavity was performed. Nodular regenerative hyperplasia of the liver was diagnosed. No significant abnormalities were found in the blood. Elevated bilirubin was reduced after laparocentesis. Also, the pressure began to drop to 100 over 50 on average.

We wondered which of the bunch of diagnoses causes such ascites. Fortunately for us, we were advised by a good hepatologist from a neighboring town. We went to him, and after the examination, he gave us an accurate diagnosis of the liver, which caused such an accumulation of fluid in the peritoneum. This is cirrhosis of the liver according to Chald Pugh. We were told the most radical method of treatment - liver transplantation. But by the time of the examination, the water from the abdominal cavity had gone and the condition had somewhat stabilized. Therefore, we were offered treatment with medicines until a possible deterioration.

We were prescribed a complex of hepatoprotectors: Ursofalk, Hofitol, Anaprilin, Heptral, Veroshpiron, as well as a course of droppers with albumin. Later we started taking one sachet of Hepamerz three times a day. The condition has been stabilized. It is clear that this is a temporary achievement, since cirrhosis tends to progress, but for now we are in line for a liver transplant and receive maintenance therapy, which excludes the formation of fluid in the abdominal cavity.

The history of the treatment of ascites with folk remedies Grigory, 48 years old

I had to urgently return home and go to the hospital for examination. I was diagnosed with ascites of the abdominal cavity of the transient stage. According to doctors, about a liter of fluid accumulated in the stomach. Treatment with diuretics and albumin drip was prescribed. The symptoms were relieved, and the condition stabilized.

Upon returning home from the hospital, I began to be treated with folk recipes. My grandmother was an herbalist and left behind a whole library of her notes, where I found methods for treating abdominal ascites, or in the popular “dropsy”.

Here is a tentative treatment plan:

• Decoction of bean pods. It is a good diuretic. For cooking, use the husk from 30 pods. They need to be filled with water in an amount of about a liter and put to boil. After 10 minutes, the broth is removed from the heat and infused for 20 minutes. The mixture is filtered and cooled. You need to take the drug 200 grams at a time. The first portion - at five in the morning, the second - half an hour before breakfast, the third - half an hour before dinner, the fourth - no later than eight o'clock in the evening.
• apricot broth. This remedy helps to replenish the reserves of potassium, which is actively lost by the body during ascites and after the use of diuretics. Compote is prepared from fresh fruits or dried apricots. A glass of fruit should be poured with a liter of water and boiled for about 40 minutes. Every day you should drink up to half a liter of this decoction.
• Parsley decoction. Effectively removes excess water from the body and tissues. For cooking, you need to pour 300 grams of greens with a liter of water and boil for half an hour. Ready broth is filtered. It should be drunk half a cup every hour in the morning before lunch.

The history of the treatment of ascites with dietary nutrition Vyacheslav, 53 years old

I have been in the gastro-department of the local hospital several times. While I was there, my stomach dropped. As soon as I returned home, the problem recurred. I threw away a lot of money for expensive drugs, but to no avail. Then I decided to pull myself together and take care of my health on a mental level.

I am not a doctor or a psychologist. I just believe that attitude plays a crucial role in the treatment of any disease. I made it a rule to think only in a positive way. In addition, I resumed my morning runs. I have always been involved in sports, but at the time of the exacerbation of the disease, of course, there could be no talk of any physical activity. Now I began to run every morning - to overcome about 10 kilometers with a light jog.

In addition, I decided to take a course of cleansing with Polyphepan. This is such a powerful absorbent that looks like damp black earth. It must be diluted in water and drunk several times a day. It does not cause dysbacteriosis and well relieves of any dirt that has accumulated in the intestines. True, if the problem of increased gas formation ceased to bother me, then the fluid in the abdominal space remained the same - a little, but I felt it.

I switched to a healthy diet. First, as little salt and sugar as possible. They retain water in the body, which, in my case, was highly undesirable. I also eliminated all spices from my diet. Completely switched to vegetarian food. My "favorite" dish for several months was oatmeal on the water. Moreover, you can eat it without fear several times a day - as patience is enough.

I also continued to drink Polyphepan regularly. He removed toxins from the body regularly, which helped the liver. Periodically, I inject myself with vitamin B12 into the muscle. It also has a good effect on the liver, stimulates its work. I use milk thistle cake. I buy it in a pharmacy and brew it according to the instructions. Another remedy for the liver.

It is extremely important to adhere to the regime in nutrition and sleep. I switched to 8-3 or 8-5 mode. That is, I go to bed at 8 pm, wake up at 3 or 5 am. It is best to meditate in the morning. I have been practicing meditation for a long time, they really help me to form the right mood, to keep negative thoughts out. After meditation, I go for a run.

To get the negativity out of my head, I also constantly fill my head with the background sound of music or audiobooks. This is a great distraction from heavy thoughts.

And, of course, you should regularly undergo examinations and take tests. It is better to know in advance what is wrong with the body than to accumulate new ailments in yourself.

