The dropsy (ascites) is an accumulation in the abdominal cavity of a free fluid, the volume of which, depending on the severity of the underlying disease, can range from 3 to 30 liters. Most often, ascites is manifested with cirrhosis of the liver - the prognosis of treatment is very unfavorable. In half of the cases there is mortality from cirrhosis within two years after the appearance of dropsy.
Causes of dropsy
Ascites in cirrhosis develop due to the inability of the affected liver to "filter" the proper amount of blood. Therefore, its liquid fraction seeps through the vessels, filling the abdominal cavity.
The development of ascites is influenced by factors such as:
- high pressure in the portal vein - enhances the yield of free fluid;
- Insufficiency of protein-synthesizing function - due to deficiency of albumins, blood loses its ability to retain liquid fraction;
- Insufficiency of the lymphatic system - due to the inability of the diseased liver to cope with the current of lymph, it swims from the surface of the gland, getting into the abdominal cavity.
Symptoms of ascites in liver cirrhosis
As a complication of cirrhosis, dropsy in 50% of patients occurs within ten years after diagnosis. Ascites are characterized by an increase in body weight and abdominal volume. The patient complains of heaviness in the stomach, heartburn, swelling of the extremities. With a moderate dropsy (volume of fluid over 3 liters), the abdomen hangs in a standing position. When the patient lies down, the stomach spreads out to the sides. When a side impact is formed, the response wave is opposite. With intense ascites (volume of liquid 20-30 liters), the abdomen becomes smooth, the skin on it is shiny and stretched, the enlarged veins, especially around the navel, are clearly visible.
Treatment of ascites with cirrhosis of the liver
When dropsy therapy is aimed at treating the liver itself, and to reduce the discomfort caused to the patient with ascites, resort to the following measures:
- diet;
- reception of diuretics;
- puncture.
Diet
Diet in ascites and in general with liver cirrhosis implies a decrease in the amount of salt in the diet to 5.2 g. This means that food is undesirable to add salt, in addition, it is worth to give up too fatty foods. Patients are undesirable to take more than 1 liter of fluid per day, although, according to some experts, this restriction does not affect the course of dropsy. In the diet should be:
- fish, lean meat;
- cottage cheese;
- vegetables fruits;
- greenery;
- cereals.
In this case, it is desirable to cook food for a couple. Alcohol, pickled dishes, coffee, strong tea and spices with ascites are contraindicated!
Diuretics
If the diet does not give an effect, treatment of ascites with cirrhosis of the liver is to take diuretics:
- Spironolactone;
- Furosemide;
- Ectric acid;
- Amyloride and others.
Patients are shown bed rest, since in the vertical position of the body there is a decrease in the response to diuretics, which is even more pronounced with moderate physical exertion.
Reduction of the volume of free fluid should occur gradually: 1 kg per day in the presence of edema and 0.5 kg, if there is no swelling.
Puncture
If the last stage of cirrhosis takes place, ascites can be reduced by puncturing the abdominal cavity. Puncture is performed by observing aseptic rules and using a thick needle. The puncture is done below the navel, and at one time, as a rule, it is possible to evacuate the entire volume of fluid. To prevent dropsy from progressing, diuretics are prescribed and again a diet with a reduced salt content in food.
Along with the removed liquid, a large amount of protein leaves the body, so patients are prescribed albumin infusions: the preparation contains about 60% of plasma proteins.