Dropsy Of The Abdomen (abdominal Dropsy) - Causes, Symptoms And Treatment

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Symptoms and treatment of dropsy of the abdomen

Dropsy of the abdomen (ascites) is a significant accumulation of transudate in the peritoneal cavity. This pathology can be caused by portal hypertension, in which portal vein blood flow is blocked above, inside or below the liver. Ascites can also be caused by edema syndrome in chronic heart failure, kidney disease, alimentary dystrophy, impaired lymph flow back through the thoracic duct as a result of injury or compression. Dropsy of the abdomen often develops with the growth of tumors and the development of the tuberculous process. The factors listed above are quite common in various combinations.

Normally, a small amount of serous fluid is always present in the abdominal cavity, which makes it possible for the organs located there to displace, protects against shock and injury. If the water exchange between the tissues of the peritoneum and the blood vessels is disturbed or stopped, ascites, or dropsy of the abdomen, occurs.

Content:

• Causes of the disease
• Symptoms of abdominal dropsy
• Diagnostics
• Treatment of dropsy of the abdomen
• Complications

Causes of the disease

Dropsy of the abdomen is not an independent diagnosis, but a symptom of severe diseases of internal organs or systemic disorders in the work of the human body. The addition of dropsy doubles the likelihood of death, worsens the condition of the patient, already suffering from serious pathology.

Causes of dropsy of the abdomen:

• Portal hypertension. In this disease, the outflow of blood through the portal vein is blocked due to cirrhosis of the liver, thrombosis of the hepatic veins or portal vein, and compression of the vein by tumors. Due to the high hydrostatic pressure, blood plasma from the veins of the gastrointestinal tract penetrates into the abdominal cavity and accumulates there.
• Kidney disease. The cause of ascites in these pathologies is nephrotic syndrome.
• Decompensated heart failure. Ascites is caused by congestion and edema in the systemic circulation resulting from a heart attack, myocarditis, heart valve pathology.
• Alimentary dystrophy.
• Benign ovarian tumor.
• Carcinomatosis of the peritoneum. The spread of malignant tumor cells in the tissues of the peritoneum.
• Ascites-peritonitis. Development of the tuberculous process in the peritoneum.

In one patient, several causes of dropsy of the abdomen can be combined.

Causes of ascites in young children:

• Congenital edema caused by incompatibility of the Rh factor of the mother and the child (hemolytic disease of the newborn).
• Diseases of the liver and gallbladder of newborns.
• Latent fetal blood loss.
• Dystrophy against a background of protein deficiency in the child's food.
• Congenital kidney disease.
• Exudative enteropathy is the loss of blood plasma proteins through the gastrointestinal tract.

Symptoms of abdominal dropsy

Ascites can be acute - as, for example, with the formation of a blood clot in the lumen of the portal vein; the symptoms of dropsy of the abdomen can also develop gradually over several months. The course of the disease is accompanied by flatulence, which in some cases is the dominant symptom.

The watery fluid is most often serous, rarely streaks and blood clots are present in it, and chyle transudate is practically not found. In some cases, up to 30 liters or more of fluid is retained in the abdominal cavity. The diagnosis of ascites is made when at least one liter of transudate accumulates in the peritoneal cavity.

In a patient suffering from severe ascites, the abdominal circumference increases: it takes the form of a ball with a half protruding forward or hanging downward. The peritoneal wall is tense and taut, the skin is thinned, the folds are smoothed. When a significant volume of fluid accumulates, the navel can protrude, resembling a balloon in shape, the skin is greatly stretched, and white stripes are noticeable on the abdominal wall. When percussion of the abdomen, a dull sound is heard over its sloping part or on the sides. Methods for early diagnosis of ascites include determining the presence of fluid in the Douglas space during rectal or vaginal examination.

As a result of increased pressure inside the abdominal cavity, an umbilical or femoral hernia may develop. In some cases, as a result of rupture of the navel, the disease is complicated by peritonitis, and rectal prolapse may also occur. Patients have swelling of the lower extremities; Free fluid can also accumulate in the pleural cavities, causing respiratory failure and cardiac overload.

An important diagnostic value is the study of the aqueous humor taken during the puncture of the abdominal cavity. Most often, the liquid is transparent, it has a neutral or slightly alkaline reaction. Transudate contains a large number of endothelial cells, and in case of tumor diseases - cancer cells. The specific gravity of the liquid does not exceed 1.015, the protein content is not more than 2.5%. With repeated punctures, leukocytes are found.

