Why fluid in the abdominal cavity. Abdominal ascites: causes and treatment. Laboratory and instrumental diagnostics

The accumulation of free fluid in the abdominal cavity occurs as a result of an inflammatory reaction, a violation of the outflow of lymph and blood circulation due to various reasons. A similar condition is called ascites (dropsy), its appearance can lead to the development of serious consequences for human health.

The fluid accumulated in the peritoneum is an ideal habitat for pathogenic microflora, which is the causative agent of peritonitis, hepatorenal syndrome, umbilical hernia, hepatic encephalopathy and other no less dangerous pathologies.

To diagnose ascites, one of the safest and most non-invasive, but highly accurate methods is used - a study using ultrasound waves. Detection of the presence of fluid in the abdominal cavity by ultrasound is carried out as prescribed by the attending physician on the basis of existing clinical signs of the pathological process.

The abdominal cavity is a separate anatomical zone, which constantly releases moisture to improve the sliding of the visceral sheets of the peritoneum. Normally, this effusion is able to be dynamically absorbed and not accumulate in areas convenient for it. In our article, we want to provide information about the causes of abnormal fluid reserve, the diagnosis of a pathological condition on ultrasound, and effective methods for its treatment.

Why does free fluid accumulate in the abdominal cavity?

Ascites develops as a result of various kinds of pathological processes in the pelvic organs. The initially accumulated transudate is not inflammatory in nature, its amount can range from 30 ml to 10-12 liters. The most common causes of its development are a violation of the secretion of proteins that provide impermeability to tissues and pathways that conduct lymph and circulating blood.

This condition can be provoked by congenital anomalies or development in the body:

cirrhosis of the liver;
chronic heart or kidney failure;
portal hypertension;
protein starvation;
lymphostasis;
tuberculous or malignant lesions of the peritoneum;
diabetes;
systemic lupus erythematosus.

Often, dropsy develops during the formation of tumor-like formations in the mammary glands, ovaries, digestive organs, serous membranes of the pleura and peritoneum. In addition, free fluid can accumulate against the background of complications of the postoperative period, pseudomyxoma of the peritoneum (an accumulation of mucus that undergoes reorganization over time), amyloid dystrophy (disturbances in protein metabolism), and hypothyroid coma (myxedema).

The mechanism for the formation of dropsy is leakage into the abdominal cavity of fluid from the main lymphatic ducts, blood vessels and organ tissues.

Signs of ascites

In the early stages of the development of this condition, patients do not have any complaints, the accumulation of free fluid can only be detected using ultrasound. Visible symptoms appear when the amount of transudate exceeds one and a half liters, a person feels:

an increase in the abdominal part of the abdomen and body weight;
deterioration in general well-being;
feeling of fullness in the abdominal cavity;
swelling of the lower extremities and scrotum tissues (in men);
belching
heartburn;
nausea;
difficulty breathing;
flatulence;
tachycardia;
protrusion of the umbilical node;
discomfort and pain in the abdomen;
stool and urinary disorders.

When a large amount of effusion accumulates in the peritoneum, a person can hear a characteristic splash of fluid and feel a wave.

If an ultrasound examination of the abdominal cavity showed the presence of excess moisture, the attending physician needs to accurately establish the root cause of the pathological condition. Pumping out accumulated transudate is not an effective treatment for ascites.

Preparation for ultrasound and its course

This study does not have any contraindications or restrictions; in emergency cases, it is carried out without prior preparation of the patient. A planned procedure requires improved visualization of pathological changes in organs. The patient is recommended to exclude foods containing a large amount of fiber and increasing gas formation from the diet 3 days before the study.

On the eve of the study, drink a laxative or make a cleansing enema. To reduce the accumulation of gases in the intestines on the day of the ultrasound, you need to take Mezim or activated charcoal. Modern methods of ultrasound diagnostics make it possible to determine the most probable areas of accumulation of free fluid in the abdominal cavity.

That is why qualified specialists examine the following anatomical zones:

The upper "floor" of the peritoneum, which is located under the diaphragm. Of particular diagnostic importance are the spaces located under the liver and formed by the main section of the small intestine - the ascending and descending parts of the colon. Normally, the so-called lateral channels do not exist - the covers of the peritoneum fit snugly against the intestine.
The small pelvis, in which, with the development of pathological processes, effusion can accumulate, flowing from the lateral canals.

The physical features of the moisture accumulated in the peritoneum for any reason do not allow the ultrasonic wave to be reflected, this phenomenon makes the diagnostic procedure as informative as possible. The presence of effusion in the studied anatomical spaces creates a dark moving focus on the monitor of the apparatus. In the absence of free fluid, diagnostics last no more than 5 minutes.

To detect excess moisture, the probe of the ultrasound device is moved along the anterior and middle axillary lines on both sides of the patient's body from top to bottom of the abdomen.

If it is not possible to detect a transudate, indirect signs may indicate its presence:

displacement of the colon loops;
change in sound during percussion (tapping) - tympanic in the upper parts of the peritoneum, blunt in the lower.

Types of abdominal dropsy on ultrasound

The international classification of diseases does not single out ascites as a separate disease - this condition is a complication of the last stages of other pathological processes. According to the brightness of clinical symptoms, the following forms of ascites are distinguished:

initial - the amount of water accumulated inside the abdomen reaches 1.5 liters;
with a moderate amount of liquid- manifested by swelling of the legs, a noticeable increase in the size of the chest, shortness of breath, heartburn, constipation, a feeling of heaviness in the abdomen;
massive (the volume of effusion is more than five liters) - a dangerous condition characterized by tension in the walls of the abdominal cavity, the development of insufficiency in the function of the cardiac and respiratory systems, and infection of the transudate.

In the bacteriological assessment of the quality of the free fluid, which is produced under special laboratory conditions, a distinction is made between sterile (absence of pathogenic microorganisms) and infected (presence of pathogenic microbes) dropsy.

According to diagnostic forecasts, there is ascites, which is amenable to drug therapy, and a stable pathological condition (its recurrence or not amenable to treatment).

What is done after confirmation of the pathology by ultrasound?

The course of therapeutic measures depends on what disease caused the accumulation of excess moisture in the peritoneum. To accurately diagnose the pathological process, practitioners conduct a comprehensive examination of the patient, including:

biochemical and general clinical blood and urine tests;
study of oncological markers and indicators of electrolyte metabolism;
survey radiography of the chest and abdominal cavities;
coagulogram - evaluation of the parameters of the coagulation system;
angiography of blood vessels, which allows to assess their condition;
MRI or CT scan of the abdomen;
hepatoscintigraphy - a modern technique for examining the liver using a gamma camera, which allows visualizing the organ;
diagnostic laparoscopy with therapeutic puncture of ascitic fluid.

To pump out the transudate from the abdominal cavity, the method of therapeutic laparocentesis is used - a puncture is made in the anterior wall of the abdomen, through which excess fluid is removed

In patients with cirrhosis of the liver, intrahepatic portosystemic shunting is recommended, the technique of which is to place a metal mesh stent, to create an artificial connection between the collar and hepatic veins. In severe cases, an organ transplant is necessary.

In conclusion of the above information, I would like to emphasize once again that the accumulation of free fluid in the abdominal cavity is considered an unfavorable manifestation of the complicated course of the underlying disease. The development of ascites can provoke a violation of the functional activity of the heart and spleen, internal bleeding, peritonitis, cerebral edema.

