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It is not a disease, but a symptom, sometimes spectacular. It may indicate the development of the disease or signal its very advanced stage.
Manufacturing and absorption
The name of the ailment initially explains what it is, but it does not fully exhaust it, because it is not water, but serous fluid that accumulates not in the abdomen, but in the peritoneal cavity. This cavity is the space between the parietal peritoneum, which lines the inside of the abdominal cavity, and the visceral peritoneum, which surrounds the internal organs. Serum fluid is always present in the peritoneal cavity, because it is responsible for wetting its walls, but in a healthy person its production and absorption are coordinated with each other, so there is no risk that an excess will form. However, there are a number of diseases and conditions that impair the adjustment mechanism. Serum fluid overproduction occurs, for example, as a result of complications of hypertension in the portal system of the liver; they can also be caused by neoplastic changes in the abdominal cavity.
In extreme cases, up to 20 liters of fluid can accumulate in the stomach of a sick person!
Everything flows
The simplest division of the causes of ascites is that of neoplastic and non-neoplastic diseases.
Ascites is found in over half of patients with ovarian, endometrial, colorectal, liver, pancreatic and stomach cancer. As you can see, these are tumors that are located in the abdominal cavity or in the pelvic cavity. Less frequently, but still, they are found in patients suffering from prostate cancer or malignant melanoma.
The pathological non-neoplastic processes associated with the occurrence of ascites are primarily liver cirrhosis or other liver diseases, e.g. portal vein thrombosis and cardiac circulatory failure; in addition, renal failure, nephrotic syndrome or chronic glomerulonephritis, tuberculosis, peritonitis, leukemia.
With ascites caused by liver cirrhosis, one should also take into account the possibility of spontaneous bacterial peritonitis, as a result of which the ascites fluid becomes infected with bacteria. Antibiotic therapy is then used, but the ailment may recur and, as a result of complications, even result in the patient’s death.
Although it happens that ascites is only the first sign of a malignant tumor, it is usually a bad sign that heralds the terminal stage of the disease.
It’s not good
But even after excluding the neoplastic background, ascites must not be underestimated.
– It is always an alarming symptom, because it proves that the disease, not necessarily cancerous, but e.g. liver cirrhosis or circulatory failure, has already reached a very advanced stage – says Dr. Jolanta Lewera, gastroenterologist, member of the Polish Gastroenterological Society and the Polish Hepatological Society, working at the Gastrology and Hepatology Center in Wrocław.
It should also be remembered that the diagnosis of ascites alone does not clearly determine its origin. In further diagnostics, a sample of fluid is collected through the abdominal wall of the patient for cytological and biochemical examination, or the level of specific tumor markers is examined, and if this is not enough, more invasive activities remain: laparoscopy or endoscopic ultrasound.
Tsunami in the peritoneum
Although the presence of excess fluid in the abdominal cavity seems to be a symptom that is not easy to miss, sometimes patients see their doctor late because they think that they are… just getting fat! This is confirmed by Dr. Lewer:
– Of course, with a slight ascites, it is possible to take it for ordinary weight gain. But the doctor should not be wrong. If he has doubts, he can verify them with an ultrasound.
Ascites is usually diagnosed in a clinical examination, which mainly consists of an assessment of the appearance of the abdomen, which changes with the influence of even a small amount of fluid. In the first stage, bulges appear on the sides of the abdomen, but the front part is flattened, so such a spilled abdomen is often called “frog”. As the peritoneal cavity becomes fuller, the abdomen becomes convex, smooth and taut, the navel is no longer sunken, and sometimes even protrudes outward; there is also an umbilical hernia. When there is already a lot of fluid, the symptoms are also bubbling, when the wave of fluid disturbed by palpation hits the properly positioned palm of the doctor through the skin of the abdomen.
Fluid in reverse
The management of ascites depends on many factors, mainly its cause and the amount of accumulated fluid.
– Ascites caused by cirrhosis or cardiovascular disease is treated pharmacologically and the patient is successfully treated with diuretics. In the case of cancerous ascites, it is rather unsuccessful and it is necessary to perform paracentesis – explains Dr. Jolanta Lewera.
Paracentesis is when a needle is put into a peritoneal cavity and the fluid is dropped mechanically. There are rules for the amount of liquid that is drained at one time: it is assumed that no more than two liters are removed the first time. And already when taking five liters, it is necessary to give the patient albumin or other crystalloids, which will help prevent complications, especially a drop in blood pressure.
Needle, catheter, surgery
People suffering from ascites, but with healthy kidneys and a functioning liver, may be qualified for TEN surgery, which should at least minimize the problem of fluid pooling in the abdomen.
In a terminal cancer patient, expressing fluid is no longer a cure, but only or even better quality of life: eliminating pain and reducing pressure on the diaphragm, which makes breathing difficult. The process of draining the fluid from the peritoneal cavity may then be facilitated by inserting a catheter in a patient staying at home. This is done under local anesthesia, and then the nurse can drain the fluid through it as needed. This procedure saves the patient’s precious strength.
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