Maybe you don’t think too much about that expanding waistline — other than knowing you should lose a few pounds. You might have been advised to cut down on alcohol and eat fewer goodies.
But there could be more to it.
You may want to knowabout ascites, a condition caused by severe liver disease. It causes excess fluid to build up in the abdomen, making your belly swell and protrude.
Ascites is a build-up of fluid in the peritoneal cavity – the space between the lining of the abdomen and abdominal organs. the most common cause is liver cirrhosis. Other causes include cancer, heart failure, tuberculosis, pancreatitis, and blockage of the hepatic vein. In fact When portal hypertension develops as a result of liver cirrhosis, blood bypasses the liver and is diverted to abdominal peritoneal vessels Then, due to increased capillary pressure, fluid leaks into the peritoneal cavity , many of the risk factors for developing ascites are the same as those for cirrhosis. The term is from the Greek ‘askítes ‘meaning “baglike”
Technically, it is more than 25 mL of fluid in the peritoneal cavity. Symptoms may include increased abdominal size, increased weight, abdominal discomfort, and shortness of breath. Complications can include spontaneous bacterial peritonitis. Diagnosis is typically based on a examination together with ultrasound or a CT scan. Testing the fluid can help in determining the underlying cause.
The most common risk factors for ascites include hepatitis B, hepatitis C, chronic alcohol abuse, congestive heart failure, malignancy, and kidney disease.
Signs and symptoms
These are symptoms of ascites:
• Swelling in the abdomen
• Weight gain
• Sense of fullness
• Sense of heaviness
• Nausea or indigestion
• Swelling in the lower legs
• Shortness of breath
On physical examination –
• flank bulging -there will be visible bulging of the flanks in the reclining patient ,
• shifting dullness -difference in percussion note in the flanks that shifts when the patient is turned on the side) or
• fluid thrill or fluid wave –that is tapping or pushing on one side will generate a wave-like effect through the fluid that can be felt in the opposite side of the abdomen.
Other signs of ascites may be present due to its underlying cause. For instance, in portal hypertension (perhaps due to cirrhosis or fibrosis of the liver) patients may also complain of leg swelling, bruising, gynecomastia, hematemesis, or mental changes due to encephalopathy. Those with ascites due to cancer (peritoneal carcinomatosis) may complain of chronic fatigue or weight loss. Those with ascites due to heart failure may also complain of shortness of breath as well as wheezing and exercise intolerance.
Ascites exists in three grades:
• Grade 1: mild, only visible on ultrasound and CT
• Grade 2: detectable with flank bulging and shifting dullness
• Grade 3: directly visible, confirmed with the fluid wave/thrill test
Ascitic fluid can accumulate as a transudate or an exudate. Amounts of up to 35 liters are possible.
Causes of high serum-ascites albumin gradient (SAAG or transudate) are:
• Cirrhosis – 81% (alcoholic in 65%, viral in 10%, cryptogenic in 6%)
• Heart failure – 3%
• Hepatic venous occlusion: Budd–Chiari syndrome or veno-occlusive disease
• Constrictive pericarditis
• Kwashiorkor (childhood protein-energy malnutrition)
Causes of low SAAG (“exudate”) are:
• Cancer (metastasis and primary peritoneal carcinomatosis) – 10%
• Infection: Tuberculosis – 2% or spontaneous bacterial peritonitis
• Pancreatitis – 1%
• Nephrotic syndrome
• Hereditary angioedema
Other rare causes:
• Meigs syndrome
• Renal dialysis
• Peritoneum mesothelioma
• Abdominal tuberculosis
Roughly, transudates are a result of increased pressure in the hepatic portal vein (>8 mmHg, usually around 20 mmHh, e.g. due to cirrhosis, while exudates are actively secreted fluid due to inflammation or malignancy. As a result, exudates are high in protein and lactate dehydrogenase and have a low pH (<7.30), a low glucose level, and more white blood cells. Transudates have low protein (<30 g/L), low LDH, high pH, normal glucose, and fewer than 1 white cell per 1000 mm³. Clinically, the most useful measure is the difference between ascitic and serum albumin concentrations. A difference of less than 1 g/dl (10 g/L) implies an exudate.
Portal hypertension plays an important role in the production of ascites by raising capillary hydrostatic pressure within the splanchnic bed.
Regardless of the cause, sequestration of fluid within the abdomen leads to additional fluid retention by the kidneys due to stimulatory effect on blood pressure hormones, notably aldosterone. The sympathetic nervous system is also activated, and renin production is increased due to decreased perfusion of the kidney. Extreme disruption of the renal blood flow can lead to hepatorenal syndrome. Other complications of ascites include spontaneous bacterial peritonitis (SBP), due to decreased antibacterial factors in the ascitic fluid such as complement..
If the physical examination is equivocal,
• ultrasound confirms the diagnosis of Ascites.
• diagnostic paracentesis should be performed When the cause is in doubt, The ascitis fluid is analyzed for cell count and the differential is done before therapy because dieresis may alter fluid characteristics.
• Serum and ascetic fluid albumin levels are compared to assess the cause of fluid accumulation. Ascites resulting from hydrostatic disease (portal hypertension, congestive heart failure) has serum Ascites albumin difference greater than 1.1g/dL, whereas inflammatory or neoplastic disease produces a serum Ascites albumin difference less than 1.1g/dL.
• cytologic analysis- If malignancy is suspected, a large volume of fluid (i.e.,> 1L) must be send
• radiographic study – If the cytology is positive, radiographic or endoscopic studies or both are obtained to localize the sources of malignancy
• An abdominal CT scan is a more accurate alternate to reveal abdominal organ structure and morphology
With infection, ascetic fluid exhibits increased cellularity, decreased pH, and increased lactate content as well as positive gram stains and cultures.