How Nikolay cured ascites with herbal decoctions, 42 years old

Deficiency provoked dropsy of the abdomen. A little liquid then accumulated, pumped out with a tube. As a result, about 3-4 liters came out, that is, moderate ascites, because in the department I saw how other patients were pumped out of the stomach with a bucket of water. Then I got really scared. How to treat abdominal ascites and whether any treatment helps in such cases, I did not know. Mentally prepared for the worst.

Then my attending physician reassured me a little, saying that my condition was not so deplorable, and if the liver was started, the dropsy would go away and I could live for more than one year. Only, of course, you have to give up your usual lifestyle and addictions.

I began to actively take all the medicines that were prescribed to me, and the water no longer accumulated, and the liver function returned to normal. After being discharged from the hospital, I continued to be treated at home.

First of all, I studied the treatment regimens for abdominal ascites with folk remedies on the Internet and consulted with local herbalists how to help a weakened liver. I learned a long time ago that medicinal chemistry has a negative effect on the liver, eliminating only the symptoms of the disease, but continuing to destroy its cellular structure.

First of all, I started drinking diuretic teas. At the same time, you can’t drink a lot of them, since a large volume of fluid will again accumulate in the abdominal cavity or settle in the form of edema. I drank about a liter and a half of liquid per day. I prepared tea from bearberry and hernia in a ratio of 1: 1. I took half a glass of this mixture and poured 300 grams of water. Boiled for 20 minutes. After cooling, strained and drank before eating for breakfast.

I was also advised to take baths with birch broth. I took 20 grams of birch leaves and buds and poured 200 grams of boiling water. I insisted the mixture for about 6 hours. After that, filtered and poured into the bath. Took it for half an hour.

In addition, therapeutic self-massage effectively helped me improve my overall well-being. It is very simple to make, but it is important to do it daily. I made it with linseed oil. He rubbed his stomach first clockwise, then against.

There is another method for removing excess fluid from the body, which one folk doctor advised me. You need to try to sit by the fire more often so that the water evaporates from the body more actively. I did this about once or twice a week.

In general, after a month of such treatment, my condition improved significantly. Of course, I did not drink, I ate according to a special diet, I began to follow the daily routine. For the past two years I have been regularly undergoing examinations, the liver has not fully recovered, but at least it does not bother me anymore.

How to treat abdominal ascites - look at the video:

Word " ascites"translated from ancient Greek means" dropsy of the abdomen" see photo, and this word, in turn, is derived from the combination "fur for storing liquid." Indeed, ascites, the disease that will be discussed today, lies in the fact that in the abdominal cavity a large amount of liquid accumulates.

That is, the stomach becomes the very “fur” that stores liquid. What is this liquid and where does it come from?

What is the disease ascites?

Ascites it is rather not a disease, but a symptom of many diseases, and the generalizing point in their development is that there is decompensation (impairment) of blood and lymph circulation in the abdominal cavity.

Most often, in about 80% of cases, the cause of ascites is cirrhosis of the liver, usually in the last stage - the so-called decompensation stage, when the liver reserves are depleted, there are severe circulatory disorders, both in the liver and in the abdominal cavity, and against this background, fluid begins to accumulate in the stomach.

Ascites is a consequence of liver cirrhosis in 89% of cases, malignant neoplasms in 10% and heart failure in 5% of cases.

What other diseases, besides cirrhosis of the liver, can cause ascites?

In addition to cirrhosis of the liver, some oncological diseases(in about 10% of cases), most often it is ovarian cancer in women, which, sadly, in most cases, young women are subject to.

With ovarian cancer, there is a violation of lymphatic circulation, the paths of lymphatic drainage from the abdominal cavity are blocked, and as a result, fluid accumulates. In this case, ascites has a rather aggressive course and most often this condition indicates that the patient has reached the “finish line” and he does not have long to live.

And another group of common diseases, about 5%, which are accompanied by ascites - this. We are talking about patients with heart defects, with various chronic heart diseases and circulatory decompensation, in which there is a general stagnation of blood in the body. Often in these patients, in addition to the accumulation of fluid in the abdominal cavity, there are also very swollen, edematous legs(feet, shins, thighs), as in the photo, but there are swelling up to the axillary region, and fluid accumulates not only in the abdominal cavity, but also in the pleural regions, that is, in the lungs.

It happens, but more rarely, that ascites develops in other diseases - with chronic pancreatitis, with chronic renal failure, combined with diabetes, etc.

Sometimes there are combinations of various diseases that cause ascites.

The rate of accumulation of fluid and its amount from the existing disease

Amount of liquid with all these diseases, it can be quite significant, up to 20 or more liters. So in one patient with huge ascites that developed against the background of cirrhosis of the liver, a 57-year-old man, rather large, weighed more than 160 kg, and so within 3-4 days he was “released” about 60 liters of fluid.

The fastest fluid accumulates in malignant diseases, and finally, cardiac edema- in this case, the accumulation of fluid occurs more slowly, that is, for a longer time.