The mortality rate of patients with a massive form of abdominal dropsy reaches 50%. Measures that prevent the occurrence of this pathological condition are the timely treatment of infectious and inflammatory processes, proper nutrition, refusal to drink alcohol, moderate exercise, preventive examinations of medical specialists and the exact implementation of their recommendations.

It's called ascites. The cause of ascites is usually inflammation, circulatory problems. Ultrasound is used for diagnosis and treatment.

The prognosis of treatment depends on the state of the human immune system and the specific cause that caused the pathology.

Signs of ascites

The characteristic symptoms of ascites are an increase in intra-abdominal pressure, an increase in the abdomen from accumulated fluid.

Ascites (abnormal accumulation of fluid) disrupts the functioning of the lungs, organs of the gastrointestinal tract.

The reasons for the accumulation of fluid may be different: ascites may appear due to several disorders of the body, organ pathology. The most common cause of ascites is cirrhosis of the liver.

Diagnosis of ascites occurs with the help of ultrasound and examination by a doctor. Once diagnosed, treatment takes a long time. It is necessary to save a person from both ascites and the disease that caused it, at the same time.

The duration of the course, the severity of the disease, the further prognosis depend on the health of the person, the cause of the disease. Ascites may appear suddenly or gradually over several months.

Symptoms of ascites begin to appear if more than one liter of fluid has accumulated in the abdomen.

Symptoms of abnormal accumulation of fluid:

dyspnea;
increase in weight and volume of the abdomen;
swelling of the legs;
belching;
discomfort when bending over;
distension of the abdomen, pain;
heartburn;
swelling of the scrotum (in men).

Usually, at first, a person pays attention to such symptoms as a protrusion of the navel, an increase in the abdominal part - in a standing position, the stomach sags, looks like a ball, and when a person lies down, the stomach “blurs”.

In women, white stretch marks may be a symptom - this is one of the signs of ascites.

Some symptoms are associated with additional ailments, the root cause of ascites.

For example, if excess fluid is caused by pressure in the vessels of the liver, then veins are pronounced on the abdomen (front, side).

If there are problems in the vessels under the liver, then the characteristic signs of the disease are vomiting, jaundice, and nausea.

Tuberculous ascites is characterized by all of the above, as well as headache, increased fatigue, weakness, and palpitations.

Problems with outflow in the lymphatic vessels contribute to the rapid increase in the abdomen. If there is a lack of protein, then the signs of ascites are swelling of the extremities, shortness of breath.

If the disease is associated with problems in the lymphatic vessels, then ultrasound of the veins, vessels of the problem area is prescribed. If oncology is suspected, ultrasound is also performed.

Why does pathology occur?

Causes of fluid accumulation:

oncology (malignant formation);
cirrhosis of the liver (occurs in 75% of people);
heart failure;
various kidney diseases;
tuberculosis;
increased pressure in the liver;
gynecological diseases (in women);
pancreatitis.

One of the most difficult cases is the presence of oncology. A patient with a poor prognosis and exacerbated symptoms may be scheduled for surgery.

Newborns can also suffer from ascites. Usually, its cause is developmental disorders in the gastrointestinal tract in a child, various congenital edema.

Of course, in this case, the main causes of the pathology are various diseases or bad habits of the mother who was carrying the child.

Excess fluid can cause a lack of protein in the baby's food. Sometimes the prognosis of ascites for newborns is disappointing.

To understand exactly why excess fluid began to accumulate in the body, you need to visit a specialist and undergo hardware diagnostics.

The mechanism of fluid accumulation and diagnosis

The development of the disease in each person occurs in different ways. Let's look at the human body to better understand how this happens.

Inside is a serous membrane (membrane) that covers the organs. Some it covers completely, some barely touches. In addition to enveloping organs, the membrane produces fluid.

During the day, it is released and absorbed, allowing the organs to work normally and not stick together. If a person suffers from excess fluid, then the function of its production is impaired.

The reverse process occurs, creating a favorable environment for toxins. In this regard, characteristic symptoms also appear.

If a person has cirrhosis of the liver, then the fluid accumulates in a different way.

There are four ways in which ascites can form:

With cirrhosis of the liver, pressure rises, as a result of which fluid accumulates in the abdomen;
The body tries to reduce the load on the veins by lymph drainage. Formed lymphatic hypertension (the body can not cope with the load), the fluid flows from the vessels into the abdominal cavity. For a while she absorbs the liquid, then ceases to cope with it;
With cirrhosis of the liver, the number of liver cells decreases, less protein is produced, the fluid leaves the vessels, the free peritoneum ceases to be such;
Simultaneously with the accumulation of fluid in the abdominal cavity, there is an outflow of fluid from the blood. This is followed by a decrease in the amount of urine excreted, and blood pressure rises.

After the fourth point, the accumulation of fluid is faster and aggravated. Further complications are possible due to oncology (if any).

If a person suffers from heart failure, then the pressure in the liver jumps, as a result of which the fluid evaporates from its vessels.

The inflammatory process of the peritoneum provokes a large production of fluid, which it cannot cope with, as a result of which it penetrates into the peritoneum.

Doctors usually use ultrasound to help diagnose ascites. Along with this, the liver is examined for the presence of cirrhosis.

An ultrasound is also done to understand the state of the heart, the patient's veins, and the places where fluid accumulates.

You can conduct an examination without ultrasound - make a palpation of the patient's abdomen. If fluid fluctuations are felt, then ascites is diagnosed.

Modern technologies and ultrasound make it possible to examine a liquid with a volume of more than half a liter.

Apply hepatoscintigraphy (similar to ultrasound) to establish the condition of the liver, the degree of cirrhosis.

The degree of cirrhosis, its development is established by a coagulometer - a device that helps determine blood clotting.

Sometimes doctors take an α-fetoprotein venous blood test, which can detect liver cancer causing excess fluid.

An X-ray of the organs also helps in the diagnosis. For example, an x-ray of the lungs will help identify the degree of tuberculosis, the presence of fluid, the cause of fluid accumulation.

There is angiography - a study of blood vessels (analogous to ultrasound), which helps to identify the causes of ascites (ascites of vascular origin).

The analysis of a biopsy of a peritoneum, a liver is possible. Sometimes doctors take a fluid analysis, then conduct research. The patient may be prescribed an analysis of urea, sodium, creatinine, potassium.

Treatment methods for the disease

Now there are several ways to treat ascites. This disease is most often associated with disorders of the gastrointestinal tract, liver.

Taking into account this fact, doctors most often prescribe a diet free from junk food, unhealthy foods, alcohol, and salt.

Patients with ascites need to strictly follow the diet, otherwise there is a risk of complications or recurrence of the disease.

You can not eat radishes, garlic, onions, radishes, sorrel, cabbage, turnips, various types of citrus fruits. You should eat only skim milk, skimmed dairy products.

You can not eat fried, salty, spicy. Various smoked meats, sausage, stew are not recommended. Confectionery from dough, any pastries are also impossible.

However, the diet for this disease does not imply a significant reduction in the diversity of the human diet. The patient should drink warm drinks.

Ninety percent of meals should be steamed. Bread can be dried. Meat soups are recommended. You can cook porridge without millet.

Eggs can be consumed in the form of an omelet, once or twice a week. For dessert, you can eat jelly, marshmallows.

The main goal of this treatment is to achieve weight loss in the patient. In a week, a person should lose at least two kilograms.

