ASCITES

Dictionary Meaning -

(according to Dorland's pocket medical Dictionary)

Effusion And Accumulation Of Serous Fluid In The Abdominal Cavity.

Chylous Ascitis - The Presence Of Chyle In The Peritoneal Cavity As A Result Of Anomalies, Injuries, Or Obstruction Of The Thoracic Duct. Called Also CHYLOPERITONEUM

Pathological Point Of View -

• Ascites Is A Gastroenterological Term For An Accumulation Of Fluid In The Peritoneal Cavity. 

• The Medical Condition Is Also Known As Peritoneal Cavity Fluid, Peritoneal Fluid Excess, Hydroperitoneum Or More Archaically As Abdominal Dropsy. 

• Although Most Commonly Due To Cirrhosis, Severe Liver Disease Or Metastatic Cancer, Its Presence Can Portend Other Significant Medical Problems Such As Budd–Chiari Syndrome.

Signs & Symptoms :-

• Mild Ascites Is Hard To Notice, But Severe Ascites Leads To Abdominal Distension. Patients With Ascites Generally Will Complain Of Progressive Abdominal Heaviness And Pressure As Well As Shortness Of Breath Due To Mechanical Impingement On The Diaphragm.

• Ascites Is Detected On Physical Examination Of The Abdomen By Visible Bulging Of The Flanks In The Reclining Patient ("flank bulging"), "Shifting Dullness" (Difference In Percussion Note In The Flanks That Shifts When The Patient Is Turned On The Side) Or In Massive Ascites With A "Fluid Thrill" Or "Fluid Wave" (Tapping Or Pushing On One Side Will Generate A Wave-Like Effect Through The Fluid That Can Be Felt In The Opposite Side Of The Abdomen).

• Other Signs Of Ascites May Be Present Due To Its Underlying Etiology. For Instance, In Portal Hypertension (Perhaps Due To Cirrhosis Or Fibrosis Of The Liver) Patients May Also Complain Of Leg Swelling, Bruising, Gynecomastia, Hematemesis, Or Mental Changes Due To Encephalopathy. Those With Ascites Due To Cancer (Peritoneal Carcinomatosis) May Complain Of Chronic Fatigue Or Weight Loss. Those With Ascites Due To Heart Failure May Also Complain Of Shortness Of Breath As Well As Wheezing And Exercise Intolerance.

Cause :-

Pathophysiology :-

Ascitic Fluid Can Accumulate As A Transudate Or An Exudate. Amounts Of Up To 35 Liters Are Possible.

• Roughly, Transudates Are A Result Of Increased Pressure In The Hepatic Portal Vein (>8 mmHg, Usually Around 20 mmHg), e.g. Due To Cirrhosis, While Exudates Are Actively Secreted Fluid Due To Inflammation Or Malignancy. 

• As A Result, Exudates Are High In Protein, High In Lactate Dehydrogenase, Have A Low pH (<7.30), A Low Glucose Level, And More White Blood Cells. Transudates have low protein (<30g/L), low LDH, high pH, normal glucose, and fewer than 1 white cell per 1000 mm³. 

Portal Hypertension Plays An Important Role In The Production Of Ascites By Raising Capillary Hydrostatic Pressure Within The Splanchnic Bed.

Regardless Of The Cause, Sequestration Of Fluid Within The Abdomen Leads To Additional Fluid Retention By The Kidneys Due To Stimulatory Effect On Blood Pressure Hormones, Notably Aldosterone. The Sympathetic Nervous System Is Also Activated, And Renin Production Is Increased Due To Decreased Perfusion Of The Kidney. Extreme Disruption Of The Renal Blood Flow Can Lead To Hepatorenal Syndrome. Other Complications Of Ascites Include Spontaneous Bacterial Peritonitis (SBP), Due To Decreased Antibacterial Factors In The Ascitic Fluid Such As Complement.

Classification :-

Ascites Exists In 3 Grades.

• Grade 1: Mild, Only Visible On Ultrasound And CT.
• Grade 2: Detectable With Flank Bulging And Shifting Dullness.
• Grade 3: Directly Visible, Confirmed With The Fluid Wave/Thrill Test.

For More Details :-

• http://en.wikipedia.org/wiki/Ascites

 Invastigation :-

Management :-

 Homoeopathic Treatment :-

" One Single Simple Drug Substance In Its Most Suitable Potency, According To Symptom Similarity Based On Totality! "

In Case Of  Ascitis, List Of Useful Remedies (According To REPERTORY

by Oscar E. BOERICKE, M.D.) Are As Below-

ASCITES -- Acet. ac., Adon v., Apis, Apoc., Ars., Aur. m., Aur. m. n., Blatta am., Cahinca, Canth., Cinch., Cop., Dig., Digitalin, Fluor. ac., Helleb., Iod., Kali c., Lact. v., Led., Lyc., Nat. chlor., Oxydend., Prun. sp., Samb., Senec., Sep., Tereb., Uran. n.

 For Detail Study Of Above Mentioned Individual Remedy From HOMŒOPATHIC MATERIA MEDICA by William BOERICKE, M.D.:-

•  http://www.homeoint.org/books/boericmm/

Special Thanks To Damini Rathwa, Dipti Varma, Dhwani Gamit & Hiral Markar.

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