Ascites- accumulation of fluid in the abdominal cavity. It can occur in any condition accompanied by generalized edema. In adults, ascites most often occurs with liver cirrhosis, heart defects, and nephrotic syndrome. In children, ascites is more often observed with nephrotic syndrome and malignant neoplasms.
Code according to the international classification of diseases ICD-10:
Causes
Etiology and pathogenesis. Increased hydrostatic pressure.. Liver cirrhosis.. Hepatic vein occlusion (Budd-Chiari syndrome).. Obstruction of the inferior vena cava.. Constrictive pericarditis.. Congestive heart failure.. Heart defects (stenosis or tricuspid valve insufficiency). Decrease in colloid osmotic pressure (albumin content<20 г/л) .. Терминальная стадия заболевания печени со снижением белоксинтетической функции.. Нефротический синдром с потерей белка.. Нарушения питания.. Энтеропатии с потерей белка.. Белковое голодания. Повышение проницаемости капилляров брюшины.. Туберкулёзный перитонит.. Бактериальный перитонит.. Злокачественные заболевания брюшины.. Метастазы в брюшину (рак яичников, толстой кишки, поджелудочной железы и т.п.) .. Непроходимость лимфатических путей (лейкоз, лимфома) . Истечение жидкости в брюшную полость.. Хилёзный асцит (вторичный при разрыве лимфатического протока вследствие лимфомы или травмы) .. Мочевой асцит. Прочие причины.. Микседема.. Синдром Мейга.. Хронический гемодиализ.
Liquid type contained in the abdominal cavity. Transudate (for congestive heart failure, constrictive pericarditis, liver cirrhosis, nephrotic syndrome, hypoalbuminemia) .. Indicators characteristic of transudate: ... Protein<2,5 г% . Относительная плотность 1,005-1,015 ... Соотношение альбумины/глобулины: 2,5-4,0 ... Лейкоциты до 15 в поле зрения... Проба Ривальта отрицательна. Экссудат (при опухоли, туберкулёзе, панкреатите, микседеме, билиарной патологии, синдроме Бадда-Киари) .. Показатели, характерные для экссудата: ... Белок >2.5 g% ... Relative density >1.015 ... Albumin/globulin ratio: 0.5-2.0 ... Leukocytes over 15 in the field of view... Rivalta test is positive.
Symptoms (signs)
Clinical picture. Discomfort or abdominal pain. Increase in abdominal volume. Increase in body weight. Anorexia, nausea, heartburn. Quick satisfaction of hunger while eating. Increase in body weight. Dilation of the veins on the anterior wall of the abdomen (portocaval and cavacaval anastomoses). Dullness of percussion sound in the lateral parts of the abdomen, moving with changes in body position (with a volume of ascitic fluid of at least 2 liters). Swelling of the penis, scrotum, lower extremities. Formation of umbilical, inguinal, femoral hernias. With intense ascites - a positive symptom of fluctuation. Shortness of breath, sometimes orthopnea. Formation of pleural effusion, wheezing in the lungs may be heard. Swelling of the neck veins.
Diagnostics
Diagnostics. Ascites is indicated by abdominal enlargement, a positive symptom of fluctuation, or moving dullness detected by physical methods. An ultrasound scan reveals fluid in the peritoneal cavity. Paracentesis can be performed followed by analysis of ascitic fluid. The diagnostic sign of exudative ascites is an increase in the total protein content in the serum of more than 2.5 g%; usually seen with tumors, infections and myxedema. The difference between the level of albumin in the serum and the protein content in ascitic fluid of less than 1 g/l indicates a high probability of the malignant nature of ascites; more than 1.1 g% indicates the presence of portal hypertension. With pancreatic ascites, the content of amylase in the exudate is increased. With chylous ascites, the concentration of fat (in the form of chylomicrons) is increased; chylous ascites develops with liver cirrhosis or lymphoma. Malignant tumors are detected by cytological studies of ascitic fluid; malignant ascites is also characterized by an increase in cholesterol content above 50 mg%. A white blood cell count in ascitic fluid greater than 500/μL suggests infection. The predominance of neutrophils allows one to suspect a bacterial infection; the predominance of lymphocytes is most likely in tuberculosis or a fungal infection. A red blood cell count greater than 50,000/mm3 indicates hemorrhagic ascites, usually due to malignancy, tuberculosis, or trauma. Hemorrhagic pancreatitis, ruptured aortic aneurysm, or liver tumors may cause obvious bleeding into the abdominal cavity. The presence of a bacterial infection is confirmed by bacteriological examination of the exudate. pH of ascitic fluid<7 предполагает наличие бактериальной инфекции.
Laboratory research. Ascitic fluid.. Indicators that must be determined: ... Total number of cells... Number of neutrophils... Total protein... Culture for cultivation (at least 10 ml).. Indicators that facilitate diagnosis: ... Contents LDH... Amylase content... Cultivation of acid-fast and fungal flora... Cytology... Triglyceride content.. Additional studies of ascitic fluid... Helminths, talc granules... Presence of urine, blood... Fetal cancer Ag > 10 ng/ml (10 µg/l). Blood - creatinine (<1,4 мг%), электролиты. Моча.. содержание натрия в одной пробе: ... <10 мЭкв/л (диуретики неэффективны) ... 10-70 мЭкв/л (назначают диуретики) ... >70 mEq/L (diuretics not indicated).
Special studies. Laparoscopy. Ultrasound or CT. Diagnostic paracentesis.
Treatment
TREATMENT depends on the cause of ascites.
Diet with a low sodium content (no more than 0.5 g/day) and limiting the amount of liquid to 1 l/day. All dishes are prepared without salt. Exclude.. Products containing baking powder and baking soda (cakes, cakes, pastries, regular bread, etc.).. Pickles, marinades, canned food, ham, pates, sausages, cheeses, sauces, mayonnaise, ice cream.. Sweets , marshmallows, milk chocolate.. All cereals except semolina and rice. Allowed.. Salt-free bread and butter.. Beef, rabbit meat, chicken, fish (100 g/day), one egg/day.. Sour cream, milk (1 glass/day).. Fresh vegetables and fruits or in the form of compote.
Drug therapy
When daily sodium excretion is 5-25 mmol, potassium-sparing diuretics are prescribed: spironolactone 100-200 mg/day. After 4 days of treatment, it is necessary to consider the indications for prescribing furosemide 80 mg/day.
When daily sodium excretion is less than 5 mmol, potassium-sparing and loop diuretics are prescribed - furosemide 40-160 mg/day every other day in combination with potassium chloride - 50 mmol potassium per day.
As long as the patient has edema, daily diuresis of up to 3 liters is safe (weight loss of no more than 1.0 kg/day is acceptable). After the edema disappears, daily diuresis should not exceed 800-900 ml (optimal weight loss is about 0.5 kg/day).
In case of tense ascites, it is necessary to consider the indications for therapeutic paracentesis.. Tense ascites.. Ascites with edema. Contraindications to therapeutic paracentesis.. Child's group C liver cirrhosis.. Blood bilirubin above 170 µmol/l.. Prothrombin index (PTI) below 40%.. Platelet count less than 40 ´ 109/l.. Blood creatinine above 3 mg%. Daily sodium excretion is less than 10 mmol.
Therapeutic paracentesis. The volume of fluid removed is 5-10 liters. Simultaneously with the removal of fluid, it is necessary to inject salt-free albumin intravenously - 6 g per 1 liter of fluid removed.
Surgery. In case of chronic ascites that cannot be treated, an abdominal-jugular shunt (Levine shunt) is possible, but there is a high risk of infection and disseminated intravascular coagulation.
