Ascites. Causes, symptoms and signs. How to defeat the symptom of "Medusa Gorgon" - a red-blue mesh of capillary patterns What does the head of a medusa mean in medicine

Which instead of hair is covered with wriggling snakes)

expansion of the saphenous veins of the anterior abdominal wall with serpentine branching around the navel; observed with portal hypertension.

1. Small Medical Encyclopedia. - M .: Medical encyclopedia. 1991-96 2. First aid. - M .: Great Russian Encyclopedia. 1994 3. Encyclopedic Dictionary of Medical Terms. - M .: Soviet encyclopedia. - 1982-1984.

Synonyms:

See what "Medusa's Head" is in other dictionaries:

HEAD OF MEDUSA - (caput Medusae), the designation given to the convoluted dilated subcutaneous venous vessels of the anterior abdominal wall, observed with obstruction of the portal circulation [see. dep. tab. (to the station Granulomas), fig. four]. They are named so because they resemble ... Big medical encyclopedia

Noun., Number of synonyms: 1 algol (2) ASIS synonym dictionary. V.N. Trishin. 2013 ... Synonym dictionary

- (caput Medusae; Medusa is a mythical monster whose head is covered with wriggling snakes instead of hair) expansion of the saphenous veins of the anterior abdominal wall with serpentine branching around the navel; observed in portal hypertension ... Large Medical Dictionary

Astrophytum jellyfish head ... Wikipedia

Gorgon head is an expression associated with the severed head of the Gorgon Medusa by Perseus and is used in various meanings. In a figurative sense, a symbol of something terrible (the gaze of the mythological head turned those who looked at her to stone and after ... ... Wikipedia

The head of Medusa, severed by Perseus and placed in Minerva's shield. An explanation of the 25,000 foreign words that have come into use in the Russian language, with the meaning of their roots. Mikhelson A.D., 1865 ... Dictionary of foreign words of the Russian language

This term has other meanings, see Medusa (disambiguation). This term has other meanings, see Gorgons ... Wikipedia

- "Medusa", Caravaggio, 1598 99, Uffizi. The image of the severed head of the Gorgon Gorgon Medusa (Greek Μέδουσα, more precisely Medusa "guard, protector, mistress") is the most famous of the Gorgon sisters, a monster with a woman's face and snakes instead of hair ... ... Wikipedia

- (Γοργόνες). Three terrible monsters, one look at which turned people to stone: Euryale, Sfenyu and Medusa. They were the daughters of Forkis and Keto. Their heads were covered with snakes instead of hair, they had wings, terrible teeth and claws. Of the three Gorgons, one ... ... Encyclopedia of mythology

Books

Head of Medusa, King Stephen, Barker Clive, Campbell Ramsey. 20 stories that will make your heart stop with overwhelming horror From the acclaimed masters of the genre Howard Philips Lovecraft, Stephen King, Robert Aikman, Richard Matheson, Charlotte Perkins ...

Are you familiar with the story of Medusa Gorgon, a mythical fury that is merciless and deadly? Now a symptom is named after her, which medicine classifies as a terrible disease, in the spirit of that very fabulous jellyfish. When the skin of your legs is "painted" in a red-blue mesh of capillary patterns, it means that the body signals about circulatory disorders and warns that you are overtaken by varicose veins (albeit at the initial stage).

If in the abdomen there are the same intricate patterns named after the mythical character "the head of a jellyfish", you need to urgently consult a doctor. This suggests that your liver is very seriously affected and that irreversible changes are taking place in its tissues.

The “jellyfish head” symptom, like the capillary nets on the legs, is a kind of “fatal seal” - a sign of venous insufficiency. Since all the "garbage" from the liver is dumped through a very thick vessel, the portal vein, the outflow through it becomes poor, and stagnation begins in the liver. One of the most important glands of our body ceases to get rid of harmful substances, and they poison the liver itself and the whole body, because they are not excreted, but endlessly circulate inside us along with the blood.

The liver is a purifying filter and barrier for everything that should not enter our circulatory system and, accordingly, our organs. After all, the food and drinks that we consume, being absorbed through the intestinal wall into the blood, are necessarily sorted in the liver - they pass a kind of test for "usefulness". Poisons and slags, of course, must be discarded. But this happens only within the framework of a healthy lifestyle, which only a few can now boast of. Ordinary mortals disregard all the commandments of Hippocrates, and, not sparing their liver, abundantly fill the stomach with everything that pleases its owner so much:
fatty pieces of fried meat, smoked meats, sausages and cheeses, "seasoned" with saltpeter and other preservatives, completing this "toxic feast" with excessive doses of alcohol.
Unfortunately, the liver cannot signal that it is time to stop. It is not for nothing that it is called the most "silent" organ, since it has no nerve endings and its pain signals cannot enter our brain. But sooner or later it still fails, its cells begin to suffer and even irrevocably die; toxic hepatitis develops and all the consequences arising from it. The classic signs of problems in the hepatic kingdom are weakness and constant lethargy. The same depression is very typical for a situation of binge or overeating.

To understand that your liver is sick, you just need to look at the results of blood biochemistry. This analysis will overestimate the so-called "liver function tests". However, if the capillaries "streaked" your stomach, then even without analysis it is already clear that the liver is not in order! After all, usually the symptoms of liver failure are not so obvious. Therefore, you can cut off the "head of a jellyfish" in its very embryo, it is enough to start cleaning the liver in time. Nutraceutical Hepacept will start the process of natural self-cleaning of liver cells and relieve chronic inflammation.

Take care of your liver!