What is the fluid that accumulates in the abdominal cavity?

This is a liquid of a different nature, it has a rather complex composition, and it depends, among other things, on the disease that caused ascites.

Even in patients with the same disease, the composition of the fluid is different. For example, with cirrhosis of the liver for the first phase of the disease, it is more valuable (contains more protein) than at a later date, so it is not always necessary to simply “remove” it, sometimes it is better to “treat” it with proper methods and “return” it to the body.

By the way, therefore, one of the prerequisites, including for the primary diagnosis of the cause of ascites, is the intake of fluid for special studies. To do this, a puncture is made with a thin needle and 25-30 ml of liquid is drawn into the syringe for analysis, which will not only show the composition of the liquid, but also determine whether it is infected, which is very dangerous and often happens in patients with cirrhosis, especially if the disease is running. Such a state is called ascites-peritonitis. If you do not take urgent action, then death is inevitable.

Where does the infection in the abdominal cavity come from

Infection arises not from the outside, of course, but from the very same organism. If it “floats” in a liquid for a long time, sooner or later its wall loosens, and in the intestines, in the feces, in particular, there is a lot of infection. In such cases, both pain and temperature appear, sometimes up to 39. Kidney function begins to suffer, patients fall into a coma, and die within a few days. So the condition is very dangerous, but fortunately, it does not last 1-2 days, but sometimes up to several weeks. So it is quite possible to take all necessary measures in a timely manner.

But back to what else the liquid taken for research can tell. In addition to the fact that we will find out its composition, it will also help clarify the diagnosis, that is, it will give a complete picture of the cause of ascites. Because not always preliminary examination methods, for example, the same ultrasonography (ultrasound), give an accurate picture. Unfortunately, cirrhosis of the liver, which in most cases contributes to the development of ascites, is not always visible on ultrasound. Sometimes patients are even indignant that ultrasound was done repeatedly, over many years, but no cirrhosis was detected in them.

Why ultrasonography does not show the presence of liver cirrhosis

The fact is that there are various forms of cirrhosis, including those that ultrasound cannot really determine. To explain this, a few words about cirrhosis of the liver.

is a statement of the fact that the liver has become as a result of long-term chronic hepatitis, which usually has an aggressive course, and which, unfortunately, is not always noticeable. And this, by the way, is a tragedy for many patients with cirrhosis of the liver, because there is no pain during its development. That is, the disease slowly develops over many years, the liver is destroyed, and the person does not suspect it.

In the place where they collapse liver cells, scars are formed, and gradually the liver is transformed. From a soft and elastic structure, it turns into a hard and bumpy one, over the course of many years it seems to petrify.

In this case, two types of cirrhotic liver damage are observed - the scars formed in the liver can be large or small. So, when the liver turns into a large-tuberous structure, this can be seen on ultrasound along its contour, along its increased density, etc. When the nodules in the liver are small, it looks like a bag full of cereals and its contour on ultrasound practically does not differ from the norm. And there are no exact methods for determining the density of the liver yet, though it appeared not so long ago elastography, but in this case it is not entirely appropriate, since it shows the degree of fibrosis, and fibrosis and cirrhosis are completely different things. Cirrhosis is not just a violation of the shape, structure and size of the liver, but also gross violations of the blood, lymph and bile circulation in it, which gradually cause the development of portal hypertension syndrome, when, as a result of a gradual compaction of the liver and impaired blood circulation in it, an increased resistance to blood flow develops inside liver.

Liver, as you know, the central organ that is responsible for all types of metabolism and in order to ensure the perfusion (pumping) of blood through it, that is, the actual “blood processing”, and the liver itself and the portal vein through which the blood passes must be in an appropriate state . In the case of cirrhosis, due to a violation of the structure of the liver, in the vessels leading to the liver, the blood pressure increases. This increased pressure is a protective reaction of the body (otherwise the liver could not work), it tries with all its might to "drive" the necessary amount of blood through the liver, but it is unable to "process" it.

Unfortunately, sooner or later, the body's reserves are depleted at this stage, and this stage of the development of the disease passes to the following stages. One of them is development of ascites.

What happens in cirrhosis of the liver

The blood goes under more than necessary pressure to the liver. There, its liquid part slowly sweats out - first into the liver tissues, and then flows down the liver capsule into the abdominal cavity. Roughly speaking, liquid drips from the liver into the abdominal cavity like from an icicle.

In a normal state, we all have a mechanism that ensures the normal function of the intestine, peristaltic processes in it, etc. etc., that is, all our insides are a little damp. The fluid necessary for normal life sweats through various internal organs: liver, intestines etc. During the day, from 1 to 1.5 liters of fluid can flow through the abdominal cavity. It is completely absorbed, providing all the necessary processes.

In case of liver diseases, the amount of this fluid increases tenfold, since the absorbing lymphatic vessels that are located on the paretal peritoneum do not have time to fully "accept" the fluid "draining" from the liver, their "throughput" is much lower.