Elevated fluid triglyceride levels in Ascites should prompt an evaluation for malignancy or tuberculosis. High ascetic fluid amylase levels should point to an evaluation for pancreatic disease
it can lead to following complications –
Ascites can make eating, drinking, and moving around difficult. It can also make it hard to breathe. Ascites can lead to
• abdominal infections, which may cause kidney failure.
• It can also cause umbilical or inguinal hernias
• Spontaneous bacterial peritonitis
• Hepatorenal syndrome
• Thrombosis- Complications involve portal vein thrombosis and splenic vein thrombosis: clotting of blood affects the hepatic portal vein or varices associated with splenic vein. This can lead to portal hypertension and reduction in blood flow
Diet-Salt restriction is the initial treatment, which allows diuresis (production of urine) since the patient now has more fluid than salt concentration. Salt restriction is effective in about 15% of patients. Water restriction is needed if serum sodium levels drop below 130 mmol L−1 following are the steps taken-
• Cut back on your salt intake. Avoid salt substitutes that contain potassium. This is because some medicines used in treating ascites can cause your potassium levels to rise.
• Cut back on the amount of fluids is taken
• Stop drinking alcohol.
• Take diuretic medicines to help reduce the fluid in your body.
• In certain cases, it may be required to remove large amounts of fluid fromabdomen through a needle. This is called paracentesis
Certain steps to helpavoid cirrhosis of the liver and cancer can prevent ascites. These include:
• Stop drinking alcohol.
• Maintain a healthy weight.
• Exercise regularly.
• Stop smoking.
• Limit salt in your diet.
• Practice safe sex to decrease your chance of getting hepatitis.
• Do not use recreational drugs to decrease your chance of getting hepatitis
Homoeopathy treatment – Homeopathic medicine treat the underlying cause of cirrhosis of liver such as viral infections .genetic tendency .Bad effects of alcohol and metabolic changes .
Helps to control the scarring of tissues .And if homeopathy has started at the early stage(compensated stage ) it is possible to restore the altered function of the liver .
And if it is started at a later stage it can halt the further progress of the disease and prevent the patient from getting into the complication of portal hypertension .
Homeopathy can be started at any stage of the cirrhosis early or late, depending upon when one has chosen to opt for Homeopathy ,or depending upon till what stage disease has progressed .It can differentially give an individual a better quality of life by allaying his pain and reducing his discomfort .
• Apis mellifica.
In post scarlatinal dropsy and in acute febrile dropsy Apis is the remedy when the patient is thirstless; this seems to be characteristic.It is especially adapted to cases depending on kidney disease. The skin is pale and waxen, transparent, the urine is scanty and Apis speedily brings about an increase; there may be nettle-rash on the skin. If the dropsy be of cardiac origin there will be swelling of the feet; if hydrothorax, there will be dyspnoea and a feeling as if death were approaching, but no fear thereof as in Arsenicum and Aconite. Another characteistic indication is puffiness under the eyes, another is bruised, sore sensation all over the body. Apis, after serous inflammation where the effusion is not absorbed, is a most useful remedy, hence its use in ascites, hydrothorax, hydrocephalus, etc. Dropsy of the knee, also Iodine. Apis is better given in trituration in these cases.
This remedy is suitable in all forms of dropsy, particularly in those depending on disorders of the heart and lungs. In dropsy of renal origin it also stands prominent. There is puffiness of the face with oedema about the eyelids, waxy transparent skin, thirst, vomiting, etc. Ulcers forming on the legs. In dropsy oozing of a serum is also and indication. This is found also under Rhus and Lycopodium. Arsenicum is an important diuretic.
• Acetic acid.
Here we have the waxen, emaciated, alabaster skin and dropsies especially about the lower limbs and abdomen. There is thirst, sour belching, water brash and diarrhea, a broken down constitution. It stands between Apis and Arsenicum, but it has great thirst, and the prominent gastric symptoms will separate it from Arsenicum. Profuse sweating is a prominent symptom.
• Apocynum Cannabinum.
This drug is useful for swelling anywhere of dropsical origin disease. It seldom does more than palliate, though in renal dropsy it may do more. The special symptoms calling for it are a gone feeling at the pit of the stomach, cannot tolerate food, great thirst, but drinking causes distress,irregular heart, torpidity and slow pulse. It seems to be a diuretic in small doses, hence this effect can only be palliative and when so used it should be freshly prepared.
Cardiac dropsies; feeble irregular heart, feeling as if it should still with desire to take a deep breath; scanty, dark, albuminous urine, slow pulse, scrotum and penis swollen. Hydropericardium, hydrothorax. Cold sweat. Dropsies of brain. Post scarlatinal dropsy, anasarca with a bluish cyanotic color. In dropsies of the chest Mercurius sulphuratus should be remembered. Muriatic acid. Dropsy from cirrhosed liver.
This is a very useful remedy in many forms of dropsy. There is a jelly-like diarrhea, urine dark and scanty. It may be used in general anasarea, ascites, post scarlatinal dropsies, and here it has proved a marvelous remedy. Sudden dropsies, acute dropsies accompanied by great debility. Hydrocephalus.
Dropsy, urine dark and albuminous, dark skin or bluish white. Hydrothorax with suffocative fits after scarlet fever may indicate the remedy. Terebinth. Dropsy from congestion of the kidney, dull aching in renal region and dark, smoky urine. Colchicum. Dropsy with dark urine, especially as a complication of rheumatism may indicate this remedy. Lycopodium. Dropsy from liver disease; lower half of body and abdomen distended. Ulcers form on lower extremities.