Based on materials from http://www.medicus.ru

This case took place at Digestive Care Associates, Peoria, with a 43-year-old man who is infected with hepatitis C virus and has a long history of alcohol abuse. He was hospitalized with signs of ascites and edema. (Note: Ascites is a condition in which large amounts of free fluid appears in the abdominal cavity.liver cirrhosis in 75%, malignant neoplasms - in 10%, heart failure in 5% of cases. Clinically, patients have bloating and progressive weight gain). Over the past year, the patient drew attention to the progressive enlargement of the abdominal veins, which made him go to the clinic. When examined by a doctor, the patient revealed: palmar erythema, enlargement of the parotid glands, edema of the extremities, hepatosplenomegaly, ascites and a pathological venous network on the abdominal wall, which arose against the background of portal hypertension - "the head of a medusa" (see photo) - so named because the convoluted dilated saphenous veins resemble the image of the head of the mythological Medusa the Gorgon, in which wriggling snakes grew from the head instead of hair (she was portrayed by the artist Peter Paul Rubens "Head of Medusa the Gorgon"). Ultrasound examination of the abdominal organs revealed ascites, hepatosplenomegaly, liver cirrhosis - they were the main reasons for the recanalization of the umbilical veins. These signs of the disease significantly impede the passage of blood through the liver, as a result of which severe congestion develops in all the veins of the abdominal cavity and the phenomenon of abdominal dropsy or ascites occurs. But such stagnation in the portal vein is trying to be compensated by the development of a colateral outflow of blood through the anastomoses of the portal vein with the veins of the esophagus, as well as through the preserved lumen of the umbilical vein or w. paraumbilicales, located in the round ligament of the liver, from where the blood is directed through the saphenous veins of the anterior abdominal wall into the subclavian vein, which gives the clinic for the expansion of the serpentine convoluted saphenous veins of the abdomen. The patient received a course of moderate doses of oral diuretics. Over the next three months, the patient continued diuretic therapy.

They develop secretly, so there are practically no symptoms of the disease. The first external signs of liver cirrhosis appear already in the later stages, when the disease has struck significant areas of the organ. The main external manifestations are associated with a change in the color of the face, palms, atrophy of the muscles and phalanges of the fingers. In the event of cirrhosis complicated by ascites, an enlarged abdomen appears, the mammary glands become denser in women and increase in men, hair on the abdomen, pubis and legs falls out, and the limbs swell greatly.

In the early stages, cirrhosis "does not show" itself, but as it develops, it affects the color and shape of the integument, swells the stomach.

External signs of liver cirrhosis

Along with general symptoms such as pain in the right hypochondrium, colic, nausea with vomiting, decreased muscle tone and strength, pruritus, diarrhea and exhaustion, cirrhotic patients greatly change in appearance. It is the visual signs that are specific to cirrhosis.

The most characteristic external manifestations of cirrhotic liver damage are as follows:

jaundiced skin tone;
drying out of the dermis with severe peeling;
xanthelasm - yellow-brown age spots around the eyes;
thickening of the fingers on the upper limbs with swelling of the lower and obvious swelling of the joints;
vascular "asterisks" and "cobwebs" on the abdomen, limbs, joints;
swelling of the tongue.

At the terminal, last stage, most cirrhotic patients develop ascites - an excess accumulation of fluid in the abdominal cavity. The main symptom of this complication is an enlarged abdomen with a pronounced network of vessels, similar to the "head of a jellyfish". At the same time, the skin is smooth, mirror-like, without hair growth.

Some of the signs indicate concomitant diseases that developed against the background of cirrhosis.

Face

The first external manifestations of cirrhosis are visible on the face, which becomes very emaciated and different:

unhealthy subicteric skin tone with bright scarlet, unnatural lips;
prominent cheekbones with erythema and capillary dilation;
dark brown circles under the eyes;
smooth, translucent skin, which, due to dryness, peels off and seems wrinkled.

Changes in the skin of the facial part and vascular blood networks cannot be hidden by cosmetics, and dryness is not eliminated by creams of any fat content.

Leather

With cirrhosis of the liver, the skin suffers greatly. Numerous rashes of a different nature are formed on it, the shade becomes icteric. The skin dries out constantly, so it itches a lot, wrinkles and flakes. This sensation is associated with an excess of the level of bile components in the blood due to obstructive liver damage. Antihistamines and a diet rich in unsaturated fatty acids and cholestyramine can help reduce itching.

Along with a variety of hives-like rashes, cirrhosis causes "stars" to appear on the skin in the upper body, which is associated with dilated blood vessels. The skin of the palms and feet undergoes a strong visual change, which becomes unnaturally red. This symptom is called erythema palmar. Sometimes redness is observed on the folds of the phalanges of the fingers.

With inflammation of the liver, the skin loses its elasticity, itches, turns yellow.

Pigment spots gradually appear on the body, which turn pale when pressed, but quickly return as the pressure ceases. Purpura also develops, which is characterized by a small hemorrhagic rash. The symptom manifests itself on the lower limbs and legs.

If the hepatobiliary system has been affected, dirty gray patches appear on large areas of the skin. With secondary hormonal disorders, atrophic stripes appear in the thighs on the legs, on the buttocks and in the lower abdomen.

With cirrhosis, blisters, superficial scars and other age spots may appear on exposed skin.

Jaundice

A characteristic sign of progressive cirrhosis is an icteric color of the skin, mucous membranes and eye sclera. The condition is associated with the loss of the ability of the affected organ to recycle bilirubin. This substance begins to be released into the blood and urine, so the skin turns yellow, and the fluid emitted by the urine darkens.

Tongue

In the last stages, this organ in people with cirrhosis acquires an unnaturally bright red hue. As the condition worsens, the color darkens to a purple hue. The organ dries up and swells, which signals the development of liver failure.

Vascular spiders

This term is called a condition in which the subcutaneous vessels dilate strongly, which is manifested by the appearance of a cobweb from the vessels or spider veins. A spider web is an uncharacteristic accumulation of veins, which is localized on the skin of the trunk, face, arms.

Inflammation of the liver makes itself felt by the formation of blood cobwebs on the skin.

When pressing on the angioma in the center, the red dot "asterisk" - the central arteriole - will pulsate. As the blood diverges through the capillaries, the point will fade.

Vascular "asterisks" signal serious liver damage. However, the symptom can manifest itself not only with illness, but also during pregnancy, severe malnutrition, and in healthy people.

Xanthomas

This term refers to changes in the skin caused by a violation of lipid metabolism. Xanthomas are yellowish, soft plaques localized around the eyes on the eyelids. This symptom often develops in women with cirrhosis.

Redness of the palms

A specific external manifestation of cirrhosis is redness of the palms, which are also called hepatic or erythremal. The symptom is outwardly similar to a pronounced spotty red rash. Redness is localized mainly on the outside of the palm in the direction from the thumb to the little finger. The condition is associated with a change in hormone metabolism, vascular changes against the background of cirrhosis.