As you understand, all processes are much more complicated, and the accumulation of fluid depends not only on what happens in the abdominal cavity, but also on many other things, for example, on the characteristics of the lymphatic circulation.

How does fluid accumulate in the abdomen in other diseases?

In ovarian cancer, for example, metastases cover the entire peritoneum, disrupting its work, and it is there that the absorption of fluid should occur, so it accumulates gradually.

At cardiac pathology a slightly different mechanism, but it is also associated with the phenomena of stagnation of blood circulation in the venous vessels of the abdominal cavity. The pressure is not as high as with portal hypertension, but more blood flows in than the heart can pump, and it stagnates. And when the blood stagnates, not only the legs swell, but also the insides, and then the fluid gradually “drains” from the swollen liver, intestines, pancreas, spleen, etc. Absorption is difficult because the heart is not working well enough to provide proper circulation.

The lymphatic system regulates the exchange of fluids in the body

Generally speaking, all fluid exchange processes in the body are regulated through the lymphatic system. In places where there are serous cavities - starting from the joints, lungs, heart bag, abdominal cavity, etc. the circulation of fluids, the "lubrication" of the surfaces of organs depend on the lymphatic system. Moreover, the resorption of edema, inflammation also depends on the functioning of the lymphatic system.

By the way, lymphatic system one can say the oldest of the systems functioning in living organisms, since primitive animals, for example, worms, do not have a circulatory system at all, but there are three lymph nodes.

So if stagnation appears in the lymphatic system for one reason or another, various diseases can occur, including quite serious ones, which, in turn, can lead to complications. The most famous and obvious disease associated with lymphostasis (lymph stagnation) is elephantiasis.

Surely, many have seen women with swollen legs that really look like elephants. This is due to lymphatic congestion, which has developed due to inflammation of the lymphatic vessels.

Semi-open, (unlike the circulatory, which is closed), it has lymphatic roots in all organs. And everything that seeps into the interstitial tissue lymphatic system collects, like small streams, and returns "to the river", namely to the main lymphatic vessel of the body - thoracic lymphatic duct, from where the collected, previously lost fluid with substances valuable for the body returns "to work", into the bloodstream. Kind of a wasteless process. So, the excess of capacitive permeability of the lymphatic system causes the accumulation of fluids, which actually occurs in many diseases that cause ascites.

Is it possible to notice the symptoms of ascites when fluid accumulates in the abdomen?

Unfortunately, at the initial stages there are no obvious symptoms of ascites. A person practically does not feel anything, because there is no pain. You can, of course, say about the feeling of fullness after eating, about the feeling of heaviness and discomfort in the stomach. But this can be noted with a huge number of other diseases.

It can also be called symptom of ascites like thirst. There is even such a phrase that "a patient with ascites dies of thirst in a barrel of water." But on the other hand, thirst is also noted in other diseases, for example, with diabetes.

If we talk about the size of the abdomen, then its obvious increase is noticeable already at later stages. True, it can be noted that even in the initial stages of ascites, when the patient is in a supine position, his stomach looks like a frog, it seems to blur from the liquid in it, and if you push it a little from one side, then there will be a kind of return in the other - like a small wave, but it is problematic to notice it on your own.

Well, actually, if there is any suspicion, you can go for an ultrasound, which will show the presence of fluid in the abdomen by 100%.

On the other hand, just like that, “out of nothing”, ascites does not arise. In most cases, patients with ascites are people who have been sick for many years. hepatitis, and this diagnosis can be made to them many years ago. And hepatitis, as you know, is a long-term inflammatory process in the liver, as a result of - cirrhosis of the liver and, as a concomitant symptom - ascites.

What is the danger of fluid accumulation, is it possible to do without its removal

The accumulation of large volumes of fluid in the abdominal cavity causes disruption of vital organs. The liquid presses on the diaphragm, compresses the lungs, presses on, makes breathing difficult. Sometimes, if there is a lot of it and the patient simply suffocates, even at the first stage and without analysis, an unloading laparocentesis (fluid removal) can be done. In this case, 2-3 liters are released to reduce pressure in the abdomen and allow the person to breathe normally.

Just like that, without appropriate indications, tests and control, the fluid is not released, the patient is constantly under a dropper, his pulse is monitored, liver and kidney tests are done.

The procedure itself is performed under local anesthesia, using modern medical technologies, with the help of very comfortable catheters. Everything happens within a few hours so that the pressure in the abdominal cavity falls gradually, otherwise unwanted complications are possible.

You should not be afraid of this procedure and its consequences, although it happens that for some reason patients steadfastly refuse it, arguing that the accumulated fluid is valuable for the body and if it is released, the body will be depleted. Indeed, the liquid has its value and the condition may worsen, but only if laparocentesis performed inappropriately. In the bulk, the procedure can be carried out, and more than once, but only in specialized clinics and only after examining the fluid. Because if it is really valuable, there are other ways to solve the problem.

