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