If this does not happen, then he is sent to the hospital, diuretic drugs are prescribed. The patient often takes tests for the content of electrolytes in the blood.

After undergoing such a course of treatment, the prognosis for a person suffering from ascites may improve.

The operation is prescribed in especially severe cases, if treatment with diets and drugs does not help. As a rule, with this decision, the prognosis of ascites is disappointing.

It is likely that such a patient may have one of the stages of oncology. The symptoms of ascites and hardware research methods will help to find out this in more detail.

Now there are the following operations for the treatment of ascites:

installation of a peritoneovenous shunt;
paracentesis, puncture of the abdominal wall (transudate is removed after the puncture);
liver transplant.

The most common operation to eliminate ascites is a puncture of the abdominal wall, in which free fluid is simply pumped out.

Other types of intervention require special conditions - anesthesia, close monitoring. For example, a liver transplant is done with varying degrees of oncology.

If the patient was prescribed paracentesis, local anesthesia is done - the navel area. After that, an incision is made one centimeter long, pumping out excess fluid begins.

This operation involves the sitting position of the patient.

It should be noted that the operation has some contraindications. There is a risk of hepatic coma, internal bleeding.

Patients with infectious diseases this type of operation is contraindicated. Paracentesis sometimes causes complications - emphysema, hemorrhage in the abdominal cavity, impaired functioning of organs.

Sometimes the operation is performed using ultrasound. The accumulated fluid after the operation can flow out of the patient's body for a long time, which helps to get rid of the disease.

Those who want to get rid of ascites can use alternative medicine methods that alleviate the symptoms of the disease.

Alternative medicine is for those who have relatively "mild" symptoms of fluid accumulation, a promising prognosis, and no suspicion of varying degrees of cancer.

Pumpkin helps the liver function better. For the treatment of ascites (fluid accumulation), you can make pumpkin porridge, baked pumpkin.

Parsley tincture is often used as a diuretic. Soak two tablespoons of parsley in a glass of hot water.

The container needs to be closed, you need to insist for two hours. It is necessary to drink one hundred milliliters of infusion five times a day.

Parsley can be soaked in milk. You need to take one parsley root, soak in a liter of hot milk, put in a water bath. Insist half an hour. You should drink in the amount indicated above.

Doctors often prescribe diuretics. A similar medicine can be prepared at home. For example, you can prepare a decoction of bean pods.

The pods need to be crushed - you need two tablespoons of such a powder. Next, you need to boil the powder in water (two liters) for fifteen minutes.

A day, to overcome ascites, you need to drink three times one hundred milliliters.

Abdominal ascites is the concentration of effusion fluid in the peritoneal region, which is not related to any internal organ. The presented condition can develop due to a fairly significant number of deviations associated with various internal organs and systems. However, in 75% of cases, ascites is a complication of liver cirrhosis, while the effusion is difficult to remove - it can accumulate quite quickly. Given this, I would like to dwell in more detail on what are the causes, treatment and prognosis in this case.

Causes of ascites in an adult

Talking about the causes of ascites in an adult, it is strongly recommended to pay attention to such factors as cirrhosis of the liver, malignant tumors (in 10% of cases) and heart failure - in 5% of the total number of cases. In addition, effusion and fluid in the abdominal cavity may be concentrated due to an increase in pressure in the portal vein of the liver. Experts pay special attention to such reasons as:

amyloidosis, glomerulonephritis - kidney pathology;
deficiency associated with the human diet, namely the lack of vitamins, minerals and nutrients;
carcinomatosis, namely the seeding of the mucous membrane of the abdomen with cells associated with cancer of the intestines, stomach and even breasts - treatment in this case is the most problematic;
tuberculous lesions of the peritoneal region;
the presence of tumors in the specified zone - mesothelioma and others, the treatment of which should be carried out in a separate manner.

In addition, effusion can accumulate due to certain gynecological diseases (cyst, tumors in the ovarian region). This can also be influenced by such reasons as disturbances in the work of the endocrine system, diseases of the digestive tract, destabilization of the outflow of lymph. Separate attention deserves all those reasons that influenced the fact that the effusion began to focus on the abdomen of the child.

Causes of illness in children

In some cases, a newborn or infant may well develop ascites. This happens due to congenital edema: due to Rh or group incompatibility (between mother and child), blood loss in the prenatal period can also have an effect. In addition, some congenital anomalies associated with the development or functioning of the kidneys and the biliary system as a whole can be identified in the baby.

We should not forget about congenital nephrotic syndrome, which will be accompanied by swelling. Treatment will also be required for exudative enteropathy (plasma protein is lost through the intestines) and for kwashiorkor (a disease associated with protein deficiency in the female body). In order to better understand why exactly effusion begins to accumulate, it is necessary to pay attention to everyone who is at risk.

What do you need to know about risk factors?

The accumulation of fluid, the prognosis for which will not always be positive, is highly likely to develop in someone who has been abusing alcohol for a long time or has experienced chronic hepatitis (viral origin in this case is not of particular importance). Effusion also accumulates when injecting drugs are introduced, with frequent blood transfusions. Special attention, according to experts, deserves the following cases:

tattoo;
living in a region where chronic viral hepatitis is common;
the presence of obesity;
type 2 diabetes mellitus;
high or even elevated cholesterol levels, the treatment of which is difficult.

What are the symptoms of ascites?

It must be borne in mind that a small amount of free fluid cannot lead to the formation of characteristic symptoms. The fact is that they begin to appear only after one liter of transudate (liquid) in the peritoneal region. The symptoms of ascites are as follows: distension and pain in the abdomen, weight gain and, directly, a change in the volume of the peritoneum.

Difficulties in bending over, flatulence, and heartburn deserve special attention. The likelihood that a negative prognosis will develop can be affected by belching, the occurrence of shortness of breath during walking, and swelling of the legs. In addition, the fact that treatment is required is indicated by the fact that the navel systematically protrudes outward, and white stretch marks appear on the skin.

If ascites and effusion in general are provoked by increased pressure in the region of the portal vein of the liver, then dilated saphenous veins will be noticeable on the anterior and lateral planes of the abdomen. At the same time, when portal hypertension is provoked by blockade of the subhepatic vessels, a person will develop jaundice, nausea and vomiting.

In the tuberculous form of ascites, the previously presented symptoms will be joined by signs of intoxication, for example, weakness or fatigue, headaches. In addition, the patient's weight loss will be identified and it is highly recommended to start treatment as early as possible. In the presence of protein deficiency, the effusion is not pronounced, but edema is present in the extremities. In addition, the effusion will spread to the pleural area, accompanied by shortness of breath. Before starting treatment, it is strongly recommended to pay attention to diagnostic measures.

Diagnosis of the disease

The diagnosis should be determined on the basis of examination of the patient, ultrasound and radiography of the peritoneum, as well as the chest cavity. However, this is not all diagnostic measures, because it will be required:

laparoscopy and laparocentesis - analysis of fluid from the peritoneum;
hepatoscintigraphy - a study that allows you to identify the defeat of cirrhotic changes;
CT and MRI;
angiography - to determine the vascular origin of ascites;
biochemical indicators, in particular, the ratio of albumins, fractions of globulins and other criteria.