Treatment of ascites with an operative method on the thoracic lymphatic duct

Sometimes it makes sense to perform an operation to correct the lymph circulation, which improves the permeability of the lymph. After all, the liver is the most lymphatic organ. So per day, normally, 2-3 liters of lymph are produced in the body, and 60% of them are lymph from the liver. Moreover, in patients with cirrhosis, who have increased pressure in the parahepatic vessels, this lymph is produced 2-3, or even 5 times more, that is, not 1.5 liters per day, as is normal, but 15, but then 20 liters. It turns out that the liver literally "chokes" in the liquid - in addition to the fact that the liquid flows through it into the abdominal cavity, it also floats in it. A kind of vicious circle: the fluid must pass through the capillaries into the lymphatic channel, the one that did not have time to pass, again enters the stomach and again into the lymphatic channel.

The throughput capacity of the main lymphatic vessel that collects lymph from the whole body - the thoracic lymphatic duct - is insignificant - its diameter is only 3 mm (by the way, it is very similar to the usual dropper for us, because from it the lymph enters the bloodstream not in the form of a trickle, but through drops), and he just does not have time to miss everything.

Therefore, a special operation is performed on the thoracic lymphatic duct in order to restore it and increase its throughput.

Ways to address the increase in lymph throughput

In this case, there are several options for solving the problem. The first - a catheter is inserted into the vessel passing through the neck (which is left with the patient for several days, and sometimes weeks) and the lymph is released outside. The procedure is very effective, but, unfortunately, only for a while, which, by the way, is sometimes very, very necessary, because the liver has time to recover a little. Sometimes if the liver succeeds in this way to help in time, the ascites can be further controlled.

The second option is anastomosis of the vessel, when an additional, new vessel fistula is made, while maintaining the old one, with another part of the vein or with another vein. Such an operation is called a lymphovenous anastomosis, and it is quite complicated in technical execution, but sometimes it gives a simply miraculous result.

With the right combination of circumstances and proper treatment, it can be many years. If the liver is helped (by correcting the lymph circulation) during a critical period, which averages from 3 months to a year, the liver is able to partially recover, its function stabilizes, and patients live for 10 years or more.

On average, it is believed that from the appearance of ascites to the sad ending, the patient remains about a year (if we are talking about cirrhosis).

It is very important, for example, to observe almost bed rest. There is even such a phrase: "The liver loves a horizontal position."

The liver also “loves” water procedures, since, as you know, a person becomes lighter in water, and blood circulation improves due to the partial disappearance of the negative effects of gravity.

Equally important is limiting the use table salt- hyposalt diet, as it retains fluid in the body. Of course, be sure to follow other recommendations regarding the diet: exclude fried, smoked, salty, etc.

It is necessary to use a sufficient amount of liquid, at least 1-1.5 liters per day. Although such a misconception as a sharp restriction on the amount of fluid consumed is widespread. For some reason, the patient believes that if he practically stops drinking water, then the liquid from the abdomen will “gradually disappear”.

And in fact it is absolutely wrong and even stupid. The fluid accumulates not because we drink water, but because the lymph and blood circulation is disturbed. A certain amount of fluid is necessary for our body so that all processes normally proceed in it. Yes, and the blood should have a certain liquid state, it should not thicken, but if a person drinks little, circulatory disorders can be added to all the existing problems - thick blood passes through small vessels poorly, and this disrupts the work of many organs.

As for the treatment of ascites, its tactics may be different, but it should be comprehensive and aimed primarily at treating the underlying disease. After all, laparocentesis is a temporary improvement in the condition. The main thing is that the main treatment gives results.

If ascites has developed as a result of cirrhosis of the liver, the tactic is one, which provides for various options, if as a result of heart disease, of course, the approach is different.

How many times can you release the fluid accumulated in it from the stomach

With a reasonable approach and proper treatment, this can be done an unlimited number of times. But the point is not in carrying out these procedures, but in the fact that with proper treatment, the need for them will disappear.

There are very neglected patients who need to release about a bucket of liquid every week, but this is not an option, it is necessary to treat the underlying disease, eliminate the cause, not the effect.

It is believed that a condition such as ascites develops in the final stages of the disease, that it is incurable, but there are various approaches that can improve the patient's quality of life and prolong life for quite a significant time. At least, this applies to ascites that developed against the background of cirrhosis. The reserves of the liver are enormous. Ancient doctors, the same Hippocrates, for example, considered the liver to be the main organ in the body, not the heart, and not even the brain. And they motivated this by the fact that the liver is the central organ for the regulation of all types of metabolism: protein, electrolyte, salt, water, fat, carbohydrate, hormonal.

Sometimes it seems that the patient is at the finish line and he has 2-3 months to live. But sometimes the right treatment gives amazing results, prolonging the life of even hopeless patients for several years, the main thing is to contact a competent specialist in time and follow the necessary recommendations.

