Ascites (ascites, aquatic)

If the circumference of the abdomen increases, the cause is usually love handles, which the body deposits for bad times. But also disturbances in the inside of the abdomen can be behind it: Especially liver diseases lead to accumulation of fluid in the abdomen. Ascites, ie a fluid accumulation (edema) in the abdominal cavity is not an independent disease, but a symptom that may have different causes. Mostly, however, there is a liver disease behind it. Ascites is a sign that indicates an advanced disease - which is why most of the symptoms have previously been different.

Causes of ascites

The most common cause is cirrhosis of the liver, ie the connective tissue remodeling of the liver tissue, which in turn is the result of various liver diseases. Cirrhosis makes the tissue stiffer than normal. whereby the vessels are exposed to a higher resistance. Therefore, the blood can no longer flow freely, accumulates in the portal vein in front of the liver and is squeezed out of the vessels into the abdominal cavity.

In addition, cirrhosis affects liver function and therefore fewer proteins are formed. These usually draw liquid to themselves and thus hold them back in the vessels. Also malignant tumors or metastases z. B. in the peritoneum can change the blood composition accordingly and thus lead to edema. In addition, they "sweat out" water themselves.

Another cause is a right heart failure, in which the pumping power of the right ventricle decreases and therefore the blood in the veins of the systemic circulation dammed back. Again, water is pressed into the abdominal cavity again, typical are also water retention in the ankles. The same happens with occlusions (thrombosis) of the splenic vein, portal vein or hepatic vein.

Symptoms of ascites

In the foreground are the symptoms of the underlying disease. The ascites themselves are noticeable by the increasing belly circumference - so little by little pants and belts fit. The abdomen increasingly bulges outward, the border to the navel passes or it forms an umbilical hernia.

The amount of water in the abdomen (and thus the weight gain) can be huge - 10 liters and more are not uncommon. As a result, the stomach tenses enormously, which can be very painful and lead to a lack of air.

Therapy of the ascites

The ascites and their extent can be easily determined by ultrasound. In the foreground is the therapy of the underlying disease, z. For example, delay the progression of liver cirrhosis, remove a tumor, treat heart failure. However, the ascites is usually already a sign of a poor prognosis, so that usually no cure, but at best a delay of the disease can be achieved.

The ascites themselves are treated with a flushing out of the fluid by means of diuretics and a restriction of the fluid supply. Often an ascites puncture is performed, in which 0.5-1.5 liters of fluid are removed from the abdomen via a cannula. As a result, the symptoms improve at least for a while.

Another - often last and dangerous - therapy option is to create a short circuit between the portal vein (in front of the liver) and the vena cava (right heart) (portosystemic shunt) to bypass the blood and bypass the high pressure there, However, the liver can no longer fulfill its (residual) function of blood detoxification and there is an increased risk of brain damage (hepatic encephalopathy).

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