Further, before starting treatment, specialists can insist on the implementation of a coagulogram and the identification of alpha-fetoprotein indicators in the blood from a vein. Only after such a step-by-step and detailed diagnosis will it be possible to talk about how exactly the effusion should be treated and why. Also, experts will approximately be able to determine the prognosis in the development of a pathological condition, based, among other things, on how long fluid accumulation occurs.

Features of the treatment of ascites

In the process of treating ascites associated with the abdominal cavity, the regimen, namely bed and semi-bed, is extremely important. Special attention is strongly recommended to pay to the diet. In particular, an absolute elimination of sodium from the diet may be required. In order to achieve this, it is highly recommended to reduce the use of salt. With cirrhosis and in the case when the effusion is active, it will be necessary to limit the use of liquids (up to one liter during the day, in some cases a free dosage is determined).

Special attention will need to be paid to monitoring the dynamics of a person's weight within 24 hours. This is explained by the fact that at least 500 grams should be lost over the specified period of time. In this case, the fluid consumed should not be significantly more than the amount released under the condition of optimal body temperature, as well as ambient air.

Treatment with medication will directly depend on what exactly turned out to be the cause of ascites. For example, for all its types, the appointment of diuretic compounds with potassium will be required. Traditionally, such a combination should include the drug Veroshpiron, used in conjunction with Lasix or Torasemide. Asparkam, Panangin and other compounds are used as a constant source of potassium.

When identifying cirrhosis of the liver, when the accumulation occurs quickly enough, hepatoprotectors of various directions of action should be prescribed. For low protein values, transfusion of protein formulations is used, for example, albumin 5-10% or fresh frozen plasma. The latter remedy is used when there are disorders associated with the blood coagulation system. All those operations that can and should be performed with ascites deserve special attention, especially if ascites significantly aggravates vital processes.

What do you need to know about surgical treatment?

Surgical treatment is necessary when the patient's body has not responded properly to the diuretic drugs used. Speaking of this, it should be borne in mind that methods such as:

laparocentesis - removal of fluid in ascites through a puncture in the abdominal wall. Traditionally, a drainage tube with a clamp is placed in the presented hole, which will make it possible to remove excess fluid for several days;
transjugular intrahepatic shunting - the formation of an artificial communication between veins such as the hepatic and portal. The operation should be carried out under mandatory X-ray control in order to exclude any complications after that;
transplantation of the liver area - may be needed when it comes to abdominal ascites in oncology.

Ascites prognosis

The prognosis will most directly depend on the cause that provoked ascites, as well as on the effectiveness of the recovery course. Factors such as age over 60, low blood pressure, and a decrease in blood albumin below 30 should be considered unfavorable. In addition, an aggravation is identified in the presence of diabetes mellitus, if the disease has formed as a complication of liver cancer or when glomerular filtration changes ( according to the sample or photo of Reberg). Experts estimate that half of patients with ascites will die within two years. If ascites does not respond to diuretic medicinal formulations, then 50% die within six months.

What are the possible complications?

It must be understood that even after successful treatment, some complications may form. In particular, we can talk about peritonitis (spontaneous bacterial suppuration - free form), refractory ascites - there is no weight loss even with the use of diuretic compounds. Further, hepatic encephalopathy, hepatorenal syndrome, and spontaneous discharge of fluid due to ascites from the umbilical region should be noted. Such complications after an illness or operation are noticeable even in the photo.

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1. Can cancer be prevented?
The occurrence of a disease such as cancer depends on many factors. No one can be completely safe. But everyone can significantly reduce the chances of a malignant tumor.

2. How does smoking affect the development of cancer?
Absolutely, categorically ban yourself from smoking. This truth is already tired of everyone. But quitting smoking reduces the risk of developing all types of cancer. Smoking is associated with 30% of cancer deaths. In Russia, lung tumors kill more people than tumors of all other organs.
Eliminating tobacco from your life is the best prevention. Even if you smoke not a pack a day, but only half, the risk of lung cancer is already reduced by 27%, as the American Medical Association found.

3. Does excess weight affect the development of cancer?
Keep your eyes on the scales! Extra pounds will affect not only the waist. The American Institute for Cancer Research has found that obesity contributes to the development of tumors in the esophagus, kidneys, and gallbladder. The fact is that adipose tissue serves not only to store energy reserves, it also has a secretory function: fat produces proteins that affect the development of a chronic inflammatory process in the body. And oncological diseases just appear against the background of inflammation. In Russia, 26% of all cancer cases are associated with obesity.

4. Does exercise help reduce the risk of cancer?
Set aside at least half an hour a week for exercise. Sport is on the same level as proper nutrition when it comes to cancer prevention. In the US, a third of all deaths are attributed to the fact that patients did not follow any diet and did not pay attention to physical education. The American Cancer Society recommends exercising 150 minutes a week at a moderate pace or half as much but more vigorously. However, a study published in the journal Nutrition and Cancer in 2010 proves that even 30 minutes is enough to reduce the risk of breast cancer (which affects one in eight women in the world) by 35%.

5.How does alcohol affect cancer cells?
Less alcohol! Alcohol is blamed for causing tumors in the mouth, larynx, liver, rectum, and mammary glands. Ethyl alcohol breaks down in the body to acetaldehyde, which then, under the action of enzymes, turns into acetic acid. Acetaldehyde is the strongest carcinogen. Alcohol is especially harmful to women, as it stimulates the production of estrogen - hormones that affect the growth of breast tissue. Excess estrogen leads to the formation of breast tumors, which means that every extra sip of alcohol increases the risk of getting sick.

6. Which cabbage helps fight cancer?
Love broccoli. Vegetables are not only part of a healthy diet, they also help fight cancer. This is also why recommendations for healthy eating contain the rule: half of the daily diet should be vegetables and fruits. Especially useful are cruciferous vegetables, which contain glucosinolates - substances that, when processed, acquire anti-cancer properties. These vegetables include cabbage: ordinary white cabbage, Brussels sprouts and broccoli.

7. Which organ cancer is affected by red meat?
The more vegetables you eat, the less red meat you put on your plate. Studies have confirmed that people who eat more than 500 grams of red meat per week have a higher risk of developing colon cancer.

8. Which of the proposed remedies protect against skin cancer?
Stock up on sunscreen! Women aged 18-36 are particularly susceptible to melanoma, the deadliest form of skin cancer. In Russia, in just 10 years, the incidence of melanoma has increased by 26%, world statistics show an even greater increase. Both artificial tanning equipment and the sun's rays are blamed for this. The danger can be minimized with a simple tube of sunscreen. A study published in the Journal of Clinical Oncology in 2010 confirmed that people who regularly apply a special cream get melanoma half as often as those who neglect such cosmetics.
The cream should be chosen with a protection factor SPF 15, apply it even in winter and even in cloudy weather (the procedure should turn into the same habit as brushing your teeth), and also do not expose yourself to the sun's rays from 10 to 16 hours.

9. Do you think stress affects the development of cancer?
By itself, stress does not cause cancer, but it weakens the entire body and creates conditions for the development of this disease. Research has shown that constant worry alters the activity of the immune cells responsible for turning on the fight-and-flight mechanism. As a result, a large amount of cortisol, monocytes and neutrophils, which are responsible for inflammatory processes, constantly circulate in the blood. And as already mentioned, chronic inflammatory processes can lead to the formation of cancer cells.

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Abdominal ascites is an accumulation of excess fluid in the abdominal cavity.