The accumulation of fluid in the abdomen is called dropsy or ascites. Pathology is not an independent disease, but only a consequence of other diseases. More often it is a complication of liver cancer (cirrhosis). The progression of ascites increases the volume of fluid in the abdominal cavity, and it begins to put pressure on the organs, which aggravates the course of the disease. According to statistics, every third dropsy ends in death.

What is abdominal ascites

A symptomatic phenomenon in which a transudate or exudate collects in the peritoneum is called ascites. The abdominal cavity contains part of the intestine, stomach, liver, gallbladder, spleen. It is limited to the peritoneum - a membrane that consists of an inner (adjacent to the organs) and an outer (attached to the walls) layer. The task of the translucent serous membrane is to fix the internal organs and participate in metabolism. The peritoneum is richly supplied with vessels that provide metabolism through the lymph and blood.

Between the two layers of the peritoneum in a healthy person, there is a certain amount of fluid, which is gradually absorbed into the lymph nodes to make room for the new one to enter. If for some reason the rate of water formation increases or its absorption into the lymph slows down, then the transudate begins to accumulate in the peritoneum. Such a process can occur due to multiple pathologies, which will be discussed below.

Causes of accumulation of fluid in the abdominal cavity

Ascites of the abdominal cavity often occurs in oncology and many other diseases, when the barrier and secretory function of the peritoneal sheets is disturbed. This leads to the filling of the entire free space of the abdomen with fluid. Constantly increasing exudate can reach up to 25 liters. As already mentioned, the main reason for the defeat of the abdominal cavity is its close contact with the organs in which a malignant tumor is formed. The tight fit of the peritoneal folds to each other ensures the rapid capture of nearby tissues by cancer cells.

The main causes of abdominal ascites:

• peritonitis;
• peritoneal mesothelioma;
• peritoneal carcinosis;
• cancer of the internal organs;
• polyserositis;
• portal hypertension;
• cirrhosis of the liver;
• sarcoidosis;
• hepatosis;
• hepatic vein thrombosis;
• venous congestion in right ventricular failure;
• heart failure;
• myxedema;
• diseases of the gastrointestinal tract;
• drift of atypical cells into the peritoneum.

Among women

The fluid inside the abdominal cavity in the female population is not always a pathological process. It may collect during ejaculation, which occurs monthly in women of reproductive age. Such a liquid resolves on its own, without posing a health hazard. In addition, purely female diseases that require immediate treatment, such as inflammation of the reproductive system or ectopic pregnancy, often become the cause of water.

Intra-abdominal tumors or internal bleeding provoke the development of ascites, for example, after surgery, due to trauma or caesarean section. When the endometrium lining the uterine cavity grows uncontrollably, which is why it goes beyond the female organ, water also collects in the peritoneum. Endometriosis often develops after a viral or fungal infection of the reproductive system.

In men

In all cases of dropsy in the stronger sex, a combination of violations of important body functions that lead to the accumulation of exudate is the basis. Men often abuse alcohol, which leads to cirrhosis of the liver, and this disease provokes ascites. Also, factors such as blood transfusion, injections of narcotic drugs, high cholesterol due to obesity, and multiple tattoos on the body contribute to the occurrence of the disease. In addition, the following pathologies become the cause of dropsy in men:

• tuberculous lesions of the peritoneum;
• endocrine disorders;
• rheumatoid arthritis, rheumatism;
• lupus erythematosus;
• uremia.

In newborns

Fluid in the abdomen is collected not only in adults, but also in children. More often, ascites in newborns arises from infectious processes occurring in the mother's body. As a rule, the disease develops in the womb. The fetus may have liver and/or biliary tract defects. Because of this, bile stagnates, which leads to dropsy. After birth, ascites in an infant can develop against the background of:

• cardiovascular disorders;
• nephrotic syndrome;
• chromosomal abnormalities (Down's disease, Patau, Edwards or Turner syndrome);
• viral infections;
• hematological problems;
• congenital tumors;
• serious metabolic disorder.

Symptoms

The signs of abdominal ascites depend on how quickly the ascitic fluid collects. Symptoms may appear on the same day or over several months. The most obvious sign of dropsy is an increase in the abdominal cavity. This causes an increase in body weight and the need for larger clothing. In a patient in a vertical position, the stomach hangs down like an apron, and in a horizontal position it is flattened on two sides. With a large amount of exudate, the navel protrudes.