Other diseases manifested by this symptom are as follows:

rheumatoid arthritis;
hyperthyroidism;
cancer of the blood.

The palms can turn red in a pregnant woman due to hormonal changes.

Nails

Inflammation of the liver also harms the human cornea.

With cirrhosis of the liver with massive obstruction, the nails are severely affected. Changes in the structure of the nail plate are associated with severe metabolic disorders, poor protein synthesis and insufficient absorption of vitamins with minerals. Against this background, the nail plate is destroyed at the cellular level due to a violation of the maturation processes of the base. With the gradual destruction of liver tissue and the appearance of persistent dysfunction, the nails become:

thin, fragile;
grow poorly;
covered with whitish spots and stripes of different sizes.

There are several states:

Milky nails, when the plate becomes a solid white shade with an inconspicuous nail hole. The root cause of the symptom is a violation of the production of keratin, a protein that is involved in the maturation of the nail.
Mürke lines, when whitish stripes appear on the plate, running parallel to its hole. This is due to a decrease in the concentration of albumin produced by the liver.
Terry's nails, when the lower half of the nail becomes dark in color, and the upper half is light milky. It is caused by the developed edema and weakness of the blood circulation. Between these zones, a pink or brown strip is formed on the plate, the width of which is 0.3-0.5 mm.

"Hour glasses", when the nails become convex and too smooth, mirrored. It is caused by the replacement of healthy tissue between the bone and the nail connective plate.

Phalanges

The condition is called "drumsticks", when the terminal phalanges round and swell, and the nail plate bulges out. The muscle part of the long phalanx gradually "shrinks", and the joint swells. The toes become hooked.

The root causes of the development of symptoms are:

metabolic disorders under the influence of severe liver damage;
oxygen starvation due to impaired blood circulation in the terminal phalanges and the appearance of anastomoses to improve blood flow.

Drum sticks often indicate the development of biliary liver disease.

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The site provides background information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. A specialist consultation is required!

What is ascites?

Ascites - This is the accumulation of fluid in the abdominal cavity, manifested by an increase in the size of the abdomen and a number of other symptoms. Ascites is not an independent disease, but only a manifestation of various diseases and pathological conditions that have led to a violation of the regulation of fluid exchange in the body. Nevertheless, the appearance of fluid in the abdominal cavity is always a sign of a severe course of the disease and a violation of the regulatory and compensatory reactions of the body.

Development (pathogenesis) of ascites

The abdominal cavity is a closed space bounded by the peritoneum (a thin semi-permeable membrane) and containing various organs (stomach, spleen, liver, gallbladder and some parts of the intestine). The peritoneum consists of two sheets - parietal (external, which is attached to the walls of the abdomen from the inside) and visceral (internal), which is adjacent to the walls of the intra-abdominal organs, surrounding them. The main functions of the peritoneum are the fixation of the organs located in it and the regulation of metabolism in the body.

The peritoneum contains a huge number of small blood and lymph vessels that provide metabolism. Under normal conditions, a small amount of fluid is constantly present in the abdominal cavity and between the sheets of the peritoneum, which is formed as a result of sweating of the liquid part of the blood and a certain amount of proteins through the blood vessels. However, this fluid does not accumulate in the abdominal cavity, since it is almost immediately reabsorbed into the lymphatic capillaries (the peritoneum can absorb more than 50 liters of fluid per day). The resulting lymph through the lymphatic vessels enters the venous system of the body, returning fluid, proteins and other microelements dissolved in it into the systemic circulation.

Based on the foregoing, it follows that the accumulation of fluid in the abdominal cavity can occur in two cases - with an increase in the rate of its formation or with a decrease in the rate of its absorption. In practice, these two mechanisms are present simultaneously, that is, with various diseases of the internal organs (liver, pancreas, tumors, inflammation of the peritoneum, and so on), an increase in fluid production occurs, which will certainly entail a violation of its reabsorption (absorption) as a result of compression and blockage of small lymphatic and blood vessels by cellular debris, pathogenic microorganisms or tumor cells. As the disease develops, the fluid in the abdominal cavity becomes more and more, and it begins to squeeze the organs located there, which, in turn, can aggravate the course of the underlying disease and contribute to the progression of ascites.

It is also worth noting that in addition to fluid, proteins (as well as other trace elements) are retained in the abdominal cavity. Under normal conditions, blood plasma proteins (mainly albumin) are involved in creating the so-called oncotic pressure, that is, they retain fluid in the vessels. With ascites, a large proportion of proteins are in the ascites fluid, and therefore the oncotic blood pressure decreases, which can also contribute to the release of fluid from the vascular bed and the progression of the disease.

With the progression of the disease, the volume of circulating blood decreases, since most of the fluid accumulates in the abdominal cavity. This leads to the activation of compensatory mechanisms aimed at water retention in the body (in particular, the rate of formation and excretion of urine decreases), which further increases the hydrostatic pressure in the blood vessels and also contributes to the formation of ascitic fluid.

Causes of ascites

There can be many causes of ascites, but they are all somehow associated with a violation of the outflow of blood and lymph from the peritoneum or abdominal organs.

The causes of ascites can be:

liver cancer;
disease (syndrome) of Budd-Chiari;
compression of the portal vein;

oncological diseases (tumors);
kidney disease;
anasarka;
violation of lymph circulation (chylous ascites);
fetal developmental disorders;
childhood diseases;

Ascites in liver cirrhosis

Cirrhosis of the liver is a chronic disease in which the structure and almost all functions of this organ are disrupted, which leads to the emergence and progression of various complications.

Under normal conditions, blood from many internal organs (from the stomach, spleen, pancreas, small and large intestines) flows into the liver through the portal (portal) vein. In the liver, it passes through the thin tubules (hepatic sinusoids), where it is filtered, cleansed and enriched with various substances (for example, proteins), after which it enters the inferior vena cava and returns to the systemic circulation. In cirrhosis, a large number of hepatocytes (liver cells) are damaged and destroyed by various causative factors (such as hepatitis B or C viruses). Dead cells are replaced by fibrous tissue, which significantly reduces liver function. This, in turn, leads to the activation of compensatory mechanisms, consisting in the enhanced division of the remaining (undamaged) cells. However, the structure of the newly formed tissue is disturbed (in particular, there are no sinusoids characteristic of a normal liver), as a result of which the filtration capacity of the organ decreases (that is, the amount of blood that can pass through the liver per unit of time decreases).

