Ascites

Ascites

    * Introduction
    * Causes and Risk Factors
    * Signs and symptoms
    * Diagnosis
    * Treatment
Ascites is defined by the presence of excessive amounts of fluid in the peritoneal cavity. This accumulation of fluid becomes symptomatic when the amount exceeds 500 ml.
The causes of ascites are predominantly liver cirrhosis of different etiologies, global heart failure, nephrotic syndrome, malignant or benign tumors.
Ascites may occur suddenly or insidiously, after a period of bloating and flatulence. When it installs an acute precipitating factor can be identified: upper gastrointestinal bleeding, alcohol, infections and portal vein thrombosis.
Symptoms vary depending on the amount of ascites and rapid installation. The most common allegations related to ascites are abdominal pain, fullness and dyspnea.
Clinical examination reveals ascites fluid prerzenta only when the amount is more than 1L. When ascitic syndrome is a subclinical, 1kg weight gain over 3-4 days to draw attention. Any ascites should be evaluated by diagnostic paracentesis which will allow full investigation of the liquid.
Treatment of ascites should be closely monitored, an excessive loss of fluids being able precipitate hepatic encephalopathy or renal failure. Ascites total removal is not absolutely necessary. As a prophylactic method for the occurrence of ascites of patient self-monitoring is recommended. Any increase in weight more than 1kg in 3-4 days should be considered and indicates retention specialist consultation. Treatment should be applied in stages, starting from the simple general measures, walking upward to the most aggressive. This includes: bed rest, dietary salt restriction, diuretics, paracentesis. Treatment methods include special refractory ascites: ascites ultrafiltration and re-infused, peritoneo-venous shunt are transjugular porto-caval, hepatic transplantation.
The most common complication is spontaneous bacterial peritonitis. Prognosis depends on underlying disease, its degree of reversibility and response to treatment.
Pathogenesis
The formation mechanism of ascites occur following factors: hypoalbuminemia, portal hypertension, hidrosodata retention, and increase lymphatic circulation disorder permeabiliattii subperitoneale capillaries.
Hypoalbuminemia Decreased plasma albumin hepatocellular failure secondary change which decreases the pressure gradient and hydrostatic coloidosmotice. The result is an abundance of fluid from the passage of the arterial capillaries to interstitium and a reduction of interstitial fluid reasorbtiei venous segment of capillaries.
Portal hypertension This occurs in ascites production through two mechanisms: -Increasing pressure in the capillaries splanhice, passing a consequence of which large quantities of liquid to reduce arterial segment reabsorption in the venous capillary segment -Formation of porto-renal anastomoses with the achievement of hypertension secondary to renal vein territory that will result in an increase in tubular reabsorption of sodium and water.
Retention hidrosodata It is in relation to hepatocellular failure. Is one of the main factors in the formation of ascites. In decompensated cirrhosis there is a constant vascular volume expansion global growth, which is unevenly distributed: on the one hand there is an excessive amount of fluid in the abdomen and lower membtelor and effective on the other hand the increased volume of certain sectors (kidney and brain) is diminished.
Effective blood volume decreased trains: The kidney, a decrease in renal blood flow by stimulating the juxta-glomerular apparatus lead to increased secretion of renin and aldosterone secondary, which promotes tubular sodium reabsorption in exchange for hydrogen ions and potassium By excitation of the brain-volume-receptor, an antidiuretic hormone hypersecretion that there was only partly metabolized by the liver is sick Fluid retention is a result, self-healing process, because the accumulation of water and sodium will be at the expense of the extravascular space, primarily the abdominal cavity, while the effective volume of the kidney and brain still remains diminished.
Lymphatic circulation disorder In some lymph cirrhosis exudeaza peritoneal cavity. Increased capillary permeability subperitoneale This change causes the water and protein in the peritoneal cavity, for example, tuberculous peritonitis, liver cirrhosis, peritoneal metastases.