cirrhosis ascites
Introduction
Introduction to cirrhosis ascites Liver cirrhosis ascites is commonly referred to as liver ascites. It refers to repeated inflammation of the liver due to liver disease. After fibrosis and cirrhosis, various pathological factors such as portal hypertension, hypoproteinemia, and sodium retention may cause intra-abdominal effusion. Clinical symptoms. Cirrhosis ascites is not a separate disease, but a common clinical manifestation of many end-stage (decompensation) of liver disease. Common diseases causing cirrhosis and ascites are: type B, C virus hepatitis, alcoholic hepatitis, autoimmune hepatitis and the like. basic knowledge The proportion of illness: 0.002% Susceptible people: good for people with liver disease Mode of infection: non-infectious Complications: hepatic encephalopathy, hepatorenal syndrome
Cause
Cirrhosis ascites etiology
Alcoholism (20%):
Long-term heavy alcohol abuse is one of the factors that cause cirrhosis. At present, it is believed that alcohol has a direct toxic effect on the liver. It can cause mitochondrial swelling of liver cells, irregular mitochondrial ridges, and even ethanol transparent bodies, which are manifestations of severe damage and necrosis of liver cells.
Nutritional disorders (10%):
Most scholars acknowledge that malnutrition can reduce the resistance of liver cells to toxic and infectious factors, and become an indirect cause of cirrhosis. Animal experiments have shown that animals fed a diet lacking choline or methionine can progress to cirrhosis through the stage of fatty liver.
Industrial poisons or drugs (10%):
Long-term or repeated exposure to arsenic-containing pesticides, carbon tetrachloride, yellow phosphorus, chloroform, etc., or long-term use of certain drugs such as bisphenol phenolate, isoniazid, cinchon, tetracycline, methotrexate (MTX), methyl Bar, can produce toxic or drug-induced hepatitis, which in turn leads to cirrhosis. Aflatoxin can also cause toxic damage to liver cells and cause cirrhosis.
Viral hepatitis (30%):
Currently in China, viral hepatitis, especially chronic hepatitis B, is a major cause of portal cirrhosis.
Circulatory disorders (5%):
Chronic congestive heart failure, chronic constrictive pericarditis can cause long-term congestion and hypoxia in the liver, causing hepatocyte necrosis and fibrosis, called congestive cirrhosis, also known as cardiogenic cirrhosis.
Metabolic disorders: such as hemochromatosis and Wilson's disease (also known as Wilson's disease).
Cholestatic: high concentration of bilirubin has an damaging effect on hepatocytes when extrahepatic bile duct obstruction or intrahepatic cholestasis. Hepatic cirrhosis can occur after a long period of time. Intrahepatic cholestasis is called primary biliary cirrhosis. Secondary biliary cirrhosis is caused by obstruction of the bile duct.
Schistosomiasis: In schistosomiasis, stimulating connective tissue hyperplasia in the portal area becomes schistosomiasis liver fibrosis, which can cause significant portal hypertension, also known as schistosomiasis cirrhosis.
The cause is unknown: part of the cause of cirrhosis is unknown, known as cryptogenic cirrhosis.
Prevention
Cirrhosis ascites prevention
1. Patients with high blood ammonia or poor liver function should limit protein intake to avoid hepatic coma. Those with ascites should enter a low-salt or salt-free diet.
2, diet should provide adequate nutrition, food should be diversified, supply high-priced protein containing amino acids, multi-vitamins, low-fat, less slag diet, to prevent rough multi-fiber food damage to the esophageal vein, causing major bleeding.
3, pay attention to bleeding, cyanosis, fever, changes in mental and neurological symptoms, and get in touch with the doctor in time.
4, daily measurement of abdominal circumference and measurement of urine volume, abdominal obesity is a great way to identify fatty liver.
Regarding the prevention of early cirrhosis, regular examination is an important measure to prevent early cirrhosis, and early intervention.
Complication
Cirrhosis ascites complications Complications, hepatic encephalopathy, hepatorenal syndrome
Can be complicated by hepatic encephalopathy, liver and kidney syndrome.
Symptom
Cirrhosis, ascites symptoms, common symptoms, diffuse drum sound, abdominal swelling, bloating
Symptoms and signs
Before the occurrence of ascites, patients often have a feeling of bloating. When a large amount of ascites is formed, the abdominal distension is aggravated. It can be observed that the abdomen gradually expands, and the abdominal wall is tight and shiny, like a frog's abdomen. The enlarged abdominal cavity may even affect the patient's daily life and difficulty walking. A large amount of ascites can raise the diaphragm, reduce the volume of the chest, increase the respiratory rate caused by the pressure of the lungs, breathe superficial and even hernia, and have a sitting breathing and umbilical hernia. The typical signs are positive for mobile dullness, and a large amount of ascites is turbid.
Systemic symptoms
(1) In the ascites of the liver, in addition to abdominal abdomen caused by a large amount of abdominal water, it is often accompanied by edema of both lower extremities, often with concave edema.
(2) When spontaneous peritonitis occurs in ascites, there are often abdominal irritation such as fever, abdominal pain, and increased stool frequency.