Complications and their treatment. Spontaneous bacterial peritonitis.. Develops in 8% of patients with liver cirrhosis with ascites.. 70% of patients develop abdominal pain, fever, abdominal tenderness on palpation, sharp deterioration.. The protein concentration in ascitic fluid is usually less than 1 g%.. More often is generally caused by a gram-negative pathogen from the intestinal group. Immediate administration of antibacterial therapy is necessary when the number of neutrophils in ascitic fluid is more than 250 per μl. Parenteral administration of third-generation cephalosporins and oral fluoroquinolones is effective. Development of hepatorenal syndrome (see Hepatorenal syndrome).
Prevention. Do not force diuretic therapy!
Course and prognosis. The prognosis depends on the cause of ascites. With cirrhosis of the liver, the prognosis is unfavorable (two-year survival rate - 40%). The presence of liver cell failure significantly worsens the prognosis. The mortality rate for spontaneous bacterial peritonitis reaches 50%, and for developed hepatorenal syndrome - 95%.
ICD-10. R18 Ascites
Tense ascites (ICD-10 code: R18) is a secondary condition in which specific fluid accumulates inside the abdomen. The pathology is expressed by the growth of the abdomen in volume, discomfort and pain, shortness of breath, a feeling of heaviness and other signs.
In medicine, this type of disease is called abdominal dropsy, which can accompany a large number of diseases from other areas. Dropsy is not considered an independent disease, but acts as a sign of severe pathology in the body.
An infographic of the types of ascites indicates that in seventy percent of adults it is formed due to liver disease. Cancer leads to the formation of ascites in 10% of situations, another 5% each are due to heart pathologies and other diseases. At the same time, ascites in a child indicates kidney disease.
It has been proven that the largest amount of water accumulating in the abdominal cavity with tense ascites (ICD-10 code: R18) in a patient can reach 25 liters.
Causes
The factors of ascites are diverse and are always combined with some significant pathology. The abdominal cavity is considered a closed place that should not produce unnecessary fluid.
The peritoneum has two layers. Normally, between these sheets there is always a small amount of water, which is the result of the activity of blood and lymphatic vessels located in the peritoneal cavity. However, this liquid does not accumulate, since almost instantly after separation it is absorbed by lymphoid capillaries. The remaining small portion is needed so that the loops of the intestinal tract and internal organs can easily move within the body and do not come into contact with each other.
When the barrier, excretory and resorptive functions are disrupted, the exudate ceases to be absorbed normally and accumulates in the abdomen, as a result of which tense ascites is formed.
Liver disorders
In first place is a disease called cirrhosis, as well as organ tumors and Budd-Chiari syndrome. Cirrhosis can progress against the background of hepatitis, steatosis, use of toxic pharmaceuticals, drunkenness and other conditions, but is constantly accompanied by the death of hepatocytes. As a result, good liver cells are replaced by scar matter, the organ increases in volume, compresses the portal vein, and for this reason, tense ascites is formed. In addition, a decrease in oncotic pressure promotes the release of unnecessary water, due to the fact that the liver itself is no longer able to produce plasma proteins and albumins. The pathological process during tense ascites in liver cirrhosis is enhanced by a number of reflex interactions triggered by the body in response to liver failure.
Heart diseases
Stressed ascites can progress due to heart failure, or due to constrictive pericarditis. Can be the result of almost all cardiac diseases. The mechanism of ascites formation in this case will be due to the fact that the hypertrophied heart muscle is not able to pump the required amount of blood, which begins to accumulate in the blood vessels, including in the inferior vena cava system. Due to high pressure, fluid will begin to leave the vascular bed, creating ascites. The system of ascites formation in pericarditis is approximately the same, but in this case the outer layer of the heart becomes inflamed, which makes it impossible for it to fill with blood normally. This subsequently affects the functioning of the venous system.
Kidney diseases
Dropsy is caused by chronic renal failure, which appears as a result of various diseases (pyelonephritis, glomerulonephritis, urolithiasis, etc.). Kidney diseases lead to increased blood pressure, sodium along with fluid is retained in the body, resulting in ascites. A reduction in plasma oncotic pressure, which leads to ascites, can also occur against the background of nephrotic syndrome.
Other factors
Ascites can progress with a defect in the lymphatic vessels. This occurs due to injury, due to the presence of a tumor in the body that provides metastases, due to infection with filaria (worms that lay eggs in large lymphatic vessels).
Various lesions of the peritoneum often cause ascites. Among them are diffuse, tuberculous and fungal carcinosis, tumors of the large intestine, stomach, mammary gland, ovaries, and endometrium. This also includes pseudomyxoma and peritoneal mesothelioma.
Polyserositis is considered a disease in which dropsy appears in combination with other symptoms, including pleurisy and pericarditis.
Systemic diseases are ready to lead to the accumulation of water in the peritoneum. These are rheumatism, rheumatoid arthritis, lupus erythematosus and so on.
Ascites also occurs in newly born babies and is most often considered the result of hemolytic disease of the fetus. It, in turn, is formed during an intrauterine immunological conflict, if the blood of the fetus and mother do not match the structure of antigens.
Diseases of the digestive system can cause excessive concentration of water in the abdominal cavity. This may be pancreatitis, prolonged diarrhea, Crohn's disease. This can also include all processes occurring in the peritoneum and interfering with lymphatic drainage.
Localis status of tense ascites (symptoms)
The initial sign of ascites is considered to be rapid growth of the abdomen, and more specifically, its bloating. The main factor is that a very large amount of water then accumulates, which almost never comes out. A person usually develops ascites when he is unable to fit into ordinary clothes, which not so long ago fit him in volume.
If ascites appears, then in the body, of course, there are at least two significant multifunctional pathologies that need to be cured. Most of all, this is pathological functioning of the intestinal tract, indigestion or liver abnormalities.
The rate of increase in symptoms is directly related to what actually became the factor of ascites. The procedure can progress rapidly or may take a couple of months.
Tense ascites:
- A state of heaviness in the abdominal cavity.
- The occurrence of discomfort and pain in the abdomen and pelvis.
- Bloating, signs of flatulence.
- Burning in the esophagus.
- Difficulty going to the toilet and eating.
- Attacks of nausea.
- Increase in belly size. If the sick person is in a horizontal state, the stomach bulges at the edges and resembles the appearance of the belly of a frog. If a person is in an upright position, the stomach hangs down.
- Protrusion of the navel.
- Symptom of tummy rocking or fluctuation. Constantly appears when filled with liquid.
- The more water accumulates in the abdominal cavity, the greater the shortness of breath, the swelling of the lower extremities worsens, and movements become slower. It is especially difficult for the patient to bend forward.
- Due to increased intra-abdominal pressure, a bulging femoral or umbilical hernia is likely. Against this background, hemorrhoids and varicocele can form. Rectal prolapse cannot be ruled out.
Symptoms depending on the factor
The status of localis of tense ascites is distinguished as follows:
Tuberculous peritonitis. In this case, dropsy is considered the result of tuberculous lesions of the reproductive system or intestinal tract. The sick person begins to lose weight at a rapid pace, his body temperature increases, and signs of intoxication of the body increase. Lymph nodes grow and pass along the mesentery of the intestinal tract. In the sediment of exudate taken by puncture, in addition to lymphocytes and erythrocytes, mycobacterium tuberculosis will be isolated.
Peritoneal carcinosis. If dropsy develops due to the presence of a tumor in the peritoneum, then the signs of the disease will primarily be located there, which organ it has affected. However, with ascites of oncological etiology, there is always an enlargement of the lymph nodes, which can be palpated through the wall. The effusion sediment will contain atypical cells.
Heart failure. The patient has a blue-violet coloration of the dermatological surfaces. The lower extremities, especially the feet and legs, will become quite swollen. In this case, the liver increases in volume, pain appears, localized in the right hypochondrium.
Portal vein. The patient will complain of intense pain, the liver increases in volume, but not much. There is a high risk of severe bleeding. In addition to the enlargement of the liver, there is an increase in the volume of the spleen.