Dysfunction of the liver, as well as a change in its structure, leads to the fact that the blood cannot be filtered in full, as a result of which it begins to accumulate in the portal vein. As the disease progresses, hydrostatic pressure (that is, the pressure exerted by blood on the vessel wall) in the portal vein increases (portal hypertension develops), which disrupts the process of blood outflow from internal organs (stomach, intestines, and others). As a result of stagnation of blood in them there is an expansion of blood vessels and an increase in the permeability of the vascular walls, which leads to sweating of part of the fluid into the abdominal cavity.

It is also worth noting that the liver is the main site of protein production in the body. In the later stages of the disease (when most of the hepatocytes are replaced by fibrous tissue), the protein-forming function of the liver decreases, as a result of which hypoproteinemia develops (a lack of proteins in the blood). This, in turn, leads to a decrease in oncotic blood pressure, which also contributes to the release of part of the fluid from the vascular bed.

Ascites in liver cancer

Liver cancer is a neoplastic disease that leads to damage to the structure of the liver and disruption of all its functions. Various environmental factors (radiation, toxins, viruses, and so on) can contribute to the development of cancer, under the influence of which the formation of mutant tumor cells occurs. Usually, such cells are immediately detected by the body's immune system and destroyed, however, under certain conditions (for example, when immunity is weakened or when exposed to a large dose of radiation), one tumor cell can survive and begin to divide continuously (endlessly).

Over time, the tumor grows in size and can compress large intrahepatic vessels. Also, cancer cells can break away from the main tumor and move (metastasize) to other parts of the organ, blocking the hepatic sinusoids, blood and lymphatic vessels and bile ducts. This will lead to impairment of all liver functions, increased pressure in the portal vein and the development of ascites.

Ascites in other liver diseases

In addition to cirrhosis and cancer, there are several other pathologies that can disrupt blood circulation in the liver and portal vein and cause fluid to escape into the abdominal cavity.

Ascites can be caused by:

Mesothelioma. This malignant neoplasm is extremely rare and originates directly from the cells of the peritoneum. The development of a tumor leads to the activation of the immune system in order to destroy tumor cells, which is manifested by the development of an inflammatory process, expansion of blood and lymphatic vessels, and sweating of fluid into the abdominal cavity.
Carcinomatosis of the peritoneum. This term refers to the defeat of the peritoneum by tumor cells that metastasize into it from tumors of other organs and tissues. The mechanism of development of ascites is the same as in mesothelioma.
Pancreas cancer. The pancreas is the site of the formation of digestive enzymes, which are secreted from it through the pancreatic duct. After exiting the gland, this duct merges with the common bile duct (through which bile leaves the liver), after which they together flow into the small intestine. The growth and development of a tumor near the confluence of these ducts can lead to a violation of the outflow of bile from the liver, which can manifest itself as hepatomegaly (an increase in the size of the liver), jaundice, pruritus and ascites (ascites develops in the later stages of the disease).
Ovarian cancer. Although the ovaries do not belong to the abdominal organs, the sheets of the peritoneum are involved in fixing these organs in the small pelvis. This explains the fact that in ovarian cancer, the pathological process can easily spread to the peritoneum, which will be accompanied by an increase in the permeability of its vessels and the formation of effusion in the abdominal cavity. In the later stages of the disease, metastasis of cancer to the sheets of the peritoneum may occur, which will increase the release of fluid from the vascular bed and lead to the progression of ascites.
Meigs syndrome. This term refers to a pathological condition characterized by the accumulation of fluid in the abdominal and other cavities of the body (for example, in the pleural cavity of the lungs). Tumors of the pelvic organs (ovaries, uterus) are considered the cause of the disease.

Ascites in heart failure

Heart failure is a disease of the heart in which it is unable to provide adequate blood circulation in the body. Under normal conditions, with each heartbeat, a certain amount of blood is thrown into the aorta (the largest artery in the body). As you move away from the heart, the aorta divides into smaller arteries until capillaries are formed - the thinnest vessels in which oxygen is exchanged between tissues and cells of the body. After passing through the capillaries, the blood is collected in the veins and transported back to the heart. Part of the fluid (about 10%) enters the lymphatic vessels and turns into lymph.

An important feature of the vascular system is that the wall of the arteries is dense and elastic, while the venous wall is relatively thin and easily stretches with increasing intravascular pressure. With the development of heart failure (which can be caused by a heart attack, infection, prolonged increase in blood pressure, and so on), the pumping function of the heart muscle decreases, as a result of which stagnation develops in the inferior vena cava system, which collects blood from the entire lower body. Due to the expansion of the walls of overcrowded venous vessels, as well as due to an increase in hydrostatic pressure, a certain proportion of the liquid part of the blood leaves the vascular bed and accumulates in the abdominal cavity.

Ascites in kidney disease

The kidneys are organs of the excretory system that regulate the composition and volume of fluid in the body. However, in some diseases, their function may be impaired, which, in turn, can lead to the development of various complications.

Ascites can be complicated by:
Renal failure
A pathological condition in which more than 75% of the functional tissue (so-called nephrons) of the kidneys is affected. As a result, the organ can no longer fully perform its excretory function, so some of the by-products of vital activity (such as urea, uric acid and others) are retained in the body. These substances are osmotically active (that is, they attract liquid to themselves) and, when they penetrate into the intercellular space of tissues, they lead to the development of edema.

Also, with renal failure, the blood supply to the renal tissue is disrupted, as a result of which compensatory mechanisms are activated aimed at increasing systemic blood pressure and increasing the amount of blood delivered to the kidneys. Along with this, the rate of sodium and water excretion in the kidneys decreases, which further increases the volume of circulating blood, increases the pressure in the venous system and promotes the progression of ascites.

Nephrotic syndrome
This disease is characterized by damage to the renal filter (which is normally impermeable to proteins and other large molecular substances), as a result of which the body loses a large amount of plasma proteins in the urine (more than 3 grams per day). Within a few days, this leads to a significant decrease in the oncotic blood pressure, as a result of which its liquid part can no longer be retained in the vascular bed and sweats into the abdominal cavity, leading to the development of ascites.

