In the outpatient clinic, we often encounter some patients with "big belly and poop", of course, this is only the first impression, although some people have bloating as a drum, but the limbs are emaciated, the abdomen is exposed, which is a typical Chinese medicine bulging disease, which is what we call cirrhosis ascites.
Ascites refers to the accumulation of fluid in the peritoneal cavity. Physical findings in patients with ascites include abdominal distension, fluid tremor, and dullness on lateral lumbar percussion. The accuracy of the physical examination may vary, depending to some extent on the amount of ascites, the technique used, and the clinical situation (eg, it may be difficult to examine in obese patients).
Why do people with cirrhosis develop ascites?
Ascites develops in patients with cirrhosis, which is associated with the following factors.
(1) Portal hypertension, liver function and other factors combined to lead to water and sodium retention.
In cirrhosis, the first step in fluid retention is the onset of portal hypertension. Cirrhosis can lead to deformation and obstruction of blood vessels in the liver, obstruction of blood return to the portal vein, increased intravascular pressure in the portal vein system, increased hydrostatic pressure at the venous end of capillaries, and leakage of water into the abdominal cavity, forming ascites.
When the portal vein is pressed
Portal hypertension is the inevitable result of the development of cirrhosis to a certain extent, and is the most important cause and initiating factor for the formation of ascites in cirrhosis.
(2) Renin-angiotensin-aldosterone system imbalance.
Portal hypertension causes changes in spleen and systemic circulation to increase the activity of the renin-angiotensin-aldosterone system, leading to sodium and water retention, which is also the main cause of ascites formation and relative stubbornness.
(3) Hypoproteinemia.
Cirrhosis leads to impaired liver cell function, a decrease in the ability of the liver to synthesize proteins, and a decrease in plasma albumin content, so that the osmolality of blood colloids decreases, prompting fluid to leak from plasma into the abdominal cavity, forming ascites. When plasma albumin is below 30 g/L, ascites is easily produced. The role of albumin in the treatment of ascites has attracted increasing attention.
(4) Insufficient effective circulating blood volume.
Increased sympathetic activity and decreased activity of prostaglandins, atrium, and kallikrein-kinin, resulting in decreased renal blood flow, sodium, and urination. Among them, visceral vasodilation is a key factor in cirrhosis of the liver, ascites, especially stubborn circulatory dysfunction of ascites; renal function problems, such as hepatoneal syndrome.
(5) Lymphatic return is obstructed.
Intrahepatic vascular obstruction in cirrhosis, increased hepatic lymphatic fluid production, and ascites can also occur when the returned lymph exceeds the drainage capacity. If there is obstruction and rupture of the chylocarus, chyloid ascites is formed.
Among the many factors mentioned above, hepatic insufficiency and portal hypertension run through the entire process. Ascites is often preceded by bloating, a large amount of water makes the abdomen bulge, the abdominal wall is tight and shiny, like a frog abdomen, the patient has difficulty walking, sometimes the diaphragm is significantly elevated, and respiratory and umbilical hernias appear.
Some patients have pleural fluid, most commonly on the right side, due to ascites entering the chest cavity through the diaphragm lymphatic vessels or through a valve opening.
What are the symptoms of cirrhosis of the liver and ascites?
●The abdomen is large and can cause abdominal pain – the patient's abdomen is usually enlarged in a short period of time.
●Weight gain
●Difficulty breathing
●A feeling of fullness occurs after eating a small amount
Ascites can sometimes become infected, causing severe abdominal pain and fever, and sometimes confusion.
If you develop ascites and any of the above symptoms, see a doctor immediately.