Diagnosis of ascites
Diagnosis of tense ascites (in ICD-10: R18) begins with the exclusion of other causes that cause an increase in abdominal volume. For example, cysts, pregnancy, tumors, obesity. The following actions are used as part of the check:
- Palpation, visual inspection, percussion.
- Ultrasound examination.
- Doppler ultrasound of blood vessels.
- Scintigraphy.
- Laparoscopic examination of the abdominal cavity.
- Analysis of ascitic fluid.
Percussion is characterized by a muffled sound; during palpation of the lateral part, symptoms of fluctuation are recognized. Radiography makes it possible to diagnose ascites if more than 0.5 liters of free fluid accumulates in the abdominal cavity. As for ultrasound, during this examination attention is paid to the tissues of the liver and spleen, their condition is studied, and the peritoneum is checked for tumors and mechanical lesions.
Laboratory research
An important stage of manipulation after complaints with tense ascites is taking tests:
- Coagulogram.
- Biochemistry of the liver.
- Checking antibody levels.
- General urine analysis.
If ascites is detected in a patient for the first time, the doctor prescribes laparocentesis to examine the fluid itself. In laboratory conditions, the composition, density, level of protein content is checked, and bacteriological culture is done.
Drug treatment
Drug treatment of ascites is carried out with both diuretics and potassium preparations, albumin solution, and asparkam. This is done for a reason, but for plasma pressure, thereby increasing blood volume. If the patient has severe ascites, along with medication treatment, he is sent to a laparocentesis procedure using ultrasound navigation. Piercing with a trocar removes fluid from the abdominal cavity. Sometimes doctors install drainages for long-term removal of exudate or transudate.
To remove ascitic fluid it is necessary:
- reduce sodium intake into the body;
- excrete sodium in urine as soon as possible.
To reduce the amount of sodium in the body, you need to limit its intake from food. To do this, you need to eat up to 3 grams of salt per day. After all, it has been proven that the lack of salt has a very bad effect on the body’s protein metabolism. Now many have begun to take drugs such as Captopril, Fosinopril, and Enalapril to treat ascites. They are known to speed up the elimination of sodium from the body and increase the amount of urine per day. They also contribute to the retention of potassium in the body. Do not forget that diuretics not only reduce the amount of ascites, but also remove fluid from various tissues.
Surgery
Laparocentesis is a surgical treatment for ascites. To extract excess fluid, a puncture is made and a special instrument - a trocar - is installed. On an empty stomach and with an empty bladder, the patient is seated or placed on his side, and local anesthesia is prescribed. To the side of the midline, 1-2 cm between the navel and pubis, is the puncture site. Be sure to follow the rules of antiseptics. A puncture is made on the skin with a pointed scalpel, then a trocar is inserted. To avoid a sharp drop in blood pressure, the liquid is removed gradually, at intervals of 1-2 minutes.
To extract the fluid, the torso is wrapped in a towel and the patient’s abdomen is evenly compressed with it. The fluid is either removed at one time or an indwelling catheter is placed. The doctor decides this. It is not recommended to remove more than 5-6 liters of fluid at a time, as complications may occur, such as cardiac arrest. After removing the trocar, sutures are applied. When installing a catheter, there is a possibility of developing an ascitic fistula. A fistula forms at puncture sites or between sutures. If the leakage of ascitic fluid lasts more than a day, it is necessary to close the hole with interrupted sutures
Traditional treatment
Ascites is, as you know, dropsy of the abdominal cavity, which primarily affects people suffering from cardiovascular diseases, renal failure and those prone to developing cancer. Treatment and prevention of ascites occupy a fairly important place in medical practice, therefore, in the most severe clinical cases, doctors also recommend the additional use of alternative medicine for a comprehensive impact on the problem.
What means of combating ascites does the practice of a healthy lifestyle include:
- Using birch leaves and buds to prepare medicinal potions:
- "Dry" birch baths. Birch leaves are collected and placed in a bathtub, a large barrel, or a basin. Cover with plastic wrap and let stand in a bright place for several hours. As soon as the leaves have dried, they are opened and dried a little. The patient is placed completely in such a bath and allowed to lie down for 30-40 minutes. The normal condition after dry birch baths is characterized by a slight tingling of the skin.
- Baths with birch decoction. 50 grams of dry or fresh birch leaves are poured into the bath and filled with 10 buckets of warm boiled water. After which the patient with ascites is placed in the decoction for 30-40 minutes. If upon leaving the bath you feel a slight numbness in your limbs and bright pink stripes and spots are visible on your body, the effect of the decoction is considered positive.
- Wraps with birch infusion. The decoction for wraps is prepared in the same way as for taking baths. The patient is wrapped in a sheet soaked in the medicinal drug from the armpits to the knees. Then they are laid on the bed and covered with several layers of woolen blankets. Allow to lie in this state for 45-50 minutes. Then wash with warm boiled water.
- Diuretic herbal infusions:
- Diuretic collection, which is rich in vitamins. You will need dried rose hips, raspberry, lingonberry and black currant leaves in similar proportions. Pour a quarter of a glass of these herbs into a glass of very hot water. Cook for half an hour, then cool and take twice a day.
- Drinking liquid from bean pods. Take the husks from 20 bean pods and steam them for 10-15 minutes in boiling water. Open the container, mix the substrate and let it brew for another 30 minutes. Divide into four times and drink half an hour before meals.
What is a diet for ascites?
This type of diet has its own rules that must be followed very clearly, and if this is not done, the disease will quickly progress to the next stage. One of the important rules is to eat small portions of food every three hours, and the food must be warm. Under no circumstances should you overeat or increase the time interval between meals, as this will lead to the formation of severe swelling in the abdominal cavity.
All components for dishes with ascites must be subjected to minimal heat treatment, and it is advisable to steam all food, bake without using oil or stew. The diet of people who suffer from dropsy should consist of healthy and varied foods, and emphasis should also be placed on spicy plants that have a mild diuretic effect. If dropsy appears against the background of liver cirrhosis, then it is imperative to include in the menu foods rich in easily digestible proteins.
Allowed products for dropsy
The diet of people who suffer from ascites must include low-fat sea fish, which should be cooked without salt in the oven or steamed. The menu should definitely include light liquid dishes that should be prepared with ingredients such as fennel, parsley or ginger. As for meat, preference should be given to turkey, rabbit or skinless chicken, and it is advisable to steam dishes from these types of meat. It is advisable to prepare drinks from components that have a mild diuretic effect, for example, from currant leaves or figs.
Excluded:
- back pain (M54.-)
- flatulence and related conditions (R14)
- renal colic (N23)
Excluded:
- hematemesis (K92.0)
- hematemesis in newborns (P54.0)
- vomit:
- indomitable during pregnancy (O21.-)
- after surgery on the gastrointestinal tract (K91.0)
- in a newborn (P92.0)
- psychogenic (F50.5)
Abdominal distension (gas)
Pain from gas accumulation
Tympanitis (abdominal) (intestinal)
Excluded: psychogenic airbrushing (F45.3)
Excludes: inorganic origin (F98.1)
Excludes: neonatal jaundice (P55.-, P57-P59)
In Russia, the International Classification of Diseases, 10th revision (ICD-10) has been adopted as a single normative document for recording morbidity, reasons for the population's visits to medical institutions of all departments, and causes of death.
ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. No. 170
The release of a new revision (ICD-11) is planned by WHO in 2017-2018.
With changes and additions from WHO.
Processing and translation of changes © mkb-10.com
Ascites - description, causes, symptoms (signs), diagnosis, treatment.
Short description
Ascites is an accumulation of fluid in the abdominal cavity. It can occur in any condition accompanied by generalized edema. In adults, ascites most often occurs with liver cirrhosis, heart defects, and nephrotic syndrome. In children, ascites is more often observed with nephrotic syndrome and malignant neoplasms.