It is most commonly caused by cirrhosis of the liver. Other important causes of ascites include infections (acute and chronic, including tuberculosis), malignancy, pancreatitis, heart failure, obstruction of the hepatic veins, nephrotic syndrome, and myxedema.

Ascites, i.e., the accumulation of fluid in the free abdominal cavity, occurs from various causes, most often from a general circulatory disorder with predominant venous congestion in the portal vein system with cardiac dropsy, especially with tricuspid insufficiency, with adhesive pericarditis, or with isolated portal hypertension; with cirrhosis of the liver, pylethrombosis, compression of the portal vein by enlarged lymph nodes, with general renal, especially nephrotic edema or hypoproteinemic edema of a different nature; with alimentary and secondary dystrophy; stomach cancer, malignant ovarian tumor, etc.) and others; congestive and inflammatory cause can be combined.

Dropsy accumulations are usually painless, inflammatory ones are accompanied by pain and soreness to one degree or another.

With sluggish filling in a lying patient, ascitic fluid bursts the lateral sections of the flattened abdomen (frog belly), and in a standing patient it hangs anteriorly and downwards; with tight filling with liquid, the protruding abdomen does not change shape in any position, when the intestines with their inherent tympanic sound almost do not find conditions for movement, despite the absence of adhesions. Characteristic movement of fluid with a change in the position of the patient.

With hemorrhage into the abdominal cavity (hemoperitoneum), the area of dullness is small, but there is significant swelling due to the associated inflammatory bowel paresis; muscular protection is also expressed, for example, with a burst pregnant tube, when a test puncture through the posterior fornix of the vagina makes it possible to establish a diagnosis. Recognition of acute abdominal syndrome in ectopic pregnancy helps delayed menstruation, sudden pain, bloody discharge from the genitals, fainting, gynecological examination data. A similar picture is given by a rupture of an acutely enlarged, for example, in malaria, spleen with a characteristic symptom of irritation of the phrenic nerve (pain in the left shoulder). With dropsy, the specific gravity of ascitic fluid is 1004-1014; protein not more than 2-2.5 ° / 00 leukocytes are single in the sediment, the color of the liquid is straw or lemon yellow. When peritonitis is characterized by fibrin clots that form when the liquid is standing, turbidity of varying degrees. Chylous ascites is observed when the lactiferous vessels of the mesentery are ruptured (in cancer, tuberculosis of the mesenteric lymph nodes), pseudochylous - due to fatty degeneration of effusion cells in chronic cancerous and other peritonitis.

Ascites with isolated and significant portal hypertension leads to the development of roundabout blood circulation such as the head of a medusa-supraumbilical or subumbilical when compressed by ascites and the inferior vena cava; inflammatory ascites or general venous congestion with no or lesser increase in pressure in the portal system does not create conditions for the development of roundabout circulation.

The most common cause of ascites is portal hypertension. Symptoms are usually due to distension of the abdominal cavity. Diagnosis is based on physical examination and often on ultrasound or CT findings. Treatment includes rest, a salt-free diet, diuretics, and therapeutic paracentesis. Diagnosis of infection includes analysis of ascitic fluid and culture. Treatment is with antibiotics.

Causes of abdominal ascites

The distribution of fluid between the vessels and tissue space is determined by the ratio of hydrostatic and oncotic pressure in them.

Portal hypertension, in which the total volume of blood supply to the internal organs increases.
Changes in the kidneys, contributing to increased reabsorption and retention of sodium and water; these include: stimulation of the renin-angiotensin system; increased secretion of ADH;
Imbalance between the formation and outflow of lymph in the liver and intestines. Lymph outflow is not able to compensate for the increased outflow of lymph, mainly associated with an increase in pressure in the sinusoids of the liver.
Hypoalbuminemia. Leakage of albumin with lymph into the abdominal cavity contributes to an increase in intra-abdominal oncotic pressure and the development of ascites.
Increased serum levels of vasopressin and adrenaline. This reaction to a decrease in BCC further enhances the influence of renal and vascular factors.

Ascites can be caused by liver disease, usually chronic but sometimes acute, and ascites can be caused by causes unrelated to liver disease.

Hepatic causes include the following:

Portal hypertension (in liver disease is > 90%), usually as a result of cirrhosis of the liver.
chronic hepatitis.
Severe alcoholic hepatitis without cirrhosis.
Obstruction of the hepatic vein (for example, Budd-Chiari syndrome).

Portal vein thrombosis usually does not cause ascites unless there is concomitant hepatocellular injury.

Extrahepatic causes include the following:

Generalized fluid retention (heart failure, nephrotic syndrome, severe hypoalbuminemia, constrictive pericarditis).
Diseases of the peritoneum (eg, carcinomatous or infectious peritonitis, bile leakage caused by surgery or other medical procedures).

Pathophysiology

The mechanisms are complex and not fully understood. Factors include changes in Starling forces in the portal vessels, renal sodium retention, and possibly increased lymph production.

Symptoms and signs of abdominal ascites

A large amount of fluid can cause a feeling of fullness, but true pain is rare and suggests another cause of acute abdominal pain. If ascites leads to a high standing of the diaphragm, then shortness of breath may occur. Symptoms of SBP may include new complaints of abdominal discomfort and fever.

Clinical signs of ascites include dullness of sound on percussion of the abdomen and a sensation of fluctuation on physical examination. Volumes<1 500 мл могут не выявляться при физикальном исследовании. При заболеваниях печени или брюшины обычно наблюдается изолированный асцит, либо он диспропорционален перифирическим отекам; при системных заболеваниях обычно встречается обратная ситуация.

Possible hernia of the white line of the abdomen or umbilical hernia, swelling of the penis or scrotum, right-sided pleural effusion.

Diagnosis of ascites of the abdominal cavity

Identification of ascites with a volume of more than 2 liters does not cause difficulties, but a smaller amount of ascitic fluid is not always determined by physical examination. Detection of fluid by percussion is possible only in cases where its volume exceeds 500 ml. The diagnostic accuracy of all the methods described is only 50%.

Radiation diagnostics

A plain radiograph of the abdomen may show general blurring of the image and the absence of a shadow of the psoas muscle. As a rule, centralization and separation of intestinal loops are characteristic.
With ultrasound, which is performed with the patient lying on his right side, even 30 ml of ascitic fluid can be detected. With ultrasound, the presence of both free and encapsulated fluid is determined.
Abdominal CT can detect small ascites and at the same time assess the size and condition of the abdominal organs.

Examination of ascitic fluid

Diagnostic laparocentesis. The procedure is carried out under aseptic conditions using a vascular catheter with a diameter of 20-23 G. The needle is most often inserted along the white line of the abdomen just below the navel, it can also be inserted into the iliac fossa. Severe complications of laparocentesis (intestinal perforation, bleeding, constant outflow of ascitic fluid) are observed in less than 1% of cases.