If portal hypertension has become the cause of dropsy, then a venous pattern is formed on the anterior peritoneum. It occurs due to varicose veins of the umbilical veins and esophageal varicose veins. With a large accumulation of water in the abdomen, internal pressure rises, as a result of which the diaphragm moves into the abdominal cavity, and this provokes respiratory failure. The patient has pronounced shortness of breath, tachycardia, cyanosis of the skin. There are also common symptoms of ascites:

• pain or a feeling of fullness in the lower abdomen;
• dyspepsia;
• fluctuation;
• peripheral edema on the face and limbs;
• constipation;
• nausea;
• heartburn;
• loss of appetite;
• slow movements.

stages

In clinical practice, there are 3 stages of dropsy of the abdomen, each of which has its own signs and characteristics. The degree of development of ascites:

1. Transient. The initial development of the disease, the symptoms of which cannot be noticed independently. The volume of liquid does not exceed 400 ml. Excess water is detected only during instrumental studies (ultrasound examination of the abdominal cavity or MRI). With such volumes of exudate, the work of internal organs is not disturbed, so the patient does not notice any pathological symptoms. At the initial stage, dropsy can be successfully treated if the patient observes the water-salt regimen and adheres to a specially prescribed diet.
2. Moderate. At this stage, the abdomen becomes larger, and fluid volumes reach 4 liters. The patient already notices alarming symptoms: weight increases, it becomes difficult to breathe, especially when lying down. The doctor easily determines dropsy during examination and palpation of the abdominal cavity. Pathology and at this stage responds well to treatment. Sometimes it becomes necessary to remove fluid from the abdominal cavity (puncture). If effective therapy is not carried out in time, then a violation of the kidneys occurs, the most severe stage of the disease develops.
3. Tense. Liquid volumes exceed 10 liters. In the abdominal cavity, pressure rises greatly, problems arise with the functioning of all organs of the gastrointestinal tract. The patient's condition worsens, he needs immediate medical attention. Previous therapy no longer gives the desired result. At this stage, laparocentesis (puncture of the abdominal wall) is mandatory as part of complex therapy. If the procedure does not work, refractory ascites develops, which is no longer amenable to treatment.

Complications

The disease itself is a stage of decompensation (complication) of other pathologies. The consequences of dropsy include the formation of inguinal or umbilical hernias, prolapse of the rectum or hemorrhoids. These conditions are facilitated by an increase in intra-abdominal pressure. When the diaphragm presses on the lungs, it leads to respiratory failure. Accession of a secondary infection leads to peritonitis. Other complications of ascites include:

• massive bleeding;
• hepatic encephalopathy;
• thrombosis of the splenic or portal vein;
• hepatorenal syndrome;
• intestinal obstruction;
• diaphragmatic hernia;
• hydrothorax;
• inflammation of the peritoneum (peritonitis);
• fatal outcome.

Diagnostics

Before making a diagnosis, the doctor must make sure that the increase in the abdomen is not due to other conditions, such as pregnancy, obesity, mesenteric or ovarian cysts. Palpation and percussion (finger on finger) of the peritoneum will help to exclude other causes. Examination of the patient and the collected anamnesis is combined with ultrasound, scanning of the spleen and liver. Ultrasound excludes fluid in the stomach, tumor processes in the organs of the peritoneum, the state of the parenchyma, the diameter of the portal system, the size of the spleen and liver are characterized.

Liver and spleen scintigraphy is a diagnostic imaging technique used to assess tissue function. Initialization allows you to determine the position and size of organs, diffuse and focal changes. All patients with identified ascites are sent for diagnostic paracentesis with the study of ascitic fluid. During the study of the pleural effusion, the number of cells, the amount of sediment, albumin, protein are counted, seeding and Gram staining are carried out. The Rivalta test, which gives a chemical reaction to the protein, helps to distinguish exudate from transudate.

Two-dimensional Doppleroscopy (USDG) of venous and lymphatic vessels helps to assess blood flow in the vessels of the portal system. In cases of ascites that are difficult to differentiate, diagnostic laparoscopy is additionally performed, in which an endoscope is inserted into the abdominal cavity to accurately determine the amount of fluid, proliferation of connective tissue, and the state of intestinal loops. Plain radiography will also help determine the volume of water. Esophagogastroduodenoscopy (EGDS) provides a good opportunity to see the presence of varicose veins in the stomach and esophagus.

Treatment of abdominal ascites

Regardless of the cause that provoked ascites, the pathology should be treated along with the underlying disease. There are three main therapeutic methods:

1. Conservative treatment. At the initial stage of ascites, drug therapy is prescribed, aimed at normalizing the functioning of the liver. If the patient is diagnosed with an inflammatory parenchyma of an organ, then drugs are additionally prescribed that relieve inflammation and other types of medications, depending on the symptoms and the disease that provoked the accumulation of fluid.
2. Symptomatic. If conservative treatment fails or doctors fail to prolong remission for a long time, then the patient is prescribed a puncture. Laparocentesis of the abdominal cavity with ascites is performed infrequently, since there is a risk of damage to the intestinal walls in the patient. If the fluid fills the stomach too quickly, then the patient is placed with a peritoneal catheter to prevent the development of adhesions.
3. Surgical. If the two previous treatment regimens do not help, then the patient is prescribed a special diet and blood transfusion. The method consists in connecting the collar and inferior vena cava, which creates a collateral circulation. If the patient needs a liver transplant, then he undergoes surgery after a course of diuretics.