Code according to the international classification of diseases ICD-10:
- R18 Ascites
Causes
Etiology and pathogenesis Increased hydrostatic pressure Cirrhosis of the liver Hepatic vein occlusion (Budd–Chiari syndrome) Obstruction of the inferior vena cava Constrictive pericarditis Congestive heart failure Heart defects (stenosis or tricuspid valve insufficiency) Decreased colloid osmotic pressure (albumin content<20 г/л) Терминальная стадия заболевания печени со снижением белоксинтетической функции Нефротический синдром с потерей белка Нарушения питания Энтеропатии с потерей белка Белковое голодания Повышение проницаемости капилляров брюшины Туберкулёзный перитонит Бактериальный перитонит Злокачественные заболевания брюшины Метастазы в брюшину (рак яичников, толстой кишки, поджелудочной железы и т.п.) Непроходимость лимфатических путей (лейкоз, лимфома) Истечение жидкости в брюшную полость Хилёзный асцит (вторичный при разрыве лимфатического протока вследствие лимфомы или травмы) Мочевой асцит Прочие причины Микседема Синдром Мейга Хронический гемодиализ.
Type of fluid contained in the abdominal cavity Transudate (for congestive heart failure, constrictive pericarditis, liver cirrhosis, nephrotic syndrome, hypoalbuminemia) Indicators characteristic of transudate: Protein<2,5 г% Относительная плотность 1,005–1,015 Соотношение альбумины/глобулины: 2,5–4,0 Лейкоциты до 15 в поле зрения Проба Ривальта отрицательна Экссудат (при опухоли, туберкулёзе, панкреатите, микседеме, билиарной патологии, синдроме Бадда–Киари) Показатели, характерные для экссудата: Белок >2.5 g% Relative density >1.015 Albumin/globulin ratio: 0.5–2.0 Leukocytes over 15 in the field of view The Rivalta test is positive.
Symptoms (signs)
Clinical picture Discomfort or pain in the abdomen Increased abdominal volume Increased body weight Anorexia, nausea, heartburn Quick satisfaction of hunger during meals Increased body weight Dilation of the veins on the anterior wall of the abdomen (portocaval and cavacaval anastomoses) Dullness of percussion sound in the lateral parts of the abdomen, moving with change in body position (with a volume of ascitic fluid of at least 2 liters) Swelling of the penis, scrotum, lower extremities Formation of umbilical, inguinal, femoral hernias With tense ascites - a positive symptom of fluctuation Shortness of breath, sometimes orthopnea Formation of pleural effusion, possibly listening to wheezing in the lungs Swelling of the cervical veins
Diagnostics
Diagnostics. Ascites is indicated by abdominal enlargement, a positive symptom of fluctuation, or moving dullness detected by physical methods. An ultrasound scan reveals fluid in the peritoneal cavity. Paracentesis can be performed followed by analysis of ascitic fluid. The diagnostic sign of exudative ascites is an increase in the total protein content in the serum of more than 2.5 g%; usually seen with tumors, infections and myxedema. The difference between the level of albumin in the serum and the protein content in the ascitic fluid is less than 1 g/l indicates a high probability of the malignant nature of ascites; more than 1.1 g% indicates the presence of portal hypertension. In pancreatic ascites, the amylase content in the exudate is increased. In chylous ascites, the concentration of fat is increased. (in the form of chylomicrons), chylous ascites develops with cirrhosis of the liver or lymphoma. Malignant tumors are detected by cytological studies of ascitic fluid; malignant ascites is also characterized by an increase in cholesterol content above 50 mg%. The number of leukocytes in ascitic fluid exceeding 500/μl suggests the presence of infection. The predominance of neutrophils suggests a bacterial infection, the predominance of lymphocytes is most likely due to tuberculosis or fungal infection. The number of red blood cells exceeding / μl indicates hemorrhagic ascites, usually due to malignant disease, tuberculosis or trauma. Hemorrhagic pancreatitis, ruptured aortic aneurysm or liver tumors can cause obvious bleeding into the abdominal cavity. The presence of a bacterial infection is confirmed by bacteriological examination of the exudate, the pH of the ascitic fluid<7 предполагает наличие бактериальной инфекции.
Laboratory studies Ascitic fluid Indicators that must be determined: Total number of cells Number of neutrophils Total protein Culture for cultivation (at least 10 ml) Indicators that facilitate diagnosis: LDH content Amylase content Cultivation of acid-fast and fungal flora Cytology Triglyceride content Additional studies of ascitic fluid Helminths, talc granules Presence of urine, blood Fetal cancer Ag >10 ng/ml (10 μg/l) Blood - creatinine (<1,4 мг%), электролиты Моча содержание натрия в одной пробе: <10 мЭкв/л (диуретики неэффективны) 10–70 мЭкв/л (назначают диуретики) >70 mEq/L (diuretics not indicated).
Special studies Laparoscopy Ultrasound or CT Diagnostic paracentesis.
Treatment
TREATMENT depends on the cause of ascites.
A diet with a low sodium content (no more than 0.5 g/day) and limiting the amount of liquid to 1 l/day All dishes are prepared without salt. Avoid products containing baking powder and baking soda (cakes, cakes, pastries, regular bread, etc.). d.) Pickles, marinades, canned food, ham, pates, sausages, cheeses, sauces, mayonnaise, ice cream Candies, marshmallows, milk chocolate All cereals, except semolina and rice Allowed Salt-free bread and butter Beef, rabbit meat, chicken, fish (100 g/day), one egg/day Sour cream, milk (1 glass/day) Fresh vegetables and fruits or in the form of compote.
If the daily sodium excretion is 5–25 mmol, potassium-sparing diuretics are prescribed: spironolactone 100–200 mg/day. After 4 days of treatment, it is necessary to consider the indications for prescribing furosemide 80 mg/day.
When daily sodium excretion is less than 5 mmol, potassium-sparing and loop diuretics are prescribed - furosemide 40–160 mg/day every other day in combination with potassium chloride - 50 mmol potassium per day.
While the patient has edema, daily diuresis of up to 3 liters is safe (weight loss of no more than 1.0 kg/day is acceptable). After edema disappears, daily diuresis should not exceed 800–900 ml (optimal weight loss is about 0.5 kg/day) days).
In case of tense ascites, it is necessary to consider the indications for therapeutic paracentesis. Tense ascites. Ascites with edema. Contraindications to therapeutic paracentesis. Child's group C liver cirrhosis. Blood bilirubin is above 170 μmol/l. Prothrombin index (PTI) is below 40%. Platelet count is less than 40 ´ 109/l. Blood creatinine is higher. 3 mg% Daily sodium excretion less than 10 mmol.
Therapeutic paracentesis The volume of fluid removed is 5–10 liters. Simultaneously with the removal of fluid, salt-free albumin must be administered intravenously - 6 g per 1 liter of fluid removed.
Surgery. In case of chronic ascites that cannot be treated, an abdominal-jugular shunt (Levine shunt) is possible, but there is a high risk of infection and disseminated intravascular coagulation.
Complications and their treatment Spontaneous bacterial peritonitis Develops in 8% of patients with cirrhosis of the liver with ascites 70% of patients develop abdominal pain, fever, abdominal tenderness on palpation, a sharp deterioration in condition Protein concentration in ascitic fluid is usually less than 1 g% Most often caused by a gram-negative pathogen from the intestinal group. Immediate administration of antibacterial therapy is necessary when the number of neutrophils in ascitic fluid is more than 250 per μl. Parenteral administration of third-generation cephalosporins and oral fluoroquinolones is effective. Development of hepatorenal syndrome (see Hepatorenal syndrome).
Prevention Do not force diuretic therapy!
