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.

Pruritus

Pruritus is a skin disease associated with conditions pertaining to autoimmune disorders and other advanced complications like liver cirrhosis. Pruritus cases vary from mild to complex as the symptoms associated with the condition generally aggravate with age. Untreated pruritus can be a big hindrance to an individual's normal life as it interferes with sleep patterns leading to irritability and stress. In some cases the causative agent for this disease is the Hepatitis C virus which accounts in 20% of the population.

Pruritus occurs mostly in the wrist and ankles as a scratch. The intensity of the itch facilitates other factors such as eczema, impetigo and induced urticaria. The immune response releases histamines causing allergic reactions. The association of pruritus with allergic reactions is identified by the presence of serotonin. The serotonin release caused because of pruritus occurs in case of preexisting medical conditions such as polycythemia, lymphoma and cholestasis.

The identification and diagnosis of pruritus is closely associated with the evaluation of dermatological condition of the patient. Progressive pruritus is noticed with contact dermatitis, urticaria, scabies, pediculous infections of the genital region, folliculitis and xerotic eczema.The factors associated with the respective causes along with pruritus are fomites, dust, bites, chemicals and photosensitivity. Atopic dermatitis induces aggressive form of pruritus. The intense forms of atopic dermatitis associated pruritus usually occur in pregnant women, infants and veterans. Systemic causes of pruritus involve preexisting conditions such as Hodgkin's lymphoma, HIV, scleroderma, multiple myeloma, chronic renal failure and many other conditions.

Pruritus diagnosis involves meticulous procedures in examining the exact history of the patient to rule out other forms of allergic reactions. The information pertaining to the patient history includes several factors such as travel zones, food and occupation. Differentiation of non-septic and septic forms is done to identify systemic involvement of the disease. Secondary infections and malignancies associated have to be identified. Specific sites are identified on the skin reaction to respective drug therapy is carefully monitored.

Pruritus treatment

Avoid stress which delays the healing process. Topical creams are prescribed for allergic forms of pruritus. Skin cleansing is an important step. It is predominantly done to prevent secondary infections and conditions such as psoriasis. Patients who have history of sunburn and sensitivity to extreme temperatures need to relieve the stress upon immune system that reacts immediately to such conditions. Hydration of the skin helps in the restoration of the skin cells to facilitate the process of healing. Change of diet and lifestyle is prescribed to patients who are sensitive foods such as nuts, seafood etc. Patients with a history of contact dermatitis are advised to use skin safe deodorants, shampoos and bubble bath solutions. Oral antihistamines are recommended to ease the immune system's reactivity. Hot water bath and tight clothing are to be avoided in case of pruritus as it may aggravate the condition. Topical creams containing corticosteroids are recommended during the onset of a pruritic reaction. In case of secondary infections associated with pruritus, antibiotics are given.

Hepatomegaly

Hepatomegaly refers to abnormal swelling of the liver. On palpation of the right side of the abdomen, if the liver extends below the ribs, it indicates an enlarged liver. Hepatitis indicates general inflammation of the liver. If both the liver and spleen are enlarged, the condition is called Hepatosplenomegaly.

Possible causes of Hepatomegaly include:

• Fatty Liver
  
• Cirrhosis
  
• Hepatitis
  
• Congestive Heart Failure CHF
  
• Leukemia
  
• Niemann Pick Disease
  
• Primary Biliary Cirrhosis
  
• Reye syndrome
  
• Alcohol Use
  
• Sclerosing Cholangitis (inflammation of bile ducts resulting in scars)
  

Most people suffering Hepatomegaly do not have any noticeable symptoms. Some experience fatigue, loss of appetite, nausea and pain on the right side of the abdomen. Diagnostic tests such as abdominal ultrasound, Liver Function Test and abdomen MRI are suggested.