Abdominal fluid accumulation
Abdominal fluid accumulation indicates the onset of a medical condition called ascites. Ascetic fluid is a pale yellow colored fluid. The predominant accumulation of ascetic fluid occurs in the region of peritoneum. Ascetic fluid has many sources. However the most significant source is the liver. One of the major causes for ascites is liver cirrhosis.
Causes for accumulation of ascetic fluid
The factors contributing to liver cirrhosis are associated with portal hypertension and edema caused because of tissue fluid imbalance or infection. The formation of ascetic fluid is also associated with the decrease in albumin levels. Albumin levels are decreased in portal hypertension conditions. Another significant factor that leads to accumulation of ascetic or abdominal fluid is the underlying condition of kidney failure caused due to excess salt and water retention. In addition, ascetic fluid accumulation is also caused because of underlying conditions such as neoplasm, congestive heart failure and infectious diseases such as tuberculosis. Ascetic conditions are classified into transudative and exudative types based on the protein estimation of the respective ascetic fluid. The comparative analysis of protein in the ascetic fluid is based on the albumin levels in the ascetic fluid when compared to serum albumin. This comparative analysis is also called as serum ascites albumin gradient.
Symptoms of abdominal fluid accumulation
Ascetic symptoms are associated with abdominal pain and discomfort. In some cases the ascetic condition is initially asymptomatic which progresses into a symptomatic condition. Shortness of breath occurs because of pleural effusion which is caused by the pressure on diaphragm because of the abdominal fluid rise. Apart from these other symptoms are nausea, anorexia, and bloating and flank pain.
Conditions associated with abdominal fluid accumulation such as ascites are diagnosed using laboratory analysis. Laboratory tests such as ascetic fluid protein estimation, albumin analysis, amylase, lactose dehydrogenase and triglyceride values are taken into consideration. These values help in the determination of underlying conditions which may be responsible for the accumulation of ascetic fluid in the abdominal cavity.
Microbiological analysis such as Gram's stain, acid fast stain and also cultures of both routine bacteriology and for Mycobacterium is done to diagnose the condition due to of infectious diseases. In the case of tuberculosis, the ascetic fluid tends to appear chylous or milky in nature. This because of the presence of thoracic or interstitial fluid. The serum ascites albumin gradient values are taken into consideration to determine the cause of ascites because of bacterial peritonitis, Pancreatitis, Vasculitis and portal hypertension. High albumin gradients or transudative gradients generally occur in unclear etiologies such as occult cirrhosis and portal hypertension. Hepatic vein thrombosis and liver cirrhosis related ascites is generally diagnosed by biopsy and radiological methods.
Treatment of abdominal fluid accumulation
Ascites is treated according to fluid electrolyte monitoring. The patient is prescribed a restricted salt diet in order to avoid edema. In cases of low sodium levels, the salt restriction may be increased to 1.5 l instead of 1. Diuretics are generally prescribed in the case of ascites. The research pertaining to the use of aquaretics for the excretion of electrolyte free water is still underway for the approval.
Therapeutic paracentesis is administered on a regular basis to treat refractive ascites. The most effective method for reducing the portal pressure in patients with ascites and under diuretics is the administration of trans jugular intrahepatic portosystemic shunt also known as TIPS. This is a radiological procedure used in patients suffering from refractive ascites; this technique may be performed either in conscious state or by administering general anesthesia.
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Bibliography / Reference
Collection of Pages - Last revised Date: April 5, 2020