SURGICAL DISEASES, TRAUMATOLOGY, ORTHOPEDICS, UROLOGY : ASCITES(АSСIТЕS) - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
The accumulation of free fluid in the abdomen is a symptom of processes that are causing the disorder of the portal circulation (liver cirrhosis, thrombosis of the portal vein, the squeeze of her tumors and other). Thus, all processes that interferes with normal circulation in the system of the portal vein, causing stagnation in the area of its roots, contribute to propotional serous fluid in the abdominal cavity. Ascites develops when the General stagnation of blood (failure of the right ventricle), thrombosis of the hepatic veins, kidney disease (especially when nephrosis). There is also heleny ascites after breaking large jeleznyh vessels, jeleznyh cysts and obstruction of the lymphatics by tumor. The liquid is then diluted milk contains fat droplets.
Symptoms. Fluid in the abdominal cavity of less than 600 ml produces no symptoms and is not amenable to detection. In the supine position on the back of the abdomen is flattened, the liquid expands lateral (frog belly). Stupidity in the side and lower abdomen, timpani at the umbilicus and above; transfer of waves on the abdominal wall with short strokes and a light clicks on the abdominal wall. When standing position increases the front-rear size - belly hangs, dullness in the lower divisions. When lying on the side stupidity is moved in the opposite direction, in the sideways Department at the place of dullness appears timpani. At a higher accumulation of fluid abdomen distended, tense, not deformed during the change of position, the skin is tense, brilliant, the lower aperture of the chest expanded, visible subcutaneous dilated veins (сарut Меdusае). Due to the muscle releases and tendon transfers of the mesentery, timpani at the umbilicus when lying on the back may not be available, usually persists only tympanic in the stomach. Significant effusion gives high standing of the diaphragm and breathing and blood circulation.
The course depends on the underlying disease.
Complications. Long stagnant transudate may take further inflammatory in nature.
The recognition. The greatest difficulty is sometimes diferenciacija ascites from exudative forms of tuberculous peritonitis (temperature fluctuations, changes in the blood, the tenderness, the presence of a lesion in the lung), cancer or sarcomatosis dissemination (age, primary tumor, palpation of the tumor in the abdominal cavity). Sometimes the difficulty is the difference in ascites from a huge ovarian cysts (a steady increase, a history of tumors in the lower part of the abdomen, the relationship of the tumor with the uterus, convex upwards border dull sound, the asymmetry of the abdomen). To distinguish from ascites fluid can be used to test the puncture. The transudate colourless specific weight of 1 004 - 1 014, protein not more than 2 - 2.5% of the leukocytes isolated. Exudate often hemorrhagic (cancer spread), the proportion of 1 015 and higher protein content up to 4 - 6%, to precipitate the formed elements (cells, lymphocytes, red blood cells, tumor cells). When pseudomyxoma peritonei (gap pseudomucinous ovarian cysts or cysts of the vermiform process) trial unsuccessful puncture or needle found a jelly-like mass.
It is necessary to eliminate the underlying disease. If the liquid aggravate the patient's condition shown puncture.