When the excess fluid gets accumulated in the peritoneal cavity, the condition is called ascites.
The peritoneal cavity is the space between the tissues lining the abdomen and organs of the abdominal cavity.
Various diseases result in the accumulation of fluid.
There is no fluid present normally in the peritoneal cavity. Depending on the menstrual cycle the small amount of fluid is found in the peritoneal cavity.Various diseases are responsible for fluid accumulation.If cancer spreads to the peritoneum it causes direct leakage of fluid. Some diseases can cause retention of water and sodium in the body.The most common disease that leads to fluid accumulation on peritoneum is liver disease.
Ascites is of 2 types. This classification is based on the amount of protein found in the fluid.
Normally intra-peritoneal fluid is not present in men but in women, a little amount is present depending on the menstrual cycle.
The exact mechanism of ascites development is not completely known. Several theories suggest that increase in portal blood pressure and the decrease in albumin may be responsible for the formation of abdominal ascites.
Causes for the formation of ascites are:
• Cirrhosis of the liver.
• Kidney diseases.
• Congestive heart failure.
• Venous Insufficiency.
• Chronic alcohol abuse.
Mild ascites may not be associated with any symptoms. However, following symptoms appear as the disease progresses:
• Abdominal pain.
• Shortness of breath.
• Alcoholic Hepatitis.
• Viral hepatitis.
• Portal Hypertension.
• Primary Biliary Cirrhosis.
• Biliary Disease.
• Hepatocellular Adenoma.
• Hepatorenal Syndrome.
• Nephrotic Syndrome.
Following tests may be done to determine the underlying cause:
• Complete blood count
• Urine test
• Creatinine and electrolyte levels
• Kidney function tests
• Liver function tests
• Prothrombin time
• Paracentesis may also be performed.
The treatment of ascites mainly depends on the underlying cause. Following are the treatment options:
• Diuretic medicines
• Therapeutic paracentesis (to remove large amount of fluid)
• Surgery: Trans-jugular intrahepatic portosystemic shunt which helps to reroute the blood around the liver.
• Liver transplant: It is done in cases of end-stage of liver disease.
• Intake of salt is lowered.
Malignant ascites has a poor prognosis.
• Pleural effusion.
• Bacterial Peritonitis.
• Kidney failure.
• Puffiness of various parts.
• Red rosy hue with stinging pains.
• Intolerance to heat and touch.
• Debility and restlessness.
• Nocturnal aggravation.
• Unquenchable thirst.
• Burning pain relieved by warmth.
• Prolonged intake of excessive salt causes nutritive changes resulting in retention of fluid.
• Consolation aggravates the symptoms.
• The hepatic disease causes dropsy.
• Shooting pains across the lower abdomen.
• Pains shifts from right to left side.
• A patient is pale, lean with lax, flabby muscles.
• Sensation as if the abdomen is sinking in.
• Great debility with frequent fainting.
• Dropsy with great thirst and gastric irritability.
• The diminished frequency of the pulse.
• Excessive vomiting.
• Dull, heavy, sick feeling.
• Indicated in various forms of dropsy.
• Yellow complexion.
• Extreme weariness.
• Swollen abdomen.
• Painful to touch.
• Sinking sensation.
Management of ascites includes bed rest, low intake of salt, diuretics, and treatment of the cause of ascites.
• Low intake of salt.
• Fluid restriction to one liter per day.
• Avoid alcohol.
• High protein diet.
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