What are the therapeutic options?
On the one hand, a therapy can be carried out that merely combats the symptoms. In this therapy, the free water is removed from the abdominal cavity without treating the underlying disease. For this purpose, drugs that have a draining effect, the so-called diuretics, can be used.
In addition, patients should make sure that they follow a low-salt diet. However, if the medication is discontinued without treating the underlying disease, the fluid in the abdominal cavity will replenish itself after a relatively short time. Another possibility is ascites puncture.
Here, a cannula is inserted into the abdominal cavity and the free fluid is drained from the abdomen. In general, it is therefore advisable to treat the underlying disease. If malnutrition is the cause, the fluid no longer accumulates in the abdominal cavity as soon as the patient’s nutritional condition returns to normal.
In the case of advanced liver cirrhosis or tumor disease, treatment is often difficult because the disease cannot be cured or can only be cured to a limited extent. It makes sense to combine both therapeutic approaches. In other words, to treat the underlying disease as well as to treat the symptoms by means of medicinal drainage.
What complications can occur?
Patients with ascites due to congestion of the blood in the liver often experience an emigration of the intestinal bacteria into the abdominal cavity.Serious bacterial peritonitis, i.e. inflammation of the peritoneum, can occur, which must be treated with an antibiotic as soon as possible. If this does not happen or happens too late, it can be fatal.
This is the prognosis
As a rule, the presence of free fluid in the abdomen is more likely to indicate a poor prognosis, since the most common causes by far are advanced malignant diseases, such as cirrhosis of the liver or a tumor. Although the water can be partially or completely removed from the abdomen, since the underlying disease cannot usually be treated, it will continue to form again and again during the course of the disease. The liver is the main cause of water retention in the abdomen.
If the liver is severely damaged by cirrhosis of the liver, the blood can no longer flow freely, becomes congested and leads to high blood pressure in the supplying portal vein. As a result, water is pressed from the inside of the vessel into the free abdominal cavity and collects there. But also other basic diseases, e.g. an insufficiency of the right heart, can lead to ascites via blood congestion in the liver.
In the course of chronic damage to the liver tissue, binge-tissue scars develop. This is known as liver fibrosis. If the transformation progresses further, the proportion of functionless connective tissue increases.
The liver is no longer able to fulfil its tasks in detoxification and in hormone and protein metabolism. The process is irreversible. One of the most common causes of liver cirrhosis is chronic alcohol consumption.
Chronic viral hepatitis (hepatitis B, C and D), autoimmune liver diseases and damage caused by environmental influences are less common. Since the early symptoms are very unspecific, cirrhosis often progresses and leads to severe symptoms. The connective tissue transformation of the liver tissue causes a difficult blood flow.
The blood coming from the abdominal organs accumulates back into the hepatic vein and creates an increased vascular pressure. This is called portal hypertension. In addition to the formation of bypass circuits via vessels in the esophagus and abdomen, portal hypertension leads to the development of ascites, water in the abdomen. In addition, the reduced synthesis of protein, especially albumin, leads to a shift of fluid from the vessels to the adjacent tissue. In this way, not only oedema, accumulation of fluid in the tissue, but also in the abdominal cavity is formed.
