Ascites in liver cirrhosis
Content:
- What is ascites in liver cirrhosis?
- Causes of ascites in liver cirrhosis
- Disease symptoms
- How to treat ascites in liver cirrhosis
- Diet for cirrhosis of the liver with ascites
What is ascites in liver cirrhosis?
Ascites in liver cirrhosis is the accumulation of fluid in the abdominal cavity and an increase in its volume, which occurs due to stagnation of blood and an increase in pressure in the venous system. Ascites is not an independent disease, but a complication of cirrhosis, which greatly aggravates the course of the disease and worsens the prognosis for recovery.
Due to the fact that the main disease causing ascites is widespread and occupies a leading position among the causes of mortality from gastrointestinal diseases, ascites itself in liver cirrhosis is not uncommon. Statistics indicate that ascites will occur in 50% of patients within 10 years after they were diagnosed with liver cirrhosis.
How long do people live with ascites in liver cirrhosis?
It should be understood that ascites itself becomes the cause of death of a person extremely rarely. To give a prognosis for survival, it is necessary to have information about the course of the underlying disease.
However, the following data exist:
- Patients with a compensated form of cirrhosis and ascites can live for more than 10 years, since the functions of the organ remain intact;
- Less than 20% of patients will live longer than five years with ascites in decompensated cirrhosis without an organ transplant condition;
- More than half of patients die within a year if they have a treatment-resistant (refractory) form of ascites that tends to relapse.
In addition, the patient's lifestyle has an impact, whether he is receiving adequate treatment, whether a puncture of the abdominal wall was made in a timely manner, whether he takes diuretics according to a well-designed scheme, etc. In some cases, this helps the patient to live for 10 or more years. However, most often ascites is considered an unfavorable complication of cirrhosis and is the cause of death in 50% of patients within two years.
Causes of ascites in liver cirrhosis
By itself, cirrhosis of the liver is the main cause of the development of ascites.
This is due to the following factors:
- With the disease, the death of hepatocytes (liver cells) occurs, which triggers the mechanism of excessive restoration of organ tissues, as a result of which regeneration nodes are formed, consisting of overgrown hepatocytes. The structure of these nodes differs from the structure of normal liver tissue, which leads to impaired blood circulation and clamping of the portal vein. This causes fluid to accumulate in the abdominal cavity;
- Another reason for the development of complications is the replacement of hepatocytes with fibrous tissue. The more extensive the process, the lower the functional capacity of the liver. This provokes the development of its deficiency and a decrease in the amount of blood proteins. As a result - a drop in the oncotic pressure of plasma and its exit into the abdominal cavity from the vessels;
- Due to the loss of plasma, the total circulating blood volume decreases. The body reacts to this violation by launching a number of processes, including an increased release of the hormone aldosterone. It is he who contributes to fluid and sodium retention. As a result, an increase in hydrostatic pressure and aggravation of ascites;
- With all this, the heart experiences additional stress, which becomes the cause of the development of heart failure. There is a further increase in the volume of ascitic fluid.
Symptoms of ascites in liver cirrhosis
If small volumes of fluid accumulate in the abdominal cavity, then this does not cause concern for the patient.
However, as the disease progresses, the person begins to suffer from:
- Enlargement of the abdomen in volume. Within a few days, it can grow significantly. The skin on it becomes smooth, sometimes pink stripes appear, and enlarged veins are observed. When the patient is standing, the abdomen hangs down a little, and when lying down, the side walls protrude, forming a "frog belly";
- The patient complains of discomfort and pain in the peritoneal region, gaining weight;
- Symptom of fluctuation or fluctuation of the abdominal cavity due to its filling with fluid;
- Respiratory system disorders as a result of fluid pressure on the diaphragm and a decrease in lung volume. This is manifested in the occurrence of shortness of breath, rapid breathing, dissatisfaction with oxygen. This symptom is especially acute in a horizontal position. Therefore, a person tries to take a sitting or standing position with an emphasis on elevation. Among other signs of breathing disorders, you can note blue lips, cough.;
- Digestive disorders. Pressure on the stomach leads to faster satiety during meals, with smaller amounts of food, to a feeling of heaviness, heartburn, and belching. Sometimes there is vomiting of undigested food, which occurs when the place where food passes into the intestine is clamped. On the part of the intestines, intestinal obstruction, constipation, diarrhea, vomiting of intestinal contents or bile may occur;
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Disorders from the bladder, which is expressed in the frequent urge to urinate, cystitis and pyelonephritis;
- Swelling in the lower extremities, which is due to the obstructed outflow of lymph;
- The navel protrudes forward, often the patient has an umbilical hernia.
