Ascites

disease

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synonym ascites (Ascites) generally refers to ascites (disease)

Normal state There is a small amount of liquid (generally less than 200ml) in the abdominal cavity of the human body, which plays a role in lubrication of intestinal peristalsis. whatever Pathological state Lower abdominal cavity leads to an increase in the amount of fluid in the abdominal cavity, which is called ascites when it exceeds 200ml. Hydroperitoneum is only one Symptoms There are many causes of ascites, and the common ones are Cardiovascular disease 、 Hepatopathy 、 the peritoneum Disease kidney trouble 、 Nutritional disorders Disease Malignant tumor Abdominal metastasis ovarian tumor 、 connective tissue Disease, etc.

TCM disease name

Ascites

Visiting department

General surgery

Common diseases

abdominal cavity

Common causes

Cardiovascular disease, liver disease, peritoneal disease, kidney disease, malnutrition, abdominal metastasis of malignant tumor, ovarian tumor, connective tissue disease, etc

common symptom

Cyanosis and peripheral edema in patients with heart disease; The liver patient's face is dark, and the skin and sclera are yellow; The patient with kidney disease has pale face and peripheral edema; Cachexia of malignant tumor

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essential information

TCM disease name: Ascites
Visiting department: General surgery
Common location: abdominal cavity
Common causes: Cardiovascular disease, liver disease, peritoneal disease, kidney disease, malnutrition, abdominal metastasis of malignant tumor, ovarian tumor, connective tissue disease, etc

common symptom: Cyanosis and peripheral edema in patients with heart disease; The liver patient's face is dark, and the skin and sclera are yellow; The patient with kidney disease has pale face and peripheral edema; Cachexia of malignant tumor

pathogeny

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Hydroperitoneum is the manifestation of many diseases. According to its characteristics, it is usually divided into three categories: exudative, exudative and bloody.

1. Leakage ascites

Common causes: hepatogenic, cardiogenic, venous obstructive, nephrogenic Nutritional deficiency Sex, chyle, etc;

2. Exudative ascites

Common causes: spontaneous bacteria peritonitis ， Secondary peritonitis (including cancerous ascites), tuberculous peritonitis, pancreatic origin bile Sexual and chylous fungal peritonitis;

3. Bloody ascites

Common causes: acute Portal vein thrombosis Rupture of hepatocellular carcinoma nodule Hepatic trauma Sexual rupture Hepatic aneurysm Rupture ectopic pregnancy Etc.

clinical manifestation

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Except for ascites Have original Symptoms and signs of the disease.

1. Peritoneal effusion caused by heart disease can be seen during physical examination Cyanosis , peripheral edema Jugular vein distension 、 Cardiomegaly 、 Precordial tremor 、 Hepatosplenomegaly 、 Arrhythmia 、 Heart valve Murmur and other signs.

two Liver disease There are often dark faces or Chlorosis Matte, skin Sclera yellowing , face, neck or chest can have Spider nevus Contingent Liver palms , Abdominal wall varicosity , large liver and spleen, etc.

three kidney disease The ascites caused may be Pale , peripheral edema and other signs. Flush 、 fever 、 Abdominal tenderness ， Abdominal wall Flexibility can be considered Tuberculous peritonitis 。

4. The patient is emaciated Cachexia 、 Lymph node enlargement Or abdominal mass, mostly Malignant tumor 。 It is often accompanied by fever, nausea and vomiting, abdominal distention And abdominal pain. Hemorrhagic ascites usually shows acute blood loss. The patient will have pale face, wet and cold skin, Shortness of breath , restlessness, pulse count, blood pressure drop, and even shock.

inspect

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one laboratory examination

liver function Damaged Hypoalbuminemia Can prompt cirrhosis , large proteinuria , Blood Urea nitrogen and creatinine Raise prompt Impaired renal function ， immunology Examination is also important for the diagnosis of liver and kidney diseases. adopt Abdominal puncture Fluid examination can determine the nature of ascites and identify the cause of ascites.