Course and prognosis The prognosis depends on the cause of ascites. In liver cirrhosis, the prognosis is unfavorable (two-year survival rate - 40%). The presence of hepatic cell failure significantly worsens the prognosis. Mortality in spontaneous bacterial peritonitis reaches 50%, in developed hepatorenal syndrome - 95%.
Ascites: symptoms and treatment
Ascites - main symptoms:
- Weakness
- Abdominal pain
- Dyspnea
- Labored breathing
- Cough
- Belching
- Intoxication
- Fever
- Heartburn
- Increase in abdominal volume
- Swelling of the limbs
- Flatulence
- Weight loss
- Rectal prolapse
- Enlarged veins on the abdomen
- Hernia
- Haemorrhoids
Abdominal ascites (known as abdominal dropsy) is a pathology that is a complication of other diseases. Abdominal ascites 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. This 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
Abdominal ascites is a pathological process, since the healthy functioning of the human body does not involve 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 without sticking to each other. This plasma fluid must be absorbed into the intestinal walls, but if the functioning of this mechanism is disrupted, the function of fluid secretion and its opposite role of absorption fails. This causes ascites, which involves the accumulation of excess fluid. Laparocentesis helps in such cases 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
Symptoms of ascites depend on how quickly ascitic fluid is formed, the reasons for the disease and the amount of release of the type of plasma. Symptoms of ascites may appear gradually or may occur within 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 clothing needed, as well as an increase in weight. In addition, the patient experiences constant belching, heartburn, flatulence, and severe abdominal pain. When the patient assumes a vertical position, his stomach hangs down, and when he assumes a horizontal position, it hangs to both sides. The presence of a large abdomen causes severe shortness of breath with accompanying swelling of the extremities. Abdominal dropsy is often accompanied by a hernia, hemorrhoids or rectal prolapse.
Common signs of the disease include:
- fever;
- loss of weight in other parts of the body due to an enlarged abdomen;
- signs of toxicosis;
- enlargement of the veins that are located on the abdomen.
The indicator of how much fluid accumulates in the patient’s body ranges from 1.5 to 20 liters. Tense ascites is a type of disease that involves a large fluid accumulation with a tendency to rapidly increase the fluid content in the peritoneum.
Diagnostics
Hydrocele of the abdomen can be diagnosed by a doctor even without the use of special equipment - it is enough to palpate the patient’s abdominal cavity. If, upon palpation, the doctor detects dullness in the abdomen on the side, while tympanitis is found in the middle, the patient has ascites. To carry out a more in-depth diagnosis, it is necessary to perform an ultrasound in the peritoneal cavity, examine the liver, and also perform a puncture of the peritoneum (paracentesis). Taking the fluid for analysis allows us to identify the stage of the disease and determine its treatment. Paracentesis is performed to determine the causes of the disease. Paracentesis can also be done if there is difficulty breathing or pain.
In addition to the above diagnostic methods, the patient must undergo urine and blood tests, as well as undergo immunological studies. The possibility of prescribing additional analyzes and tests depends on how much information the obtained tests provide the doctor.
Treatment
Treatment of abdominal ascites is performed by qualified surgeons, therapists, and doctors of other specializations. It all depends on the type of illness and the cause that caused it. Dropsy of the abdomen is treated using the following methods:
- diet for ascites;
- taking diuretics together with substances that contain potassium;
- the use of medications to reduce hypertension in the portal vein area;
- paracentesis;
- laparocentesis. Highly effective technique. Laparocentesis is used most often by surgeons.
The diet for ascites involves reducing fluid intake, as well as salt, due to the fact that it retains fluid in the body. Doctors recommend the Avicenna diet. Such a diet for ascites involves almost complete abstinence from fatty foods, eating nuts in large quantities, and abandoning 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 the lean type (chicken, turkey, rabbit).
Paracentesis is cutting into the abdominal cavity to identify the causes of the disease. It can sometimes cause complications (bleeding, damage to structures in the abdominal cavity). However, paracentesis is necessary as a diagnostic and therapeutic measure. Factors that negatively affect paracentesis are:
- full bladder;
- pregnancy;
- presence of bleeding;
- the presence of infection in the operated area.
Paracentesis involves examining the patient, performing ultrasound and MRI. It is performed under local anesthesia, which induces drowsiness.
Laparocentesis is the removal of excess exudate from the patient's body through surgery. In this case, laparocentesis involves removing 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 peritoneal adhesions. Laparocentesis is performed under ultrasound guidance and local anesthesia.
Treatment of ascites in liver cirrhosis, 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 in 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 disruption in the functioning of the lymphatic vessels. In addition, ascites in the presence of oncology can provoke ovarian rupture.
Ascites peritonitis is caused by infection in the plasma fluid. This increases the patient’s symptoms, which requires taking antibacterial drugs. Ascites peritonitis is usually spontaneous and requires careful examination of the infected fluid.
Chylous ascites develops with accompanying liver diseases and involves the release of fats and lymph into the peritoneal cavity from the intestines. Chylous ascites must be treated with diuretics - drugs that can quickly remove fluid from the body.
Treatment of ascites with folk remedies involves taking baths, wraps, and taking tinctures. It is suggested to cure the disease at home using birch. You can make a bath from its leaves at home, a tincture from the buds can be taken orally, and you can use a decoction to make wraps. Birch is known for its properties against stagnation of liquids.
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 problems and other severe symptoms. The presence of severe ascites, according to statistics, increases the percentage of deaths to 50%.
If you think that you have ascites and the symptoms characteristic of this disease, then a gastroenterologist can help you.
We also suggest using our online disease diagnostic service, which selects probable diseases based on the entered symptoms.
Klebsiella is a pathogen that provokes the development of several diseases in the human body and occupies a leading place among opportunistic bacteria. The severity of the disease directly depends on the state of the immune system, which is why it can range from a mild infection to severe sepsis.
Postcholecystectomy syndrome is a disease that includes a whole complex of various clinical manifestations that arose during an operation, the essence of which was the excision of the gallbladder or the removal of stones from the bile ducts.
Aerophagia (syn. pneumatosis of the stomach) is a functional disorder of the stomach, which is characterized by swallowing large amounts of air, which after some time causes regurgitation. This can happen both during and outside of eating. A similar condition can occur in both adults and children.
Stomach cough is a cough that is a symptom of a gastroenterological disease and is not related to pathological processes of the respiratory system. Typically, this type of cough has the following symptoms:
Lymphocytic leukemia is a malignant lesion that arises in the lymphatic tissue. It is characterized by the accumulation of tumor lymphocytes in the lymph nodes, in the peripheral blood and in the bone marrow. The acute form of lymphocytic leukemia has recently been classified as a “childhood” disease due to its susceptibility mainly to patients aged two to four years. Today, lymphocytic leukemia, the symptoms of which are characterized by their own specificity, is observed more often among adults.
With the help of exercise and abstinence, most people can do without medicine.
Symptoms and treatment of human diseases
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Ascites
ICD-10 code
Associated diseases
Titles
Description
Ascites is a condition in which free fluid appears in the abdominal cavity in large quantities.
Ascites is a consequence of liver cirrhosis in 75%; malignant neoplasms - 10%; heart failure in 5% of cases.
Symptoms
Causes
Main pathogenetic mechanisms:
Stagnation of blood in the systemic circulation in right ventricular heart failure;
Peritoneal carcinomatosis when cancer cells of malignant tumors of the abdominal organs migrate into the peritoneal cavity;
Local lymphostasis with filariasis of lymphatic vessels collecting lymph from the abdominal organs, or cancer metastases to regional lymph nodes;
Hypoproteinemic edema during fasting, kidney disease;
Exudation into the peritoneal cavity during peritonitis of various etiologies, for example, with tuberculosis and a number of others that are rare.
How is ascites treated in liver cirrhosis?