The first symptoms can be seen when the amount of fluid has exceeded 1 liter. The maximum content of it in the abdominal cavity with ascites can reach 25 liters. In addition, before the first symptoms of ascites appear, the patient will be disturbed by the signs of the underlying disease, that is, cirrhosis of the liver. Among them, increased weakness and fatigue, pain localized in the right hypochondrium.
How to treat ascites in liver cirrhosis
After confirming the diagnosis, doctors begin to treat ascites. But since it is a consequence of liver disease, the therapy is primarily aimed at eliminating cirrhosis.
Drug treatment is reduced to taking the following groups of drugs:
- Synthetic hepatoprotectors, for example, ursodeoxycholic acid, which protects the organ from the destructive effects of bile acids, lowers cholesterol levels, improves blood flow and prevents the death of hepatocytes;
- Plant hepatoprotectors, for example, Karsil and Allochol, which have a choleretic effect, increase intestinal motility;
- Essential phospholipids, for example, Essentiale and Phosphogliv, which restore damaged phospholipids, normalize fat and carbohydrate metabolism, relieve intoxication, stimulate the growth of hepatocytes;
- Hepatoprotective amino acids such as Ornithine and Methionine. They have a protective effect, stimulate metabolic processes in the body;
- Antiviral agents, including Pegasis (increases the body's immune forces, fights hepatitis C and B), Ribavirin (helps in the fight against the hepatitis C virus), Adefovir (destroys hepatitis B cells);
- Steroid anti-inflammatory drugs such as Prednisolone. It is recommended for use in cirrhosis caused by autoimmune processes;
- Albumin, which belongs to the group of protein drugs, which helps to normalize colloidal pressure, replenishes the deficiency of proteins in the blood;
- Diuretics of various groups, for example, Aldactone, Spiriks, Lasix, Diakarb and others. They are, first of all, the prevention of ascites.
In addition, the patient must adhere to a diet. Doctors recommend table number five. The volume of fluid you drink should be reduced to 1.5 liters per day.
The patient must adhere to bed rest, since in a horizontal position blood filtration improves due to the increased work of the kidneys.
If conservative therapy has not had the desired effect, the patient is prescribed an operation. It is called “laparocentesis”, when excess accumulated fluid is removed from the peritoneal cavity using a special needle. As a rule, doctors do not remove more than 5 liters at a time, as there is a risk of developing a collaptoid condition. Such manipulations can significantly reduce pain and improve the patient's well-being, however, there is a high risk of complications.
In the most severe cases, transplantation of the damaged organ is required.
On the subject: Treatment of liver cirrhosis with folk remedies
Diet for cirrhosis of the liver with ascites
The diet is reduced to limiting not only water, but also table salt. It is forbidden to eat pastries, fried and smoked dishes, sweets, canned food, mushrooms, fatty meats, margarine, mayonnaise, coffee and, of course, alcohol.
At the same time, the patient is allowed to oat, buckwheat and rice porridge, fresh vegetables, kefir and cottage cheese, lean meat, rosehip broth, rye bread, egg white and some other products.
Sample menu
A sample menu of a patient with ascites may look like this:
- For breakfast, you can eat a protein omelet, a slice of rye bread and drink a rosehip decoction;
- As the first snack, cookies made from non-rich dough and weak tea with milk are allowed;
- For lunch, you can prepare a salad of cucumbers, cabbage and green peas with the addition of olive oil, soup with pasta and turkey, hake zrazy, cherry jelly;
- As a second snack, it is allowed to eat a crouton with honey and drink tea with lemon;
- For dinner, you can cook rice soup and turkey cutlets with mashed potatoes, a drink - dried fruit compote;
- You can end the day with a small glass of kefir.
In this case, it is important to calculate the volume of liquid in such a way that it does not exceed 1.5 liters during the day, including soups and other liquid dishes. The diet may differ slightly, depending on the severity of the underlying disease and the degree of ascites. In more detail, what can you eat and what not in liver cirrhosis?
The author of the article: Kuzmina Vera Valerievna | Endocrinologist, nutritionist
Education: Diploma of the Russian State Medical University named after NI Pirogov with a degree in General Medicine (2004). Residency at Moscow State University of Medicine and Dentistry, diploma in Endocrinology (2006).