Laboratory research

Approximately 50 ml of ascitic fluid is required for diagnostic purposes. Pay attention to its appearance and color, determine the number of erythrocytes and leukocytes, the percentage of neutrophils, the level of total protein, albumin, glucose, triglycerides and amylase activity. In parallel, the same indicators are examined in serum samples. The ascitic fluid is cultured immediately (similar to how a blood culture is performed). In addition, samples are stained according to Gram and Ziehl-Neelsen, inoculated on media for Mycobacterium tuberculosis and fungi, and cytological examination is carried out to detect malignant cells. Gram stain is informative only for intestinal perforation.
Ascitic fluid typically contains less than 500 μl -1 leukocytes, with neutrophils accounting for less than 25%. If the number of neutrophils is more than 250 μl -1, a bacterial infection is very likely - either primary peritonitis or a consequence of perforation of the gastrointestinal tract. If there is an admixture of blood in the ascitic fluid, when calculating the number of neutrophils, an amendment must be introduced: for every 250 erythrocytes, one is subtracted from the total number of neutrophils. The level of lactate and the pH of the ascitic fluid do not play a role in the diagnosis of infection.
The presence of blood in the ascitic fluid indicates infection with Mycobacterium tuberculosis, fungi, or, more often, a malignant neoplasm. Pancreatic ascites is characterized by a high protein content, an increased number of neutrophils, and increased amylase activity. Elevated levels of triglycerides in ascitic fluid are characteristic of chylous ascites, which develops as a result of obstruction or rupture of the lymphatic vessels due to trauma, lymphoma, other tumors, or infections.

Inflammatory ascites occurs in young people more often with tuberculous peritonitis (polyserositis), in the elderly, with a cancerous neoplasm of the stomach and other organs, for example, after surgical removal of breast cancer due to seeding, etc. Cancer ascites often occurs with deep cachexia, without fever, although there are exceptions. To establish the true cause, a complete examination of the patient is required in each case.

Erroneous recognition of ascites is possible with a fat sagging abdomen, with enteroptosis, as well as with severe flatulence. A general increase in the abdomen due to flatulence is possible if both the small and large intestines are significantly swollen; with predominant swelling of the large intestine, horseshoe-shaped stretching along the colon prevails; with predominant stretching of the small intestines, stretching of the central umbilical region (mesogastrium) predominates. With peritonitis and peritonism, a sharp swelling of the intestine is often observed early. A significant expansion of the stomach, especially after operations on it, disappears after emptying with a gastric tube. With megacolon, an asymmetric stretching of the abdomen is found mainly due to the sigmoid colon, which in this disease reaches the size of a “car tire” with general exhaustion and flabby muscles of the patient. Megacolon is detected by sluggish peristaltic waves and fluctuations in the size of the abdomen, depending on bowel movements. A contrast enema gives a picture that is sharply different from the norm, and a lot of fluid is required to fill the large intestine. The disease proceeds with persistent constipation.

With large ovarian cysts, most often leading to erroneous recognition of ascites, one can trace the growth of the tumor from the depths of the small pelvis, almost no protrusion of the navel is observed, a gynecological examination establishes a connection between the tumor and the uterus. The tumor may be somewhat asymmetrical. The latter is even more pronounced with large hydronephrosis, which dramatically changes the configuration of the abdomen. A rapid increase in the size of the abdomen can also be observed with a rare false peritoneal slime mold (pseudomyxoma peritonaei), coming from a burst ovarian cyst or appendix.

Diagnosis

Ultrasound or CT if obvious physical signs are not enough.
Frequently investigated parameters of ascitic fluid.

Diagnosis may be based on physical examination in the case of large amounts of fluid, but imaging tests are more sensitive. Ultrasound and CT detect much smaller volumes of fluid than physical examination. SBP should also be suspected if the patient has ascites with abdominal pain, fever, or an unexplained deterioration.

Diagnostic paracentesis should be performed in the following cases:

newly diagnosed ascites;
ascites of unknown etiology;
suspected SBP.

Approximately 50 - 100 ml of liquid is evacuated and analyzed for general external examination, protein content determination, cell and cell count, cytology, culture and, if clinically indicated, special tests for amylase and acid-fast microorganisms are carried out. In contrast to ascites due to inflammation or infection, ascites in portal hypertension is characterized by a clear, straw-colored fluid that is low in protein and polymorphonuclear leukocytes (<250 клеток мкл) и, что наиболее надежно, высоким сывороточно-асцитическим альбуминовым градиентом, который представляет собой разницу уровня сывороточного альбумина и уровня альбумина асцитической жидкости. Градиент >1.1 g/dl is relatively specific for ascites due to portal hypertension. If the ascitic fluid is turbid and the number of polymorphonuclear leukocytes is >250 cells/µl, then this indicates SBP, while the fluid mixed with blood suggests a tumor or tuberculosis. Rare milk-like (chylous) ascites is most often a sign of lymphoma or lymphatic duct occlusion.

Primary peritonitis

Primary peritonitis is observed in 8-10% of patients with alcoholic cirrhosis of the liver. The patient may be asymptomatic or present with a full-blown clinical picture of peritonitis, liver failure, and encephalopathy, or both. Without treatment, mortality from primary peritonitis is very high, so in this case it is better to prescribe extra antibacterial agents than to delay their appointment. After receiving the culture results, antibiotic therapy can be adjusted. Usually, intravenous administration of antibacterial agents for 5 days is sufficient even with bacteremia.

Most often, ascitic fluid reveals bacteria that live in the intestine, such as Escherichia coli, pneumococci and Klebsiella spp. Anaerobic pathogens are rare. In 70% of patients, microorganisms are also sown from the blood. A number of factors are involved in the pathogenesis of primary peritonitis. It is believed that an important role is played by the reduced activity of the reticuloendothelial system of the liver, as a result of which microorganisms from the intestine penetrate into the blood, as well as the low antibacterial activity of ascitic fluid, which is due to a reduced level of complement and antibodies and impaired neutrophil function, which leads to the suppression of opsonization of microorganisms. Pathogens can enter the blood from the gastrointestinal tract through the walls of the intestine, from the lymphatic vessels, and in women also from the vagina, uterus and fallopian tubes. Primary peritonitis is often recurrent. The probability of recurrence is high when the protein content in the ascitic fluid is less than 1.0 g%. Relapse rates can be reduced by oral fluoroquinolones (eg, norfloxacin). The administration of diuretics in primary peritonitis may increase the ability of ascitic fluid to opsonize and the level of total protein.

Sometimes primary peritonitis is difficult to distinguish from secondary peritonitis caused by abscess rupture or intestinal perforation. The number and type of microorganisms detected can help here. Unlike secondary peritonitis, in which several different microorganisms are always sown at once, with primary peritonitis, in 78-88% of cases, the pathogen is the same. Pneumoperitoneum almost unequivocally indicates secondary peritonitis.

Complications of abdominal ascites

Most often, shortness of breath, weakening of cardiac activity, loss of appetite, reflux esophagitis, vomiting, hernia of the anterior abdominal wall, leakage of ascitic fluid into the chest cavity (hydrothorax) and scrotum are observed.

Treatment of abdominal ascites

Bed rest and diet.
Sometimes spironolactone, possibly with the addition of furosemide.
Sometimes therapeutic paracentesis.

Bed rest and a sodium-restricted diet (2,000 mg/day) is the first and safest treatment for ascites associated with portal hypertension. Diuretics should be used if the diet fails. Spironolactone is usually effective. A loop diuretic should be added if spironolactone fails. Since spironolactone can cause potassium retention, and furosemide, on the contrary, promotes its excretion, the combination of these drugs often leads to optimal diuresis with a low risk of rejected K content. Restriction of the patient's fluid intake is indicated only in the treatment of hyponatremia (serum sodium 120 mEq / l) . Changes in the patient's body weight and the amount of sodium in the urine reflect the response to treatment. Weight loss of about 0.5 kg/day is optimal. Bring more intense diuresis! to a decrease in fluid in the vascular bed, especially in the absence of peripheral risks; which serves as a risk of developing renal failure or electrolyte disorders (eg, hypokalemia), which, in turn, contributes to the development of portosystemic encephalopathy. Inadequate reduction of dietary sodium is a common cause of persistent ascites.

