Ascites

Ascites is accumulation in the abdominal cavity fluid in abnormal quantities. Fluid in the abdominal cavity is necessary to prevent friction of the contracting organs, but in normal it does not exceed its glass. With decompensated heart and liver diseases and malignant tumors, too much exudate can be produced, which interferes with the normal functioning of the body and significantly worsens the patient’s condition.

Ascites Cause

Practically, it is impossible to avoid the formation of intraperitoneal fluid in case of advanced cirrhosis of the liver — the share of hepatic ascites accounts for the maximum among all the processes accompanied by pathological exudation. The second most common cause is chronic heart failure, when the work of the heart muscle is so ineffective that the blood stagnates in the vessels and the plasma sweats inside the abdominal and thoracic cavities, forming ascites and pleurisy.

A large proportion is occupied by oncology effusions: malignant neoplasms, mostly localized in the abdomen, and metastatic lesions of the peritoneal sheets.

The pathogenesis of the formation of «excess» fluid in the abdominal cavity in chronic diseases of the liver and heart is somewhat different from the mechanism of excessive exudation in cancer. In chronic processes, the main reason is the inferiority of cardiac function or the difficulty of outflow of blood through the vascular bed with the inevitable exudation of plasma to the outside.

In malignant diseases, several factors are involved in the formation of ascitic fluid:

  • Blocking of lymphatic vessels by cancer cells, which prevents the lymph nodes from pumping out the formed fluid;
  • Seeding with malignant cells of the lymph node leads to the shutdown of its «pumping» function;
  • Increased exudate production by metastatic nodules on the peritoneum;
  • Irritant effect on the peritoneum of biologically active substances produced by the tumor enhances the
  • exudative activity of epithelial cells;
  • The compression of blood vessels by tumor nodes contributes to plasma sweating due to an increase in intravascular pressure — similar to the mechanism of ascites in cirrhosis and liver metastases.

In a cancer patient, several ways of producing ascitic fluid may be involved, another is important — quickly finding a way to adequately assist a patient with minimal losses to the body.

Ascites Diagnostics

Experienced specialists can see a large effusion in the abdominal cavity from a distance:

  • the patient does not have enough breathing, because the stomach is eliminated from their respiratory act,
  • the diaphragm rises, reducing the volume of the chest cavity, which is expressed in forcing the respiratory movements;
  • the stomach looks like a froggy, and when the patient is placed on a couch «blurs» like a ball filled with water, the characteristic «splashing noise» is determined when palpating the abdomen;
  • with a significant increase in intra-abdominal pressure, the navel bulges out;
  • marked swelling of the feet.

With the usual diagnostics — ultrasound examination of the abdominal cavity, excess fluid is visible, with a small amount it is found only «in sloping places». Ultrasound is enough to detect ascites, but MRI may be required to determine the tumor formation in the abdominal cavity.

When ascites acts as the only or first symptom of the disease, its verification is necessary, that is, obtaining the cellular composition of the effusion, which is achieved by laparocentesis — obtaining fluid for microscopic analysis through a puncture of the abdominal wall.

The most common neoplasms complicated by ascites are gastric carcinoma and peritoneal mesothelioma, ovarian cancers and hepatocellular carcinoma, pancreatic cancer and leukemia.

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Ascites Symptoms

With ascites, it is impossible to name the day or even the week of the onset of the disease — for a long time the pathological exudation proceeds covertly from the patient himself, because the accumulation of fluid in the abdominal cavity can reach 10–15 liters.

  • At 1–2 liters, excess fluid is evenly distributed throughout the abdominal cavity, without causing any special problems, unless it causes flatulence and occasional gastrointestinal discomfort.
  • When the ascitic displacement reaches 5, the patient begins to feel weak, with the usual «everyday» loads there is a feeling of lack of air, the appetite decreases, you may notice an increase in waist coverage and loosen the belt by several «holes».
  • If almost 10 liters have accumulated in the abdominal cavity, there is marked shortness of breath and increased heartbeat during movements, edema occurs on the feet, too fast saturation occurs during the meal, and progressive weakness is constantly felt.
  • The appearance of vomiting after eating, dyspnea at rest — signs of an advanced process that requires urgent medical measures — removal of the maximum possible amount of exudate through puncture laparocentesis.

The presence of a primary cancer, metastasis to other organs of the abdominal cavity and lungs impose additional pathological symptoms on the clinical manifestations of ascites. So with the spread of ovarian cancer in the abdominal cavity, vomiting and signs of severe pulmonary heart disease may also occur with a small ascites up to 3 liters.

For any volume of fluid in the abdominal cavity, active therapy is necessary, since proteins and trace elements go along with the plasma, causing the patient to have a pronounced nutritional insufficiency with the outcome of anorexia-cachexia fatal for an oncological patient.

Ascites Treatment

In diseases of the heart and liver cirrhosis, treatment of ascites is not as effective as possible with malignant processes.

Laparocentesis is a palliative manipulation, designed in the short term to relieve the patient from the symptoms of increased intra-abdominal pressure. Ascitic fluid is removed through an abdominal trocar puncture performed after local anesthesia.

If necessary, frequent evacuation of effusion is established a special laparoport system, which allows a puncture exclusion when it is possible to inject abdominal drugs for intracavitary chemotherapy.

Frequent removal of large amounts of ascitic fluid leads to the loss of proteins and microelements, which cannot be replaced by intravenous infusions and correction of the nutritional status. Systemic treatment of primary malignant tumors, especially ovarian and breast carcinomas, contributes to the regression of abdominal effusion.

The first laparocentesis significantly improves the condition, giving the patient an illusion of ease of treatment. Ascites therapy is a complex and not always rewarding process, since the intervals between laparocentesis are reduced, and the removal does not give the patient the desired strength. Correction of the pathological disorders that have arisen requires a systemic approach and an individual recovery program, which is implemented by specialists of the Oncological Center of Medicine 24/7