2. Physical examination

Except with Mobile dullness There are often signs of primary disease.

3. Ultrasonic and CT examination

It can not only show a small amount of ascites, but also the size of the liver, the smoothness of the liver capsule Space occupying lesion 。 The size and structure of the heart, the conditions of the cardiac inflow and outflow channels, and the blood flow. The size, shape and structure of the kidney.

differential diagnosis

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The diagnosis of ascites is generally easy, except Imaging Besides inspection, main basis Abdominal percussion Method: When the ascites reaches 500ml, it can be used Elbow knee position Percussion confirmed; More than 1000ml of peritoneal effusion can cause Mobile dullness When there is a large amount of ascites, the flanks of both sides bulge like Frog belly , inspection can have Fluid tremor ； A small amount of ascites can be achieved by ultrasound and Abdominal puncture Detected, ultrasound shows that there are Dark area 。 CT Its sensitivity is not as good as that of ultrasound.

1. Leakage ascites

(1) Hepatogenic: common in severe cases Viral hepatitis 、 Toxic hepatitis Various types cirrhosis 、 Primary liver cancer Etc.

（2） innutrition Sex: It is rare. Chronic malnutrition Plasma albumin It often decreases, which can cause edema and leakage ascites.

(3) Nephrogenic: seen in acute chronic nephritis ， renal failure ， Systemic lupus erythematosus etc. Connective tissue disease 。

(4) Cardiogenic: seen in chronic right Cardiac insufficiency or Constrictive pericarditis Etc.

(5) Gastrointestinal origin: mainly seen in various Gastrointestinal Diseases Resulting protein Diseases lost from gastrointestinal tract, such as Intestinal tuberculosis , Gastrointestinal Crohn's disease , Malignant lymphoma , Small intestine lymph gland Dilatation, congenital intestinal lymphangiogenesis, children and adults Chylous diarrhea Etc.

(6) Venous obstruction: common in Hepatic vein occlusion syndrome （Budd-ChiariSyndrome）、 Inferior vena cava Blocking or compression Portal phlebitis 、 Portal vein obstruction 、 Thrombosis Or under pressure.

(7) Mucoedema: seen in Hypothyroidism Symptoms Hypophysis Caused by Myxedema 。

2. Exudative ascites

（1） the peritoneum Inflammation: common in Tuberculous peritonitis , spontaneous bacterial peritonitis , caused by perforation of abdominal organs Acute infection Sexual peritonitis, cancerous peritonitis (including abdominal cavity or pelvic cavity Malignant tumor Peritoneal metastasis), fungal peritonitis Eosinophils Invasive peritonitis, etc.

(2) Pancreatic origin: it is mostly seen in acute necrotizing pancreatitis pancreatic pseudocyst 、 chronic pancreatitis 、 pancreatic cancer 、 Pancreatic duct Dysplasia, etc.

（3） bile Sex: mostly seen in Gallbladder perforation 、 bile duct Rupture, gallbladder, bile duct surgery or bile duct puncture injury.

(4) Chylous: the cause of chylous ascites is complex, which can be seen in the abdominal cavity or peritoneum infection（ Tuberculosis 、 filariasis ）Malignant tumor (such as lymphoma 、 gastric cancer 、 liver cancer ）Congenital intraperitoneal or intestinal lymphatics dysplasia 、 Lymphangiectasia Or local compression, abdominal trauma or intra-abdominal Iatrogenic injury And a few cirrhosis Portal vein thrombosis and Nephrotic syndrome Etc.

3. Bloody ascites

（1） Liver disease : Severe hepatitis , explosive hepatic failure 、 Postnecrotic cirrhosis , advanced liver cancer Pregnancy spontaneity Hepatic rupture 、 Hepatic aneurysm Broken, huge Hepatic hemangioma Rupture and Hepatic trauma Sexual rupture, etc.