An alternative is therapeutic paracentesis. Removing 4 liters per day is safe; many clinicians prescribe intravenous salt-free albumin (approximately 40 g during paracentesis) to prevent circulatory disturbances. Even a single total paracentesis can be safe.

In uncomplicated ascites, treatment begins with an attempt to normalize liver function. The patient should refrain from taking alcohol and hepatotoxic drugs. Complete nutrition is a must. If appropriate, prescribe drugs that suppress inflammation of the liver parenchyma. Regeneration of the liver leads to a decrease in the amount of ascitic fluid.

The drug of choice in most cases is spironolactone. The effect of the drug (suppression of the action of aldosterone in the distal tubules) develops slowly, increased diuresis can be observed 2-3 days after the start of therapy. Possible side effects include gynecomastia, galactorrhea, and hyperkalemia.
If sufficient diuresis cannot be achieved with spironolactone, furosemide can be added.
Combined therapy.

Taking drugs once a day is most convenient for patients. Amiloride is faster acting than spironolactone and does not cause gynecomastia. However, spironolactone is more readily available and cheaper. If spironolactone, in combination with furosemide, does not increase the sodium content in the urine or does not reduce the patient's weight, the doses of both drugs are simultaneously increased. Doses can be further increased, but the level of sodium in the urine at the same time almost does not increase. In these cases, the addition of a third diuretic, such as hydrochlorothiazide, may increase urinary sodium excretion, but there is a risk of hyponatremia. With the appointment of spironolactone and furosemide in the above ratios, the content of potassium in plasma, as a rule, remains normal; in case of deviations, the doses of the drugs can be adjusted.

Treatment for persistent ascites

In addition to hepatorenal insufficiency, causes of persistent ascites may be a complication of underlying liver disease, such as active hepatitis, portal or hepatic vein thrombosis, gastrointestinal bleeding, infection, primary peritonitis, malnutrition, hepatocellular carcinoma, associated heart or kidney disease, and hepatotoxic (eg, , alcohol, paracetamol) or nephrotoxic substances. NSAIDs reduce renal blood flow by suppressing the synthesis of vasodilating prostaglandins, adversely affect GFR and the effectiveness of diuretics. ACE inhibitors and some calcium antagonists reduce peripheral vascular resistance, effective circulating blood volume, and renal perfusion.

Currently, with the ineffectiveness of drug therapy (10% of cases), therapeutic laparocentesis, perito-neovenous shunting or liver transplantation are performed. Previously, side-to-side portocaval shunting was used for persistent ascites, but postoperative bleeding and the development of encephalopathy due to portal-systemic shunting led to the abandonment of this practice. The efficacy of transjugular intrahepatic porto-caval shunting for ascites resistant to diuretic therapy is not yet clear.

Therapeutic laparocentesis. In addition to the fact that the procedure takes a lot of time for both the doctor and the patient, it leads to the loss of protein and opsonins, while diuretics do not affect their content. A decrease in the number of opsonins may increase the risk of primary peritonitis.

The question of the advisability of introducing colloidal solutions after the removal of a large amount of ascitic fluid has not yet been resolved. The cost of one infusion of albumin ranges from 120 to 1250 US dollars. Changes in the level of plasma renin, electrolytes and serum creatinine in patients who were not infused with colloidal solutions, apparently, have no clinical significance and do not lead to an increase in mortality and the number of complications.

Shunting. In about 5% of cases, the usual doses of diuretics are ineffective, and increasing the dose leads to impaired renal function. In these cases shunting is shown. In some cases, side-to-side portocaval shunting is performed, but it is associated with high mortality.

Peritoneovenous shunting, for example, according to Le Vin or Denver, may improve the condition of some patients. In most cases, the patient still needs diuretics, but their doses can be reduced. It also improves renal blood flow. Shunt thrombosis develops in 30% of patients and requires shunt replacement. Peritoneovenous shunting is contraindicated in patients with sepsis, heart failure, malignancy, and a history of bleeding from varicose veins. The frequency of complications and survival of patients with cirrhosis of the liver after peritoneovenous shunting depends on how reduced the function of the liver and kidneys. The best results were obtained in a few patients with persistent ascites and relatively intact liver function. Currently, peritoneovenous shunting is performed only in those few patients in whom neither diuretics nor laparocentesis work, or when diuretics are ineffective in patients who take too long to get to the doctor to undergo therapeutic laparocentesis every two weeks.

For stubborn ascites, orthotopic liver transplant if there are other indications for it. One-year survival of patients with ascites, not amenable to medical treatment, is only 25%, but after liver transplantation it reaches 70-75%.

The main function of the intestine is the absorption of split nutrients and water that enter the human body. In addition, the intestine is responsible for the "transit" of food masses through the gastrointestinal tract and their subsequent evacuation, as well as for the breakdown of fiber (a small part of it) and the synthesis of certain vitamins (K and H). Again, all the liquid consumed by a person enters the gastrointestinal tract, with subsequent absorption of water in its more distal sections. That is, in any case, the water will be in the intestines - it simply cannot be otherwise. However, it should not accumulate there. Just as the accumulation of food masses causes the formation of intestinal obstruction, so too does excess fluid in the gastrointestinal tract become an etiological factor in various pathologies.

In no case should you confuse ascites (accumulation in the abdominal cavity of free fluid) and accumulation of fluid in the intestine. These are absolutely two different in origin and manifestations of pathology. If the cause of ascites is a chronic pathology of the liver and venous system, which leads to the accumulation of a large amount of fluid in the abdominal cavity and is an extremely unfavorable prognostic sign, then water accumulates in the lumen of the digestive tract for completely different reasons, which will be described below. In the vast majority of cases, this condition will be a consequence of all kinds of processes that occur acutely in the human body. And the accumulation of fluid in the intestines is not as dangerous as ascites (in terms of prognosis for recovery and life). At least for the reason that the problem of “flooding” of the intestine is much easier to eliminate than the accumulation of free fluid in the abdominal cavity, which is not an independent pathology, but is associated with a chronic, usually incurable process.

Causes that lead to excessive fluid retention

In this case, it would be more appropriate to talk not about the accumulation of fluid in the large and small intestines, but about its increased flow into the intestinal lumen from the tissues (by definition, it cannot accumulate, unless, of course, complete obstruction of the lumen of the digestive tract occurs, which is extremely rare) . So, the pathogenetic mechanisms contributing to the development of the considered pathology:

Intestinal infections - when pathogenic microorganisms enter the body, they interact with the receptors of the cell wall of enterocytes. This leads to disruption of the adenylate cyclase system. As a result, a large amount of sodium, potassium, magnesium and chlorine ions enter the intestinal lumen. According to the concentration gradient principle, to maintain an adequate level of electrolyte concentration, water must pass into the intestinal lumen in order to compensate for the disturbed constancy of the internal environment. What is actually happening. This is one of the main mechanisms, due to which there is an excess flow of water into the large and small intestines (even with normal intestinal peristalsis in terms of absorption, it will stay there longer than the physiological period).
Increased "flooding" of the intestine due to malabsorption of certain substances (this pathology is called malabsorption syndrome). Without a doubt, this kind of condition is quite rare, but it is this reason that leads to the development of the most severe conditions (taking into account the fact that it is chronic). That is, enterocytes do not provide the assimilation of any electrolyte (for example, glucose). This leads to an increase in the concentration of this substance in the intestinal lumen, which, in turn, causes an uncontrolled flow of fluid from the tissues and intercellular substance into the intestinal lumen (in other words, massive exudation occurs).
Features of nutrition - when eating a large amount of salty or fried foods, in the same way as in the previous version, the body needs to consume large volumes of liquid. Taking into account the fact that the banal incoming water simply will not have time to be absorbed, the effect will be similar to the situation described in the previous paragraph.
iatrogenic cause. This refers to the accumulation of fluid in the intestines, provoked by taking medications. It happens, by the way, very often. For example, massive therapy with crystalloid solutions with a high concentration of electrolytes. Or the use of special solutions for oral rehydration (oralite, rehydron) - however, it should be noted that in this case there will be a physiological increase in the fluid content in the intestinal lumen.