Other symptoms of ascites:

• The skin of the abdomen is taut, thinned;
• The abdominal wall is in tension;
• The navel is protruding outward;
• Striae appear on the abdomen - white stripes of stretched skin.

With dropsy caused by portal hypertension, edema appears on the legs. Around the navel and on the side of the abdomen, there is a characteristic symptom of "jellyfish head" - a pattern of dilated veins.

Diagnostics

When examining a patient, the doctor uses a diagnostic technique such as percussion. He taps on individual areas of the abdomen and analyzes the sound that occurs. With ascites, the sound is dulled on the side of the abdomen or in its sloping part. The effect moves when the position of the body changes because the fluid flows freely in different directions. Another symptom of ascites, detected during percussion, is fluctuation, when the palm of one hand, applied to the side of the abdomen, feels the transmission waves caused by light blows of the other hand.

The most informative instrumental study in diagnosing ascites is ultrasound and CT of the abdominal cavity.

Planned research result:

• Revealing even the smallest excess of liquid volume;
• Assessment of the severity of the pathology;
• Determination of the cause of ascites.

Laboratory tests for ascites:

• Complete blood count - with cirrhosis, there is anemia, increased ESR;
• General urine analysis - with cirrhosis of the liver, protein, cylinders and erythrocytes are found in the urine, and with ascites accompanying kidney pathology, urine has an increased density, blood appears in it (hematuria);
• Biochemical blood test - states a decrease in the protein content in the blood plasma and an increase in the concentration of bilirubin;
• General analysis of the fluid obtained during the puncture - states the transparency or impurity of blood, chylous character, transudate density, protein content;
• Rivolt's test - differentiation of transudate from exudate, during which the liquid from the peritoneum is mixed with acetic acid, if the liquid falling into the acid does not cause turbidity, it is a transudate;
• Cytology - differentiation of the tumor process from other pathologies;
• Bacteriological inoculation of transudate obtained from the abdominal cavity is carried out to identify the tuberculous process.

Treatment of dropsy of the abdomen

The doctor determines the method of treating ascites, based on the cause that caused it. Treatment can be both surgical and therapeutic. For conservative therapy, diuretics, aldosterone antagonists, salt-free and protein-free diet are used with fluid restriction in the diet to 1.5 liters per day.

If ascites is caused by heart failure, drugs of the following pharmacological groups are used:

• Cardiac glycosides, stimulants of alpha-adrenergic receptors to reduce myocardial contractility;
• Diuretics, thiazides, potassium-sparing diuretics to remove excess fluid;
• Vasodilators to relieve stress on the heart.

With ascites caused by renal failure, the patient is prescribed:

• Bed rest,
• Elimination of salt from the diet,
• Control of fluid entering the body,
• Droppers with albumin courses,
• Taking diuretics.

Children with congenital edema and exudative enteropathy are transfused with blood plasma, administered Veroshpiron, glucocorticosteroids.

With severe edema, the peritoneal cavity is drained to remove fluid from it. For anesthesia, local anesthesia is used, the procedure is performed in a sitting position.

The sequence of the puncture:

• In the area between the navel and the pubis, Novocaine solution (0.5%) is injected into the tissues.
• The doctor cuts the skin of the abdomen with a scalpel, inserts a sharp trocar into the abdominal cavity.
• After removing the trocar, a drain is introduced into the peritoneal cavity.
• A slow evacuation of fluid from the peritoneum begins, the procedure is controlled to avoid collapse due to a rapid drop in pressure. It can last from 8 to 20 hours.
• For complete drainage, the nurse tightens a towel around the abdomen above and below the insertion site with a towel.
• At the end of the procedure, drainage is removed, and the wound is treated.

There are alternative surgical treatments for ascites. This is the Kalba operation, which consists in excision of the peritoneum and muscles of the lower back to stimulate the absorption of the transudate by the subcutaneous tissue. The efficiency of the operation is only 30%, the result lasts up to six months.

Complications

With the accumulation of a large volume of excess fluid in the peritoneum, the diaphragm rises, compresses the lungs and large blood vessels. Because of this, respiratory failure and overload of the heart muscle occurs.

If an infectious factor joins ascites, peritonitis develops, the treatment of which does not tolerate delay and is carried out only by surgery.

For the prevention of dropsy of the abdomen, it is necessary to timely treat the underlying disease.

Author of the article: Alekseeva Maria Yurievna | Therapist

Education: From 2010 to 2016 Practitioner of the therapeutic hospital of the central medical-sanitary unit No. 21, city of elektrostal. Since 2016 she has been working in the diagnostic center No. 3.