Ascites with pancreatitis

Pancreatitis is a disease of the pancreas, characterized by the destruction of its tissue and the spread of the pathological process to neighboring organs. The reason for the development of this disease is the pathological activation of the digestive enzymes formed in the gland. Normally, they are released into the intestines in an inactive form and are activated only after mixing with intestinal contents. In various pathological conditions (with alcohol abuse, after eating a large amount of fried food, after an abdominal injury or as a result of viral infections), these enzymes can be activated right inside the gland, which will lead to its self-digestion.

During the described process, damage to the vessels of the pancreas occurs, which causes the penetration of digestive enzymes into the blood. If treatment is not started on time, the pathological process can destroy the wall of the gland and move to the peritoneum, which will cause the development of peritonitis (inflammation of the peritoneum) and can lead to the formation of ascitic fluid in the abdominal cavity.

Ascites with peritonitis

Peritonitis is an inflammation of the peritoneum, characterized by severe abdominal pain and progressive symptoms of general intoxication of the body (an increase in body temperature of more than 40 degrees, rapid breathing and heartbeat, impaired consciousness, and so on). This condition develops when pathogenic bacteria enter the abdominal cavity from the outside.

The cause of peritonitis can be:

rupture of a hollow organ (stomach, intestines, urinary or gall bladder);
penetrating wound of the abdominal cavity;
perforation of a stomach or intestinal ulcer;
disintegration of an intestinal tumor with damage to its wall;
migration of bacteria from other foci of infection;
spread of the inflammatory process from neighboring organs.

As stated earlier, the peritoneum contains a large number of blood and lymph vessels. With the development of an infectious or other inflammatory process, a large number of leukocytes migrate to the focus of inflammation, which causes the expansion of blood vessels and the release of fluid into the abdominal cavity.

It is also worth noting that the spread of infection along the peritoneum occurs rather quickly, which is why local (local) peritonitis in a short time can turn into a diffuse (widespread) form that affects the entire peritoneum, which, without timely and adequate treatment, can lead to the death of the patient within a few hours.

Ascites with anasarca

Anasarka is an extreme degree of edema, in which fluid accumulates in the subcutaneous fatty tissue of the trunk, arms and legs, as well as in the body cavities (in the abdominal and pleural cavities, in the pericardial cavity). This condition requires urgent medical attention, as it can lead to the death of the patient in a matter of hours or days.

Anasarka can be caused by:

Heart failure. In this case, edema and ascites develop due to a pronounced increase in hydrostatic pressure in the venous and lymphatic systems, which is due to the inability of the heart muscle to pump blood.
Renal failure With this pathology, the cause of water retention in the body is a violation of the excretory function of the kidneys.
Liver disease. With severe cirrhosis and liver failure, the concentration of proteins in the blood decreases, which can cause the development of generalized edema.
Myxedema. It is characterized by a decrease in the concentration of thyroid hormones in the blood (thyroxine and triiodothyronine), which is manifested by a decrease in the amount of proteins formed in the body and leads to the release of fluid from the vascular bed.
Hyperaldosteronism. This disease is characterized by excessive production of the hormone aldosterone in the adrenal glands (endocrine glands). Under normal conditions, this hormone is responsible for maintaining the volume of circulating blood at a constant level, however, with its excessive secretion, a pronounced retention of sodium and water in the body occurs, which contributes to the development of edema and ascites.

Chylous ascites

This disease is characterized by the accumulation of a milky white, shiny fluid in the abdominal cavity, in which the concentration of fats is increased. The reason for this is a violation of the outflow of lymph from the peritoneum, which is usually associated with squeezing or blocking the lumen of the thoracic lymphatic duct, which collects lymph from the entire lower body.

Also, the reason for the release of lymph into the abdominal cavity can be:

injury to large lymphatic vessels;
abnormalities in the development of the abdominal organs;
previous abdominal surgery;
tumor diseases (systemic lymphangiosis);
chronic inflammatory bowel disease.

Ascites in the fetus

The accumulation of fluid in the abdominal cavity of the fetus can be due to various pathologies of the mother or child.

The cause of ascites in the fetus can be:

Hemolytic disease of the newborn. This disease develops when a mother with a negative Rh factor (Rh factor is a special antigen that is present on red blood cells in certain people) carries a fetus with a positive Rh factor. During the first pregnancy, there will be no deviations from the norm, however, during childbirth, the blood of the mother and the fetus will contact, which will lead to sensitization of the maternal body (antibodies against the Rh factor will begin to be released in it). With repeated pregnancy with an Rh-positive fetus, these antibodies will begin to infect the fetal blood cells, disrupting the functions of all its organs and tissues and leading to the development of generalized edema and ascites. Without timely treatment, this disease leads to fetal death.
Genetic diseases. The human genetic apparatus consists of 46 chromosomes, formed as a result of the fusion of 23 maternal and 23 paternal chromosomes. Damage to one or more of them can manifest itself in various diseases that can be transmitted to offspring. Ascites in the prenatal period can be a manifestation of Down syndrome (in which an extra chromosome appears in 21 pairs), Turner syndrome (which is characterized by a defect in the sex X chromosome) and other hereditary diseases.
Intrauterine developmental anomalies. Prenatal developmental abnormalities can be caused by infection, radiation, or trauma. In this case, ascites can occur due to a violation of the normal development of the liver, cardiovascular or lymphatic system, with underdevelopment of the biliary system and with other malformations.
Damage to the placenta. The placenta is an organ that appears in the body of a pregnant woman and provides life (delivery of oxygen and nutrients) to the fetus during the entire intrauterine period of development. Violation of the outflow of blood from the placenta or umbilical cord can increase the pressure in the circulatory system of the fetus, thereby creating the prerequisites for the development of edema and ascites.

Ascites in children

All of the above causes of ascites in adults can also occur in childhood. However, in newborns and young children, ascites can be caused by other diseases.