That is, one can draw one and only conclusion from all the information listed: the pathological link that leads to excessive accumulation of fluid in the intestine is the same in all cases. An increase in the concentration of electrolytes (ions of sodium, potassium, chlorine, magnesium, glucose, fructose, galactose, maltose and many others) leads to the fact that there is an excessive flow of fluid into the intestinal lumen - in order to maintain the constancy of the internal environment, a physiological reaction of this kind is realized.

There is, however, an exception to this rule - the so-called "accumulation" of fluid in the intestine due to the fact that patency is impaired due to some process (as a rule, this is oncology). That is, water is retained similarly to food masses, but in this case, the clinical manifestations of this condition are offset by more serious symptoms of concomitant pathology. In addition, there is a violation of the absorption of water by the cells of the large intestine - but this congenital disease is extremely rare. That's actually all the mechanisms of development of the state in question.

How is the accumulation of water in the intestine manifested?

The most characteristic symptom of this condition is severe diarrhoea. This is confirmed by the fact that with all infectious diseases that affect the intestines, there is a violation of the stool. That is, due to the fact that a lot of fluid accumulates in the intestines, the feces change their consistency - this is exactly the mechanism that leads to the development of severe diarrhea. For example, with cholera, stools become the color of rice water - that is, they become almost colorless.

Again, talking about the constant accumulation of fluid in the lumen of the gastrointestinal tract is somewhat incorrect for the reason that it is simply not feasible due to the anatomical features of the structure of the digestive system. However, the constant excess of the proper intake of fluid in the human body leads to the development of a number of structural disorders of the intestine and nearby organs:

Due to the fact that the fluid in the lumen constantly puts pressure on the intestinal wall, there is a violation of peristaltic movements (contractions of smooth myocytes - they are constantly tense). This is the reason for the formation of a certain vicious circle - an increase in the fluid content disrupts peristalsis, which leads to difficulty in the implementation of the evacuation function. This is especially pronounced in the case of a chronic process - that is, with malabsorption, when fluid is constantly in excess quantities in the intestines, such phenomena occur on an ongoing basis, which only complicates the course of the underlying disease;
Compression of nearby organs. Naturally, the intestines swollen from an excessive amount of fluid put pressure on neighboring organs. As a rule, the bladder is exposed to pathological effects, which manifests itself in increased urination;
dyspeptic syndrome. In any case, the accumulation of fluid in the human body.

How is this condition diagnosed, and how to distinguish the accumulation of fluid in the intestine from ascites?

In the diagnosis of this process, the assessment of the general state of health is of paramount importance. That is, the person will have swollen intestines, there will be pain on palpation, tension. The occurrence of symptoms of peritoneal irritation is possible and manifests, but only these signs will not be expressed (that is, false negative). It will definitely be necessary to do an ultrasound examination of the abdominal organs and radiography with contrast (this study will be relevant only if there is every reason to suspect the occurrence of intestinal obstruction).

In addition, it will be necessary to collect an anamnesis from the patient - taking into account the fact that the accumulation of fluid in the intestine is a manifestation of some primary disease, it cannot occur by itself by definition. That is, having learned what disease struck the patient, it will be easy to guess for what reason he has an excessive flow of fluid into the intestinal lumen. Clarification of the anamnesis is a fundamental point in the differential diagnosis between excessive accumulation of fluid in the intestinal lumen and ascites. These are two completely different conditions that arise for different reasons. If infectious diseases contribute more to the flow of fluid into the intestine, then ascites occurs due to liver pathology (hepatitis, cirrhosis) - protein metabolism is disturbed, the concentration of albumin in the blood decreases and generalized exudation occurs.

When assessing the objective status of the patient, if the abdomen is enlarged and tense, there is every reason to assume the development of ascites. In confirmation of this, a violation of the structure of the venous pattern and an increase in the size of the liver will appear (with cirrhosis of the liver, its decrease will be observed).

That is, from the above information, it becomes clear that the differential diagnosis of these two conditions is of fundamental importance. This is determined by completely different approaches to the tactics of managing patients.

What are the main approaches to the treatment of the patient in this case?

Again, the method of eliminating the increased accumulation of fluid in the intestinal lumen is determined by what pathology caused this process. As mentioned above, in most cases, infectious diseases become the cause of the phenomenon in question. That is, the following therapeutic measures will be necessary:

Elimination of the pathogenic agent, due to which this process manifested itself (etiological treatment). By removing the causative factor, it will be possible to note the disappearance of all symptoms after a while. To destroy bacteria, broad-spectrum antibiotics (cephalosporins, fluoroquinolones) are used.
The treatment of a patient suffering from the accumulation of fluid in the intestines caused by malabsorption syndrome is mainly in the correction of the diet. All other components of the treatment are of additional importance.
In the event that the accumulation of fluid in the digestive system is pronounced, the treatment will be reduced to the need for therapy of the underlying disease (elimination of the causes of intestinal obstruction, for example). It will be necessary to perform surgical intervention in order to eliminate the morphological defect that obstructs the intestinal lumen and makes it difficult to remove feces and leads to fluid retention.
If it is not possible to establish the obvious cause of the accumulation of fluid, it will be necessary to perform complex tests to confirm the malabsorption syndrome.

Again, in any case, a truly effective treatment should eliminate the cause of the condition. Otherwise, the treatment will not have the desired effect.

conclusions

The definition of “fluid accumulation in the intestinal lumen” is somewhat incorrect, since, by definition, fluid does not accumulate there (even with complete obturation, the intestinal lumen cannot be completely blocked). But an increased intake of water into the lumen of the digestive canal in certain cases occurs, and often. However, in fairness, it should be noted that an increase in the water content in the large and small intestine is not in itself a life-threatening condition (except for cholera).

This condition can be diagnosed on the basis of an assessment of the general condition of the patient, a palpation examination of the abdomen. The accumulation of fluid in the intestine very rarely simulates the clinic of acute conditions.

Of great importance in this case is the differential diagnosis of fluid accumulation in the intestine with ascites. In this case, it is necessary to clearly understand that there is a complication of diseases that are completely different in nature, and the correct determination of the tactics of managing the patient is carried out just after the differential diagnosis between these two conditions.

The treatment of this condition is to eliminate the primary pathology, which is the direct cause of its occurrence. It is possible to make sure that the ongoing therapeutic measures have had the desired effect based on an assessment of the general condition of the patient.