Treatment of ascites in liver cirrhosis should be carried out immediately. This is a dangerous condition that can cause death in the patient. The appearance of ascites (ICD code 10 - R18) with a disease such as cirrhosis is common, but it is life-threatening, so you need to know in what ways it can be cured and what are the reasons for its appearance, how to get rid of the fluid that is in the process accumulates in the abdominal cavity and what are the symptoms of the disease. It is important to determine its first signs, to know how laparocentesis is performed, and whether a person can alleviate the course of the disease at home. In addition, it will be useful to understand how diet and proper nutrition influence the development of the disease, how to avoid decompensation of the body, and what stage is considered incurable.
Why are ascites and cirrhosis so common?
Based on the recorded data, 75% of cases of ascites develop in patients with liver cirrhosis, also due to alcohol abuse. During the period of systematic consumption of strong drinks over a decade, up to 25% of alcoholics develop alcoholic cirrhosis. The causes of exacerbation of the disease are directly related to the further consumption of alcohol-containing drinks. If a person does not drink alcohol, then his well-being noticeably improves, symptoms are smoothed out, and his general condition is stabilized.
When a person does nothing, ignores the diagnosis and continues to drink alcohol, hypoalbuminemia (in other words, protein imbalance) begins to develop. Ultimately, the patient with cirrhosis develops ascites.
Before discussing how ascites in liver cirrhosis can be treated, as well as what its symptoms are, it is necessary to delve into the causes of the disease. If a person does not take action, the result may be irreversible.
Signs of cirrhosis
The leading aggravating factors are:
- Manifestation of acute liver failure.
- Increased pressure, which is directly related to damage to blood circulation in the veins of the liver and nearby vessels.
This phenomenon brings with it changes in the peripheral, circulatory, muscular systems and the central nervous system. Peripheral neuritis flows into alcoholic polyneuropathy, which progresses to atrophy of the lower extremities and muscles of the shoulder girdle.
In the stage of decompensation, medical manifestations no longer depend on one reason or another. Possible manifestations of mental impairment, brain damage, and bleeding from enlarged veins of the stomach and esophagus. From the gastrointestinal tract, gastritis, ulcers and pancreatitis can be observed.
Most patients suffer from B-12 deficiency and iron deficiency anemia. Reasons why these symptoms occur:
- Toxic effects of ethanol on the liver.
- Poor nutrition leads to a deficiency of vitamins and microelements.
- Lack of iron.
- Bleeding in the gastrointestinal tract or nearby vessels.
Endless inflammation leads to hyperleukocytosis, changes in leukocyte sedimentation rate and protein starvation.
You need to know that cirrhosis is the last stage of the disease, preceded by fatty degeneration and hepatitis.
Signs and symptoms of ascites
The third stage of alcoholic hepatitis can lead to ascites. This disease is very serious and is fatal. If the patient neglects this factor and does not begin treatment, then you should not count on a long life.
Ascites in liver cirrhosis can be recognized when more than a liter of secretion begins to accumulate in the abdominal cavity. Cases have been recorded when about 25 liters of fluid were pumped out of a patient’s abdominal cavity by performing laparocentesis and paracentesis.
In this case, the person is in an upright position, and the peritoneum seems to sag, the navel becomes bulging due to the pressure of the transudate. When lying horizontally: the sides look swollen and the stomach looks vague.
The venous pattern is depicted on the taut abdominal cavity, which is concentrated in the umbilical area.
When the disease occurs with complications due to heart failure, secretion accumulates in the pleura, and a state of hydrothorax is observed. The diaphragm moves into the sternum area, which is confirmed by x-rays. As a result, pulmonary failure develops due to the fact that the movement of the lungs is constrained. Identification of the disease in the stage of decompensation may lead to complications when it is treated.
How is ascites treated in liver cirrhosis?
Treatment always involves drug therapy, which includes the use of diuretics, as well as manipulations that can restore water-salt metabolism.
When drug intervention does not bring the expected results, laparocentesis of the abdominal wall comes into force. In order to pump out ascitic fluid from the abdominal cavity, laparocentesis is performed. To do this, a small puncture incision is made in the peritoneum. Laparocentesis is performed exclusively in outpatient settings. However, frequent such manipulations lead to the appearance of adhesions in the intestines; these reasons can make it difficult for subsequent interventions.
When, after a short amount of time, the secretion again accumulates in the abdominal cavity, the chances of curing the disease are reduced to a minimum.
ICD 10 code
The abbreviation ICD 10 stands for International Classification of Diseases, Tenth Revision. At the beginning of 2007, it was recognized as a generally accepted classification for coding diseases. From that moment on, every disease carries its own code.
ICD class 10 (XVIII - symptoms, causes and disorders that were determined during laboratory and clinical tests).
Symptoms and signs that directly relate to the digestive system and abdominal cavity (R 10-R 19).
The diagnostic code in the ICD 10 section is R 18.
Diet
Considering that this disease appears against the background of the main cause of the disease and the symptoms of its course may be, to some extent, different for everyone, the diet is also selected individually, based on the causes of occurrence, the degree of development and what its stage is. The most important thing is that the diet includes those substances that are lacking in a weakened human body.
If cirrhosis is present, then the diet should be selected very carefully. For example, protein deficiency, which is accompanied by alcoholic liver disorders, cannot be compensated for by including it directly in the general diet. This may lead to a coma. Therefore, the protein is administered in the form of injections.
A diet that excludes salt makes it possible to release fluid from the vascular bed and intercellular voids without restrictions. At the same time, nutrition should limit the presence of carbohydrates, and if the diet includes them, then only in the form of vegetables, cereals and fruits.
The diet should also not contain fat. It is advisable to cook dishes using vegetable oils.
However, diet alone will not be able to improve a person’s general condition if he consumes large amounts of fluid. The maximum volume of consumed water and liquid, which is included in many dishes and drinks, should not exceed 1 liter.
Treatment of ascites with folk remedies at home cannot be carried out. Only qualified help from specialists can protect a person from his development, because the last stage is fatal. Therefore, you should immediately consult a doctor in order to start treating the disease in time and check whether there is fluid in the peritoneal area.
All materials on our site are intended for those who care about their health. But we do not recommend self-medication - each person is unique, and without consulting a doctor you cannot use certain means and methods. Be healthy!
The information on the site is provided solely for popular informational purposes, does not claim to be reference or medical accuracy, and is not a guide to action. Do not self-medicate. Consult your healthcare provider.
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ICD code: R18
Ascites
Ascites
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Treatment of ascites in liver cirrhosis should be carried out immediately. This is a dangerous condition that can cause death in the patient. The appearance of ascites (ICD code 10 - R18) with a disease such as cirrhosis is common, but it is life-threatening, so you need to know in what ways it can be cured and what are the reasons for its appearance, how to get rid of the fluid that is in the process accumulates in the abdominal cavity and what are the symptoms of the disease. It is important to determine its first signs, to know how laparocentesis is performed, and whether a person can alleviate the course of the disease at home. In addition, it will be useful to understand how diet and proper nutrition influence the development of the disease, how to avoid decompensation of the body, and what stage is considered incurable.
Why are ascites and cirrhosis so common?
Based on the recorded data, 75% of cases of ascites develop in patients with liver cirrhosis, also due to alcohol abuse. During the period of systematic consumption of strong drinks over a decade, up to 25% of alcoholics develop alcoholic cirrhosis. The causes of exacerbation of the disease are directly related to the further consumption of alcohol-containing drinks. If a person does not drink alcohol, then his well-being noticeably improves, symptoms are smoothed out, and his general condition is stabilized.
When a person does nothing, ignores the diagnosis and continues to drink alcohol, hypoalbuminemia (in other words, protein imbalance) begins to develop. Ultimately, the patient with cirrhosis develops ascites.