Ascites in children can be caused by:

Heart defects. In this case, anomalies in the development of the heart muscle are meant, which lead to a violation of the pumping function of the heart (valve defects, defects of the interventricular and interatrial septa). In the prenatal period, these abnormalities may not manifest themselves in any way, however, after birth (when the load on the heart increases), edema, ascites and other signs of heart failure may develop.
Kidney malformations. In the prenatal period, the placenta performs the excretory function, therefore, even with severe anomalies in the development of the renal system, signs of renal failure in the fetus may be absent. After the birth of a child, toxic substances and metabolic products accumulate in the blood and tissues of the baby, which can lead to the development of edema and ascites.
Infectious diseases. Infection of the fetus with various viruses (rubella, herpes, cytomegalovirus, enterovirus) or bacteria (for example, in syphilis) can lead to damage to internal organs and the development of multiple organ failure. This can be manifested by ascites, which appears in the prenatal period or immediately after the birth of the child.
Tumors. Neoplasms in newborns are extremely rare, since time is needed for the development of the tumor process and the growth of the tumor. However, the appearance of a tumor (malignant or benign) in the prenatal period or in early childhood is possible. A growing tumor can compress the child's blood or lymphatic vessels, damage various organs and tissues (liver, spleen), which can lead to the development of ascites from the first days of life.
Congenital anemia. Anemia is the general name for conditions characterized by a decrease in the concentration of red blood cells (red blood cells) and hemoglobin (the respiratory pigment in red blood cells) in the blood. Some types of anemias (sickle cell anemia, hemoglobinopathies, anemia with enzyme deficiency, and so on) are characterized by deformation and destruction of red blood cells. They are destroyed mainly in the liver and spleen, which can eventually lead to damage to these organs and the development of edema and ascites.

Ascites during pregnancy

Ascites in pregnant women can develop as a result of various diseases of the liver, heart, kidneys and other organs and systems. Also, the accumulation of fluid in the abdominal cavity is facilitated by the growth and increase in the size of the fetus, which can compress the inferior vena cava (a large vessel that collects venous blood from the entire lower body).

The growth and development of the fetus in itself requires more intensive work from all organs and systems of the female body. The accumulation of fluid in the abdominal cavity and an increase in intra-abdominal pressure further increases the load on the organs, which can lead to the decompensation of chronic diseases and the development of multiple organ failure, which threatens the health or even the life of the mother and the fetus.

The most formidable manifestations of ascites in pregnant women can be:

Respiratory failure. Enlargement of the uterus in late pregnancy displaces the diaphragm (the main respiratory muscle that separates the abdominal cavity from the chest) upward, which leads to a decrease in the tidal volume of the lungs. The appearance of a large amount of fluid in the abdominal cavity further exacerbates this process, which leads to a lack of oxygen in the blood of the mother and fetus.
Heart failure. As mentioned, the growth and development of the fetus leads to increased pressure in the abdominal cavity. As a result, blood pressure rises in the blood vessels located there. To overcome this pressure, the heart is forced to work in an increased mode. The appearance of ascites in late pregnancy further increases the burden on the heart, which can lead to dysfunction. This, in turn, can lead to insufficient blood supply to the placenta and cause intrauterine fetal death.
Compression of the growing fruit. With ascites, the amount of fluid accumulating in the abdominal cavity can reach several tens of liters. This will lead to a pronounced increase in intra-abdominal pressure and compression of all internal organs, including the uterus with a developing fetus. As a rule, this condition makes it impossible for the further development of pregnancy.

Hemorrhagic ascites

With hemorrhagic ascites, red blood cells (erythrocytes) are present in the ascitic fluid in varying amounts. As a rule, this condition develops against the background of existing chronic diseases that have caused the formation of ascites (liver cirrhosis, cancer, tuberculosis).

The cause of hemorrhagic ascites can be:

liver injury;
spleen injury;
bleeding when the tumor decays;
thrombosis (blockage by a blood clot) of the hepatic veins;
perforation (perforation) of the intestinal wall (for example, with an ulcer).

The appearance of blood in the ascitic fluid is an unfavorable prognostic sign and requires urgent diagnostic and therapeutic measures.

Tuberculous ascites

Tuberculosis is an infectious disease that affects the lungs, intestines, and other organs. The disease is caused by mycobacterium tuberculosis, which enter the body mainly by airborne droplets (by inhaling air contaminated with a pathogen) or with food. The primary focus of tuberculosis is usually localized in the lung tissue, less often in the intestine. As the disease progresses and with a decrease in the body's defenses, mycobacteria can spread from the primary focus to other tissues, including the peritoneum.

The defeat of the peritoneum with tuberculosis leads to the development of a specific inflammatory process (peritonitis), which is manifested by the expansion of blood vessels and the sweating of a large amount of fluid, lymph and proteins into the abdominal cavity.

Ascites with endometriosis

Endometriosis is a disease in which the endometrium (the lining of the uterus) grows in atypical places for it (that is, in other organs and tissues). The cause of the disease can be a violation of the hormonal background of a woman, as well as a hereditary predisposition.

Initially, the endometrial cells go beyond the uterine mucosa and penetrate into its muscle layer, starting to divide there. During the menstrual cycle, they (like the normal endometrium) undergo certain changes, which can lead to the development of bleeding. In the later stages of the disease, endometrial cells extend beyond the uterus and can affect any organs and tissues, including the peritoneum. In addition to other symptoms (abdominal pain, urinary disorders, etc.), this can be manifested by the accumulation of fluid in the abdominal cavity.

Ascites and pleurisy

Pulmonary pleura is called a thin connective tissue membrane, which consists of two sheets - outer and inner. The outer layer is adjacent to the inner surface of the chest, and the inner one envelops the lung tissue. Between these sheets there is a slit-like space (pleural cavity), which contains a small amount of fluid necessary to ensure that the sheets slide relative to each other during breathing.

Pleurisy is an inflammation of the layers of the pulmonary pleura, which is usually accompanied by the sweating of fluid into the pleural cavity. Ascites and pleurisy can simultaneously be observed in systemic inflammatory diseases of an autoimmune nature (when the immune system attacks the cells and tissues of its own body) - in rheumatic fever, systemic lupus erythematosus, rheumatoid arthritis, and so on. It is worth noting that with these diseases, there may also be an accumulation of fluid in the pericardial cavity (cardiac sac).

Ascites symptoms

Symptoms of ascites largely depend on the underlying disease that caused it. So, for example, with liver diseases, the patient will complain of indigestion, frequent bleeding (the main factors of the blood coagulation system are formed in the liver), and so on. With kidney disease, symptoms of urinary disorders and signs of intoxication of the body by metabolic by-products may come to the fore. With heart failure, patients will complain of increased fatigue and a feeling of lack of air (especially during physical exertion).

