Ascites
Introduction
Introduction There is a small amount of fluid in the abdominal cavity of normal people, generally no more than 200ml. When the amount of free fluid in the peritoneal cavity exceeds 1000ml due to increased portal pressure, visceral artery dilation, decreased plasma colloid osmotic pressure and other factors, it is called ascites (ascites). Ascites refers to ascites exceeding normal values and retention, complications such as fever, proteinuria, and decreased urine output. In general, bacterial infections, tumors, tuberculous peritonitis, perforation of the digestive tract, and cirrhosis of the liver may cause ascites.
Cause
Cause
Causes
1, portal pressure increased: normal sinus pressure is very low (0-2mmHg), portal hypertension, increased sinus hydrostatic pressure (door pressure lommHg, is the basic conditions for the formation of peritoneal effusion), a large amount of fluid flow to the Disse gap , causing excessive liver lymph production. Patients with cirrhosis are often 20 times more likely than normal people. When the thoracic duct can not drain too much lymph, the peritoneal cavity is directly leaked from the liver capsule to form ascites. Elevated sinusoidal pressure can also cause activation of intrahepatic pressure receptors, reduce renal excretion of sodium through liver and kidney reflexes, and aggravate sodium and water retention.
2, visceral artery dilatation: early stage of cirrhosis, visceral vasodilation, by increasing cardiac output and heart rate, etc., to maintain the effective blood volume in the normal range. In the advanced stage of cirrhosis, visceral artery dilatation is more obvious, resulting in a significant decrease in effective arterial circulation blood volume, decreased arterial pressure, and thus activation of the sympathetic nervous system, renin-angiotensin-aldosterone system, and increased release of vasopressin (ADH) to maintain Arterial pressure, causing renal vasoconstriction and sodium retention. Portal hypertension interacts with visceral vasodilation, altering the capillary pressure and permeability of the intestine, facilitating the accumulation of fluid in the abdominal cavity.
3, plasma colloid osmotic pressure reduction: liver cirrhosis patients intake decreased, liver reserve function decreased, the ability to synthesize albumin decreased, resulting in lower plasma albumin, and thus plasma colloid osmotic pressure decreased, a large amount of liquid into the interstitial space, forming a peritoneal product liquid.
4, other factors: the relative deficiency of plasma central sodium and the sensitivity of the body, decreased estrogen inactivation, increased drainage of vasopressin and decreased secretion of prostaglandins, resulting in renal vasoconstriction, decreased renal perfusion The redistribution of renal blood flow is related to the formation and persistence of peritoneal effusion.
Examine
an examination
Related inspection
Laparoscopic abdominal puncture
1. Microscopic examination.
2. Clinical chemistry examination.
Diagnosis
Differential diagnosis
Abdominal effusion needs to be differentiated from the following symptoms:
(1) Tumor peritoneal metastasis, abdominal malignant lymphoma, and peritoneal mesothelioma in other parts of abdominal malignant tumor can cause ascites. If the primary tumor is not obvious, the cytological examination of peritoneal effusion is of great significance. . Of course, if the primary malignant tumor is found by physical examination, ultrasound, CT, endoscopy, laparoscopy, etc., the differential diagnosis of peritoneal effusion is more significant.
(B) cirrhosis ascites effusion is the manifestation of decompensated cirrhosis, ascites effusion is leaking fluid, combined with the corresponding performance of liver disease is generally not difficult to diagnose.
(3) Tuberculous peritonitis often has symptoms of tuberculosis such as fever and night sweats. The abdominal wall flexibility is a common sign. The peritoneal effusion is exudate. The cells in the peritoneal effusion are mainly lymphocytes. PPD is often strongly positive. Bacterial culture was negative.
(4) Spontaneous peritonitis often occurs on the basis of cirrhosis and hepatocellular carcinoma. The patient usually has fever, the number of cells in the peritoneal effusion increases, and the neutrophil count increases between exudation and leakage. It is of great significance to teach the breeding network to collect and organize bacterial culture.
(5) Peritoneal effusion caused by other diseases such as constrictive pericarditis, connective tissue disease, Budd-Chiari syndrome, Meig syndrome, hypoproteinemia, etc., often compared with the performance of primary diseases Obvious, but sometimes the diagnosis is more difficult, it needs to be combined with the patient's general condition, and it needs to be combined with complicated auxiliary examination to confirm the diagnosis.