Before discussing how ascites in liver cirrhosis can be treated, as well as what its symptoms are, it is necessary to delve into the causes of the disease. If a person does not take action, the result may be irreversible.
Signs of cirrhosis
The leading aggravating factors are:
- Manifestation of acute liver failure.
- Increased pressure, which is directly related to damage to blood circulation in the veins of the liver and nearby vessels.
This phenomenon brings with it changes in the peripheral, circulatory, muscular systems and the central nervous system. Peripheral neuritis flows into alcoholic polyneuropathy, which progresses to atrophy of the lower extremities and muscles of the shoulder girdle.
In the stage of decompensation, medical manifestations no longer depend on one reason or another. Possible manifestations of mental impairment, brain damage, and bleeding from enlarged veins of the stomach and esophagus. From the gastrointestinal tract, gastritis, ulcers and pancreatitis can be observed.
Most patients suffer from B-12 deficiency and iron deficiency anemia. Reasons why these symptoms occur:
- Toxic effects of ethanol on the liver.
- Poor nutrition leads to a deficiency of vitamins and microelements.
- Lack of iron.
- Bleeding in the gastrointestinal tract or nearby vessels.
Endless inflammation leads to hyperleukocytosis, changes in leukocyte sedimentation rate and protein starvation.
You need to know that cirrhosis is the last stage of the disease, preceded by fatty degeneration and hepatitis.
Signs and symptoms of ascites
The third stage of alcoholic hepatitis can lead to ascites. This disease is very serious and is fatal. If the patient neglects this factor and does not begin treatment, then you should not count on a long life.
Ascites in liver cirrhosis can be recognized when more than a liter of secretion begins to accumulate in the abdominal cavity. Cases have been recorded when about 25 liters of fluid were pumped out of a patient’s abdominal cavity by performing laparocentesis and paracentesis.
In this case, the person is in an upright position, and the peritoneum seems to sag, the navel becomes bulging due to the pressure of the transudate. When lying horizontally: the sides look swollen and the stomach looks vague.
The venous pattern is depicted on the taut abdominal cavity, which is concentrated in the umbilical area.
When the disease occurs with complications due to heart failure, secretion accumulates in the pleura, and a state of hydrothorax is observed. The diaphragm moves into the sternum area, which is confirmed by x-rays. As a result, pulmonary failure develops due to the fact that the movement of the lungs is constrained. Identification of the disease in the stage of decompensation may lead to complications when it is treated.
How is ascites treated in liver cirrhosis?
Treatment always involves drug therapy, which includes the use of diuretics, as well as manipulations that can restore water-salt metabolism.
When drug intervention does not bring the expected results, laparocentesis of the abdominal wall comes into force. In order to pump out ascitic fluid from the abdominal cavity, laparocentesis is performed. To do this, a small puncture incision is made in the peritoneum. Laparocentesis is performed exclusively in outpatient settings. However, frequent such manipulations lead to the appearance of adhesions in the intestines; these reasons can make it difficult for subsequent interventions.
When, after a short amount of time, the secretion again accumulates in the abdominal cavity, the chances of curing the disease are reduced to a minimum.
ICD 10 code
The abbreviation ICD 10 stands for International Classification of Diseases, Tenth Revision. At the beginning of 2007, it was recognized as a generally accepted classification for coding diseases. From that moment on, every disease carries its own code.
ICD class 10 (XVIII - symptoms, causes and disorders that were determined during laboratory and clinical tests).
Symptoms and signs that directly relate to the digestive system and abdominal cavity (R 10-R 19).
The diagnostic code in the ICD 10 section is R 18.
Diet
Considering that this disease appears against the background of the main cause of the disease and the symptoms of its course may be, to some extent, different for everyone, the diet is also selected individually, based on the causes of occurrence, the degree of development and what its stage is. The most important thing is that the diet includes those substances that are lacking in a weakened human body.
If cirrhosis is present, then the diet should be selected very carefully. For example, protein deficiency, which is accompanied by alcoholic liver disorders, cannot be compensated for by including it directly in the general diet. This may lead to a coma. Therefore, the protein is administered in the form of injections.
A diet that excludes salt makes it possible to release fluid from the vascular bed and intercellular voids without restrictions. At the same time, nutrition should limit the presence of carbohydrates, and if the diet includes them, then only in the form of vegetables, cereals and fruits.
The diet should also not contain fat. It is advisable to cook dishes using vegetable oils.
However, diet alone will not be able to improve a person’s general condition if he consumes large amounts of fluid. The maximum volume of consumed water and liquid, which is included in many dishes and drinks, should not exceed 1 liter.
Treatment of ascites with folk remedies at home cannot be carried out. Only qualified help from specialists can protect a person from his development, because the last stage is fatal. Therefore, you should immediately consult a doctor in order to start treating the disease in time and check whether there is fluid in the peritoneal area.
All materials on our site are intended for those who care about their health. But we do not recommend self-medication - each person is unique, and without consulting a doctor you cannot use certain means and methods. Be healthy!
(ascites) or dropsy abdominal pain is a secondary disease, usually a manifestation or complication of some serious diseases. It is characterized by the appearance and subsequent accumulation of transudate or exudate (fluid) in the retroperitoneal space.
The inflammatory process in the abdominal cavity or pelvis is responsible for the appearance of exudative contents. This includes acute pancreatitis, peritonitis, and so on. A special form of ascites is peritoneal carcinomatosis, which occurs with ovarian cancer.
Some medical schools use the term “Ascites” to mean the accumulation of fluid of any origin, although the more precise concept of ascites is the formation of transudate, that is, free serous fluid of non-inflammatory natural origin.
A large amount of fluid can accumulate in the abdominal cavity, the volume of which can reach 10, 20, and sometimes even 25 liters. The mechanism of its appearance is determined by the nature of the disease that triggers this pathology.
Classification of ascites
According to the international classification of diseases ( ICD) ascites is divided into several types:1. Depending on the amount of fluid accumulated in the abdominal cavity:
Transitory;
Moderate;
Significant volume (massive, tense ascites).
2. Depending on the presence or absence of infection of the contents:
Sterile;
Infected;
Spontaneous peritonitis caused by bacterial infection.
3. Depending on the response to drug treatment:
Ascites that responds well to medication;
Refractory ascites that cannot be controlled by drug therapy, as well as its early relapse, which cannot be prevented with drugs.
Common and mixed forms of ascites, for example, exudative-hemorrhagic, or transudative-exudative.
Causes of the disease
Towards the appearance ascites in adults give a number of pathological conditions and diseases:1. Portal hypertension of various natures, for example, with thrombosis of the portal or hepatic vein, cirrhosis of the liver;
2. Liver diseases. For oncology or late stages of viral hepatitis;
3. Nutritional dystrophy;
4. Infection of the peritoneum due to tuberculosis;
5. Decompensated heart failure caused by heart defects due to rheumatism. Dropsy occurs in systemic autoimmune diseases;
6. Renal amyloidosis, glomerulonephritis and some other kidney diseases with nephrotic syndrome;
7. Terminal stage renal failure;
8. Peritoneal carcinomatosis or late stages of other malignant neoplasms of the uterus, ovaries and other abdominal organs;
9. Blood diseases, such as lymphogranulomatosis;
10. Crohn's disease;
11. Intestinal lymphangiectasia.
Reasons for appearance ascites in newborns and young children– hereditary, congenital or acquired pathology:
1. Hemolytic disease, appearing due to incompatibility of the Rh factor and blood group of the fetus and mother;
2. Congenital nephrotic syndrome;
3. Congenital edema caused by hidden blood loss in the fetus;
4. Lesions of the bile ducts and liver in infants;
5. Hereditary exudative enteropathy;
6. Kwashiorkor– severe dystrophy due to protein deficiency.
In veterinary practice, cases of abdominal dropsy in animals. For example, in cats, as well as in dogs, ascites can be caused by malignant tumors of the abdominal organs. Other causes are exhaustion, hydremia, poor liver function, heart or kidney failure. These pathologies lead to congestion in the portal vein, due to which peritoneal fluid is poorly absorbed.