However, regardless of the cause of the occurrence, the accumulation of fluid in the abdominal cavity will always manifest itself with certain symptoms, the identification of which will make it possible to suspect a diagnosis in the early stages of the disease.

Ascites may be accompanied by:

swelling;
an increase in body temperature;
abdominal pain;
an increase in the size of the abdomen;
enlargement of the liver;
enlargement of the spleen;
"The head of a jellyfish";
jaundice;

Swelling with ascites

Edema in ascites develops as a result of the release of fluid from the vascular bed and its transition into the intercellular space of various tissues. The mechanism of formation and the nature of edema depends on the underlying disease that caused ascites.

Swelling with ascites can be the result of:

renal failure (renal edema);
heart failure (cardiac edema);
liver failure (protein-free edema).

Renal edema
Renal edema occurs due to water retention and osmotically active substances in the body. They (edema) are symmetrical (observed in both parts of the body), are constantly present, however, they can increase in the morning hours, since a large amount of fluid and toxic substances accumulates in the body during a night's sleep. At first, edema is localized mainly in the face, neck, upper extremities, then descends to the hips and legs. The skin in the area of \u200b\u200bedema has a normal or slightly elevated temperature, and pallor of the skin may be noted. With prolonged (for 20 - 30 seconds) pressure on the edematous tissues, a depression is formed, which disappears immediately after the pressure is released.

Cardiac edema
Cardiac edema develops when the heart cannot pump blood from veins into arteries. They appear mainly in the evening, at first they are localized in the area of \u200b\u200bthe feet and legs, and then rise to the area of \u200b\u200bthe thighs and trunk. This is explained by the fact that during the day a person is in an upright position for a long time, as a result of which the hydrostatic pressure in the veins of the lower extremities increases significantly and blood stagnation develops in them. This leads to the release of fluid from the vessels into the intercellular space.

The skin in the area of \u200b\u200bcardiac edema is bluish in color, cold to the touch. With prolonged pressure, the resulting depression disappears slowly.

Protein-free edema
With a deficiency of proteins, the liquid part of the blood flows into the intercellular space, which is manifested by extremely pronounced, generalized (observed in all parts of the body) edema. The skin in the area of \u200b\u200bedematous extremities is stretched, tense, pale and dry, its temperature is lowered. When pressing on the swollen tissue, the dent disappears within a few seconds.

Temperature with ascites

Directly ascites does not lead to an increase in body temperature. The reason for the violation of thermoregulation is the main diseases that have caused the accumulation of fluid in the abdominal cavity.

With ascites, an increase in body temperature can be a manifestation of:

Peritonitis. The defeat of the peritoneum by foreign microorganisms leads to the activation of the immune system and an increase in body temperature. The highest numbers (up to 40 degrees or more) are observed in bacterial peritonitis, when pathogenic bacteria and the toxins secreted by them are absorbed into the bloodstream and spread throughout the body. With peritonitis of tuberculous etiology, the temperature is usually kept within 37 - 39 degrees.
Pancreatitis. With pancreatitis, a non-infectious inflammatory process develops in the pancreas, which is accompanied by an increase in temperature up to 38 degrees. The transition of inflammation to the peritoneum and the development of peritonitis may be accompanied by a more pronounced temperature reaction (up to 39 - 40 degrees).
Liver cirrhosis. In the early stages of the development of cirrhosis, all patients have subfebrile condition (an increase in body temperature to 37 - 37.5 degrees). If cirrhosis is a consequence of infection with hepatitis B or C viruses, an increase in temperature to 37 - 39 degrees will be a natural protective reaction of the body in response to the introduction of foreign agents. An increase in body temperature above 39 degrees is usually a consequence of the development of bacterial complications and requires urgent medical intervention.
Tumors. With all malignant tumor diseases, the patient has subfebrile condition for several weeks or months, which is usually accompanied by a feeling of weakness and weight loss. When cancer metastasizes to the peritoneum, an increase in body temperature up to 39 - 40 degrees can be observed, which is explained by the development of an inflammatory reaction in response to the introduction of "foreign" (tumor) cells.

It is also worth noting that ascites with myxedema is characterized by a decrease in temperature to 35 degrees. This is explained by the lack of thyroid hormones, which normally regulate (increase) the rate of metabolic processes in the body and body temperature.

Pain with ascites

The occurrence, nature and localization of pain depends mainly on the cause of ascites, however, in some cases, the accumulation of large amounts of fluid in the abdominal cavity can directly lead to increased pain, squeezing the abdominal organs.

Pain syndrome with ascites can be caused by:

Liver cirrhosis. Liver cirrhosis develops gradually and is usually preceded by inflammatory liver disease (hepatitis). The liver itself does not contain pain receptors, but the capsule surrounding the organ is rich in them. An increase in the size of the liver in various diseases leads to overstretching of the capsule, which is manifested by pains of varying intensity. In the initial stages of cirrhosis, patients may complain of discomfort or mild pain in the right hypochondrium, which may worsen over time. Also, patients may complain of heaviness or pain in other parts of the abdomen. This is due to a digestive disorder that occurs in the late stages of cirrhosis.
Syndrome (disease) Budd-Chiari. With this pathology, a blockage of veins occurs, through which blood flows from the liver. As a result, there is an overflow of intrahepatic blood vessels, an increase in the size of an organ and a stretching of the hepatic capsule, which is accompanied by sharp, stabbing pains in the right hypochondrium, radiating to the right parts of the back.
Inflammation of the peritoneum. The peritoneal sheets contain a large number of pain receptors, therefore, its inflammation is accompanied by severe cutting or stitching pains in the abdomen, which intensify when pressing on the anterior abdominal wall.
Pancreatitis. The development of the inflammatory process in the pancreas is manifested by acute pains of a girdle nature, which are most pronounced in the upper abdomen. Pain can be given to the area of \u200b\u200bthe right or left hypochondrium, to the back, to the heart.
A tumor. Pain in a tumor is rarely very pronounced, which greatly complicates the early diagnosis of malignant neoplasms. Patients may experience dull, pulling, or aching abdominal pains for several weeks or months. In this case, the intensity of pain can spontaneously increase or decrease.
Endometriosis. Pain in this pathology is localized mainly in the lower abdomen, however, with metastasis of endometrial cells to other organs, it can have any localization. Typically, women complain of increased pain during intercourse, during menstruation, pain when urinating or defecation. At the same time, the pain is sharp, cutting, and is not relieved by taking conventional painkillers.