（2） Peritoneal diseases : tuberculous peritonitis, peritoneal metastasis of malignant tumor in abdominal cavity or pelvic cavity Primary Peritoneal mesothelioma , peritoneum or the omentum Blood supply Obstacles, etc.

(3) Other intra-abdominal lesions: such as Abdominal aortic aneurysm Rupture Acute hemorrhagic necrotizing pancreatitis , traumatic or Traumatic rupture of spleen Others in the abdominal cavity visceral organ injury 、 Mesenteric artery or Venous embolism Or thrombosis, Portal hypertension With jejunum and ileum varicosity Rupture, intraperitoneal lymphoma, primary spleen lymphoma, gastric cancer and Colon cancer Serous membrane Affected, chronic nephritis uremia 。

(4) Pelvic lesions: ectopic pregnancy 、 Corpus luteum rupture 、 Endometriosis 、 oophoroma Or mucinous cystic carcinoma of ovary.

treatment

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Because there are many causes of ascites, whether it is exudative or exudative, it can be caused by a variety of diseases. In case of patients with ascites, the nature of the ascites should be determined as soon as possible, and then actively search for the cause. Only for Etiological treatment , ascites may decrease or disappear; If the cause is not clear, necessary measures can be taken to reduce the symptoms (including abdominal distension, respiratory restriction, etc.) caused by a large amount of ascites Symptomatic treatment 。 In addition, advanced cirrhosis liver function Severely damaged Connective tissue disease Although the cause of ascites is treated, the ascites can not be completely resolved, sometimes even become intractable ascites, and can only be treated comprehensively.

1. Limit water and sodium intake

Patients with ascites, especially Hypoalbuminemia The intake of sodium salt should be strictly controlled, followed by the intake of water; High sugar high protein , high vitamin Low fat diet ； Low salt diet It is also applicable to all patients with exudative or exudative ascites, so as to drain as much water as possible from the body through the kidney.

two Diuretic

In order to accelerate the excretion of water from the kidney, diuretics can be used. Generally, potassium retaining diuretics and potassium excretion diuretics should be used together, or diuretics acting on different parts of the kidney should be used together to achieve the best diuretic effect without occurrence Electrolyte disorder 。

3. Supplement albumin Or accelerate protein synthesis

For example, ascites is mainly caused by hypoproteinemia Plasma colloid osmotic pressure In addition to food with high protein content, albumin should also be supplemented intravenously to increase plasma colloid osmotic pressure.

4. Discharge ascites

When a large amount of ascites affects the patient's breathing or the patient's abdominal distension is too severe and unbearable, the treatment of ascites can be taken to alleviate the symptoms. 1000~3000 ml of ascites is appropriate for each time.

5. Concentrate and reinfusion of ascites, ascites jugular vein Reflux or transjugular intrahepatic Portosystemic shunt （TIPS）

If ascites is decompensated cirrhosis Portal hypertension . Hypoalbuminemia can be treated by intraperitoneal fluid concentration and reinfusion, that is, ultrafiltration of the peritoneal fluid protein 、 electrolyte And other substances into the body through the jugular vein.

six Vasodilator

When the peritoneal effusion is leakage and the amount is large and the diuretic effect is poor, vasodilators can be properly used to improve the blood supply of the kidney, for example, Intravenous drip ligustrazine or dopamine It is beneficial to enhance diuretic effect.

prevention

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1. Pay attention to diet and prevent overeating.

2. Exercise more, increase immunity and protect visceral function.

3. During the operation, the medical staff shall strictly follow the principle of aseptic operation.

4. Cultivation Reasonable diet Habits: Keep A light diet , eat more fresh vegetables and aquatic products, such as vegetables radish 、 Kelp 、 Laver Etc. Eat less, eat more, and fast Fat meat and Animal viscera Do not eat strong irritant onions, peppers, coffee, etc.

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