Symptoms and clinical manifestations of ascites
Typically, fluid accumulation occurs gradually, but there are other options, for example, rapidly developing complete thrombosis of the portal vein, with rapid formation of transudate. Signs do not appear immediately, but only when the volume of liquid reaches one liter. You feel fullness, heaviness, flatulence, and abdominal pain begins. Percussion reveals a dull percussion sound in the lower abdomen, which shifts when the patient's position changes.With a large amount of fluid, the stomach reaches an impressive size. When the patient is standing, it sags like an apron; when lying down, it spreads out to the sides, flattening in the navel area, thereby resembling a “frog belly.”
As the fluid increases, the navel protrudes outward more and more, the abdominal wall becomes tenser, the skin becomes stretched and thinner, and visually looks smooth and shiny. The inability of the skin to quickly stretch leads to the appearance of striae - skin stretch marks that look like white or bluish-purple lines. The patient loses weight, the skin acquires a pale icteric tint. The skin of the abdomen has a pronounced vascular pattern; a venous network resembling the “head of a jellyfish” becomes clearly visible.
An inevitable increase in intracranial pressure is fraught with the appearance of hemorrhoids, umbilical or femoral hernias, and rectal prolapse.
This is the clinical picture characteristic of ascites in liver cirrhosis.
Symptoms of fluid accumulation caused by other diseases:
Manifestations of a disease caused by complicated portal hypertension vary somewhat. In this condition, the inferior vena cava is compressed by exudate, which impedes the outflow of blood from the legs, and swelling of the lower extremities appears. Ascites resulting from portal hypertension is also characterized by dilation of the veins and vessels located on the skin of the abdomen, as with cirrhotic ascites;
Ascites how complication of peritoneal carcinosis accompanied by multiple enlargement of lymph nodes, clearly palpable through the anterior abdominal wall. Peritoneal effusion is noted, in most cases, hemorrhagic in nature;
Accumulation of exudate during congestive heart failure is not limited to the abdominal cavity, fluid can also be found in the pleural cavity of the lungs ( hydrothorox). Ascites from heart failure caused by decompensated dysfunction of the right ventricle is accompanied by hepatomegaly, swelling of the feet and legs, acrocyanosis, pain in the right hypochondrium;
Ascites associated severe renal failure, manifested by diffuse edema of both the skin and subcutaneous tissue;
The appearance of exudate during portal vein thrombosis promotes an increase in the size of the spleen (splenomegaly), moderate enlargement of the liver (hepatomegaly). Patients complain of severe pain in the projection of the liver and throughout the abdomen. This ascites is characterized by massive bleeding from dilated hemorrhoids and enlarged veins of the esophagus. Laboratory studies of peripheral blood reveal the presence of thrombocytopenia, anemia, leukopenia;
The disease may arise as a consequence rheumatic diseases. With this option, the manifestations of ascites are accompanied by symptoms such as shortness of breath, cough, characteristic of the presence of fluid in the cavity of the pleura and pericardium.
Statistics:
In 75% of cases, ascites is caused by cirrhosis of the liver, malignant neoplasms account for 10%, decompensated heart failure as the cause of ascites - 3%, tuberculosis - 2%, pancreatitis and other factors - up to 1%.
Diagnosis of ascites
First of all, it is necessary to differentiate ascites from other conditions or diseases that cause abdominal enlargement – pregnancy, obesity, abdominal tumors, ovarian cysts and so on.To clarify the diagnosis and determine the causes, use the following diagnostic methods:
1. Palpation and percussion(tapping, followed by determining the nature of the echo) of the abdomen. The accumulated fluid, as a rule, dulls the sound, and the boundaries of these dull percussion sounds move along with the free flow of transudate when the patient’s position changes;
2. Instrumental methods research:
Ultrasonography(ultrasound) of the abdominal organs. During the examination, the condition of the organs, their size, the presence of tumor or other pathological processes, as well as the presence of free fluid in the peritoneum are determined;
Dopplerography. Allows you to identify disturbances in blood flow in the portal system;
CT scan(CT). Helps identify the same parameters as ultrasound, but in more detail;
Radiography. Helps determine the position of the diaphragm, the presence of fluid and its location;
Hepatoscintigraphy. It is carried out if there is a suspicion of liver disease causing ascites. Determines the structure of the parenchyma, the size of the organ, the absorption-excretory function of the liver;
Esophagogastroscopy. To identify varicose veins of the stomach and esophagus;
Diagnostic paracetosis. Necessary for taking for examination and determining the nature of ascitic exudate;
Laparoscopy. Prescribed in difficult to diagnose cases for visual examination of the abdominal organs. It is possible to puncture the organ and take a biopsy sample (a piece of tissue) for examination under a microscope.
3. Laboratory tests:
Blood and urine tests(are common);
Blood chemistry with the study of liver tests;
Blood for HBsAg;
Rivolta test. Necessary for determining the nature of the fluid, helps distinguish exudate from transudate;
Bacteriological analysis taken from the fluid cavity. Using culture in a nutrient medium, the pathogen that caused the inflammation is determined. As an example, Koch's wand;
Cytological analysis of fluid. To exclude ascites from pleural carcinomatosis or other tumor process.
Methods for treating ascites
At the first stage, a diet with limited salts and liquids is recommended. Nutrition must be balanced so that the body receives the right amount of calories and vitamins for full functioning during illness. Avoid spicy and fried foods that can cause thirst.The main method of treatment is drug therapy. Diuretics are prescribed– veroshpiron, furosemide, etc. Doses and duration of administration are calculated based on the patient’s condition, amount of fluid and response to medications.
The complex includes the use of hepatoprotectors and intravenous administration of protein solutions such as plasma or albumin.
What to do if the condition cannot be corrected with drugs?
Treatment of ascites resistant to drug therapy:
Laparocentosis– pumping out fluid through a puncture of the abdominal wall;
Installation peritoneovenous shunt. Used for direct outflow of fluid;
Deperitonization(partial) abdominal walls;
Portocaval shunt, lymphovenous anastomosis, or portosystemic intrahepatic shunt with the application of portocaval anastomoses aimed at reducing pressure in the portal system;
Liver transplantation.
Traditional methods of treating ascites
Traditional medicinal medicine can complement traditional treatment. There are many plants that have a diuretic effect. Preparing decoctions, infusions or teas from individual herbs or combined herbs helps improve well-being and promotes the gentle removal of fluid, thereby relieving swelling.Diuretic herbs: burdock, lingonberry, blue cornflower, bearberry, dill, horsetail and others.
Complications of ascites
The disease itself is a stage of decompensation of other diseases. Complications of ascites include prolapse of hemorrhoids or rectum, formation of umbilical or inguinal hernias. This is facilitated by the inevitable increase in intra-abdominal pressure.Pressure of the diaphragm on the lungs leads to respiratory failure, and the addition of infection leads to peritonitis. Other complications include portal and splenic vein thrombosis, hepatic encephalopathy, massive bleeding, and hepatorenal syndrome.
Prevention of ascites
Preventive measures consist of timely recognition and, most importantly, treatment of diseases that lead to ascites. Eliminating risk factors such as long-term alcohol consumption and so on.Forecast
Most patients are interested in: “How long do people live with ascites?” Life expectancy does not depend on ascites, but on the course of the underlying disease that caused it. But fluid accumulation significantly worsens the prognosis. With cirrhosis complicated by ascites, patients live no more than three months, with cancer - up to six months.Unfavorable factors include diabetes mellitus, renal failure, hypotension and advanced age of the patient.
Two-year survival was observed in only 50% of patients.