Abdominal enlargement with ascites

This symptom becomes visible to the naked eye when more than 1 liter of fluid accumulates in the abdominal cavity. At first, this can manifest itself only in a standing position, when fluid accumulates in the lower abdominal cavity, causing the protrusion of the anterior abdominal wall. In the prone position, the abdomen may be normal in size, but the patient may begin to complain of shortness of breath (feeling short of breath), as fluid will move into the upper abdomen, limiting the movement of the diaphragm and lungs.

With further progression of the disease, the amount of ascitic fluid increases, as a result of which the bulging of the anterior abdominal wall becomes noticeable in the supine position. With severe ascites (when more than 10 - 12 liters of fluid accumulates in the abdominal cavity), the skin of the abdomen becomes taut, tense, and shiny.

Hepatomegaly and splenomegaly in ascites

Enlargement of the liver (hepatomegaly) and spleen (splenomegaly) can be important diagnostic signs that indicate a cause of ascites.

Hepatomegaly and splenomegaly can be caused by:

Cirrhosis of the liver. With cirrhosis of the liver, there is a violation of the structure of the liver tissue and its partial replacement by fibrous (scar) tissue. This creates an obstacle in the path of blood flow, as a result of which it accumulates in the veins of the liver and in the portal vein, leading to an increase in the size of the organ. To lower the pressure in the portal vein system, some of the blood is discharged into the venous vessels of the spleen, which also leads to its overflow and increase in size.
Tumor. The reason for the enlargement of the liver may be an increase in the size of an intrahepatic tumor or the proliferation of metastases from tumors of other localization. With metastasis of a malignant tumor in the liver tissue, blockage of the hepatic capillaries by tumor cells will also occur, which will lead to disruption of blood flow in the organ and may cause its increase in size.
Budd-Chiari disease. With thrombosis of the hepatic veins, the liver tissue overflows with blood and the liver enlarges. At the same time, the spleen increases only in severe cases of the disease (with the development and progression of portal hypertension).
Heart failure. With heart failure, the blood stagnates in the inferior vena cava system, increasing the pressure in it. Since the hepatic veins (which carry venous blood out of the liver) also drain into the inferior vena cava, severe heart failure can disrupt the flow of blood from the liver, leading to an increase in liver size.

Nausea and vomiting with ascites

In the initial stages of ascites development, the occurrence of nausea and vomiting may be due to the underlying disease (liver cirrhosis, pancreatitis, peritonitis, and so on). As the pathological process progresses, the amount of fluid in the abdominal cavity increases, which leads to compression and dysfunction of many organs (in particular, the stomach and intestines).

Compression of the stomach can significantly reduce its volume and impair motor skills, as a result of which a person may feel nausea even after eating a small amount of food. If vomiting occurs, the vomit will contain freshly eaten, undigested food. After vomiting, the stomach empties, which usually brings relief to the patient.

Compression of the intestines can also interfere with intestinal motility. With severe ascites, the intestinal loops can be compressed with such force that the movement of the processed food (chyme) along them becomes impossible. As a result, the chyme will begin to accumulate above the place of compression, causing increased peristalsis in this part of the intestine. At the same time, the patient will complain of paroxysmal pain in the abdomen, nausea. The vomiting that occurs in this case will contain partially digested foods or feces, and will also have a characteristic unpleasant odor.

"Medusa's head" with ascites

"Medusa's head" is the expansion of the veins of the abdominal wall, which is observed with the accumulation of a large amount of ascitic fluid and severe portal hypertension. In this case, blood from the portal vein system is discharged into the systemic circulation through the so-called anastomoses (connections between veins) located in the region of the anterior abdominal wall. This leads to increased pressure in the veins of the abdominal wall and their expansion. When the abdomen protrudes and the skin is pulled, these veins shine through under the skin and form a dense venous network on the anterolateral surface of the abdomen, which is the reason for this name of the symptom.

Jaundice with ascites

Jaundice (yellow color of the skin and visible mucous membranes) occurs with various liver diseases, accompanied by a violation of its function. The accumulation of fluid in the abdominal cavity against the background of jaundice suggests with a high degree of probability that the cause of ascites is liver pathology (cirrhosis or cancer).

The mechanism of jaundice is as follows - when red blood cells (erythrocytes) are destroyed, a yellow pigment, bilirubin, is released into the bloodstream. It is a rather toxic product, therefore, under normal conditions, it is immediately captured by liver cells, neutralized and excreted from the body as part of bile. If liver function is impaired, this process slows down or stops altogether, as a result of which the concentration of bilirubin in the blood begins to increase. Over time, it penetrates into various tissues and organs and settles in them, which is the direct cause of the appearance of an icteric color of the skin and mucous membranes.

Shortness of breath with ascites

Shortness of breath (feeling short of breath) with ascites is a consequence of increased pressure in the abdominal cavity and limited mobility of the lungs. Under normal conditions, during inhalation, the diaphragm (the main respiratory muscle) contracts, as a result of which it shifts downward (towards the abdominal cavity), allowing the lungs to expand and enter a portion of fresh air. The accumulation of a large amount of fluid in the abdominal cavity and an increase in intra-abdominal pressure makes it impossible to fully displace the diaphragm downward, as a result of which the patient receives less air with each breath.

In the initial period of development of ascites, shortness of breath occurs only in the supine position, when the fluid moves up and presses on the diaphragm. In a standing position, the liquid swells into the lower abdomen and the person breathes freely. In the later stages of the disease (when the volume of ascitic fluid reaches 10 liters or more), shortness of breath is observed in the standing position and intensifies in the supine position, which is why patients usually rest and sleep half-sitting.

Dehydration with ascites

Dehydration is a pathological condition characterized by a decrease in the amount of fluid in cells and a decrease in the volume of circulating blood (BCC). Although fluid is not lost from the body during ascites, it leaves the vascular bed into the abdominal cavity (that is, "turns off" from the circulatory system), as a result of which the BCC decreases and characteristic signs of dehydration appear.

Dubinchak-Muler D.N. Doctor of the II category