(3) Other symptoms: patients with cirrhosis and ascites may also have other complications such as gastrointestinal bleeding and hepatic encephalopathy, and there should be related clinical manifestations such as anemia and mental disorder.
Examine
Cirrhosis ascites examination
1, ascites routine: including PH, cell count and classification, traits and so on.
2, ascites biochemistry: including ascites albumin, LDH, sugar content, etc., is the main detection index to distinguish between leakage and exudate, wherein glucose determination is very important, exudate glucose due to the glycolysis of cells or inflammatory cells The glucose content in the effusion is reduced, especially in the case of purulent bacterial infection, often <1.12 mmol/L.
3, ascites lysozyme: cancer cells do not produce lysosomes, no lysozyme production, so in the exudative or inflammatory ascites, lysozyme did not increase (<23mg / L), often suggestive malignant ascites.
4, lactate dehydrogenase: LD> 200U / L in serous effusion, or the ratio of effusion LD to serum LD > 0.6 can be used as a diagnostic indicator of exudate.
5, adenosine dehydrogenase: the most abundant in red blood cells and T lymphocytes. Generally, the ADA activity in the tuberculous effusion increases and the amplitude is the largest, often >40U/L, followed by cancerousness and the lowest leakage.
6, ascites tumor markers: carcinoembryonic antigen (CEA) 15mg / L, found in malignant ascites, and suggest adenocarcinoma, ascites alpha fetoprotein (AFP) increased.
7. Ascites cholesterol, triglyceride, and lipoprotein electrophoresis are valuable for identifying true and pseudo-chylorrhea. The fat content of true chyle effusion is >4%. The lipoprotein electrophoresis shows obvious chylomicron zone. The serosal effusion triglyceride can be higher than serum triglyceride. A large number of fat globules can be seen by microscopy.
Diagnosis
Diagnostic diagnosis of cirrhosis ascites
Differential diagnosis
According to clinical manifestations and experimental examinations, most cases can confirm cirrhosis ascites, which needs to be identified as follows:
1. Ascites due to obstruction of the hepatic vein or poor reflux
(1) Hepatic vein occlusion syndrome: Sometimes there is an obstruction of the inferior vena cava, which is caused by thrombosis. Mostly secondary, often caused by embolic phlebitis, perihepatitis, liver cancer or cirrhosis compression or erosion. Can be divided into acute and chronic two types, acute type of severe abdominal pain, progressive hepatomegaly and ascites. In addition to abdominal pain and liver enlargement, the ascites is progressively increased, which is a leakage of high protein content, and the treatment effect is not good. Significant varicose veins appeared in the upper abdomen and lower chest. If there is an obstruction of the inferior vena cava, the veins of the lower abdomen are also varicose, and the direction of blood flow is from bottom to top. Inferior vena cava angiography can show obstruction.
(2) constrictive pericarditis or constrictive myocarditis: the former has jugular vein engorgement, odd pulse, pulse pressure reduction, abnormal electrocardiogram, radiographic examination can be seen at the edge of the heart with calcium deposition. The latter has no odd pulse, often has signs of atrioventricular valve insufficiency, ECG has left ventricular enlargement and left bundle branch block, and right atrial-left atrial pressure gradient.
2, ascites caused by tumor or huge abdominal cavity cyst
(1) malignant tumor: 90% of cases of peritoneal mesothelioma with ascites, the abdomen can touch the mass, laparoscopic and peritoneal biopsy can confirm the diagnosis. Primary liver cancer complicated by ascites is very common. Due to pressure or metastasis of the portal vein, it may be leakage or exudate, and there are many bloody people.
(2) huge abdominal cyst and hydronephrosis:
Characteristics of these diseases: 1 abdominal enlargement, but bilateral asymmetry; 2 patients supine, the intestines are squeezed to the posterior and bilateral sides of the abdomen, so the anterior abdominal percussion is voiced, the waist and abdomen is drum sound; 3 such as ovarian cysts, The umbilical lower abdomen circumference is larger than the umbilical or umbilical upper abdominal circumference, and the umbilicus is moved upward; 4X line barium meal perspective, the gastrointestinal tract is displaced with the tumor, and the gastrointestinal movement is not affected.
3. Ascites caused by inflammation
(1) Tuberculous peritonitis: The amount of protein in ascites is high, and the level of cholesterol in the serum is increased, resulting in the precipitation of cholesterol crystals.
(2) pancreatic ascites: for acute pancreatitis complicated by peritonitis, ascites amylase can be as high as 800 ~ 3200 units, it is believed that more than 300 units have diagnostic value, but there is also no increase in amylase.
4, obesity or flatulence caused by abdominal swelling: obese people's abdomen is spherical, umbilical sag, no moving turbidity, all parts of the body have fat deposition. When the height is bulging, it can cause abdominal distension, but the drum sound is diagnosed, the umbilicus is not prominent, and there is no moving dullness.
5. Ascites caused by other systemic diseases: such as various heart and kidney diseases, sugar-coated liver, metabolic diseases (mucus edema), malnutrition, allergic diseases (eosinophilic peritonitis), collagen diseases (distribution) Sexual lupus erythematosus). Ascites, clinical signs can be distinguished according to the signs of the primary disease.