Preparations

The main treatment for ascites is drug therapy. It includes long-term use of diuretics with the introduction of potassium salts. The dose and duration of treatment is individual and depends on the rate of fluid loss, which is determined by daily weight loss and visually. The correct dosage is an important nuance, since the wrong appointment can lead the patient to heart failure, poisoning, and death. Commonly prescribed drugs:

• Diacarb. Systemic carbonic anhydrase inhibitor with weak diuretic activity. As a result of the application, the release of water increases. The drug causes the excretion of magnesium, phosphates, calcium from the body, which can lead to metabolic disorders. The dosage is individual, it is applied strictly according to the doctor's prescription. Undesirable effects are observed on the part of hematopoiesis, the immune and nervous systems, and metabolism. A contraindication for taking the drug is acute renal and hepatic failure, uremia, hypokalemia.
• Furosemide. A loop diuretic that causes severe but transient diuresis. It has a pronounced natriuretic, diuretic, chloruretic effect. The regimen and duration of admission is prescribed by the doctor, depending on the indications. Among the side effects: a pronounced decrease in blood pressure, headache, lethargy, drowsiness, decreased potency. Furosemide is not prescribed for acute renal / hepatic failure, hyperuricemia, pregnancy, lactation, children under 3 years of age.
• Veroshpiron. Potassium-sparing long-acting diuretic. Suppresses the potassium excretion effect, prevents water and sodium retention, reduces urine acidity. The diuretic effect appears on the 2nd-5th day of treatment. With edema against the background of cirrhosis, the daily dosage is 100 mg. The duration of treatment is chosen individually. Adverse reactions: lethargy, ataxia, gastritis, constipation, thrombocytopenia, menstrual irregularities. Contraindications: Addison's disease, anuria, lactose intolerance, hyperkalemia, hyponatremia.
• Panangin. A drug that affects metabolic processes, which is a source of magnesium and potassium ions. It is used as part of complex therapy for ascites to compensate for the deficiency of magnesium and potassium, excreted while taking diuretics. Assign 1-2 tablets / day throughout the course of diuretic drugs. Side effects are possible from the side of water and electrolyte balance, the digestive system. Do not prescribe Panangin in the presence of Addison's disease, hyperkalemia, hypermagnesemia, myasthenia gravis.
• Asparkam. Source of magnesium and potassium ions. Reduces the conductivity and excitability of the myocardium, eliminates the imbalance of electrolytes. While taking diuretics, 1-2 tablets are prescribed 3 times / day for 3-4 weeks. Perhaps the development of vomiting, diarrhea, redness of the skin of the face, respiratory depression, convulsions. Do not prescribe Asparkam in violation of amino acid metabolism, insufficiency of the adrenal cortex, hyperkalemia, hypermagnesemia.

Diet

With abdominal dropsy, a limited diet is needed. The diet provides for a small fluid intake (750-1000 liters / day), a complete rejection of salt intake, the inclusion in the diet of natural foods with a diuretic effect and a sufficient amount of protein. Pickles, marinades, smoked meats, canned food, salted fish, sausages are completely excluded.

The menu of a patient with ascites should contain:

• lean meat of poultry, rabbit;
• legumes, nuts, soy milk;
• seafood, lean fish;
• brown rice, oatmeal;
• vegetable oils, seeds;
• dairy products, cottage cheese;
• parsley, cumin, marjoram, sage;
• pepper, onion, garlic, mustard;
• bay leaf, lemon juice, cloves.

Surgical methods

When ascites progresses and treatment does not help, then in especially neglected cases, surgical treatment is prescribed. Unfortunately, it is not always possible to save the patient's life even with the help of an operation, but there are no other methods today. The most common surgical treatment:

1. Laparocentesis. Exudate is removed through a puncture of the abdominal cavity under ultrasound control. After the operation, a drain is installed. For one procedure, no more than 10 liters of water are removed. In parallel, the patient is injected with drip saline solutions and albumin. Complications are very rare. Sometimes infectious processes occur at the puncture site. The procedure is not performed for blood clotting disorders, severe bloating, intestinal injuries, wind hernia and pregnancy.
2. Transjugular intrahepatic shunting. During the operation, the hepatic and portal veins are artificially communicated. The patient may experience complications in the form of intra-abdominal bleeding, sepsis, arteriovenous shunting, liver infarction. Surgery is not prescribed if the patient has intrahepatic tumors or cysts, vascular occlusion, obstruction of the bile ducts, cardiopulmonary pathologies.
3. Liver transplant. If ascites has developed against the background of cirrhosis of the liver, then an organ transplant may be prescribed. Few patients have a chance for such an operation, since it is difficult to find a donor. Absolute contraindications to transplantation are chronic infectious pathologies, severe disorders of other organs, and oncological diseases. Among the most severe complications is transplant rejection.

Forecast

Accession to the underlying disease of ascites significantly aggravates its course and worsens the prognosis of recovery. The pathology is especially unfavorable for older patients (after 60 years) who have a history of renal failure, hypotension, diabetes mellitus, heptocellular carcinoma, hepatocellular insufficiency or liver cirrhosis. The two-year survival rate of such patients is no more than 50%.

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