Ascite

A ascite is an intra-abdominal épanchement liquid . or it is an accumulation of liquid in the Cavité péritonéale . It can be several types:

  • Séreux
  • Exsudatif i.e. rich in Protein S
  • Hemorrhagic
  • Infected
  • Chyleux i.e. rich in Triglyceride S

Physical signs

  • general Signs : There exists a catch of weight at the time of a ascite because of intra-abdominal retention of water.
  • Inspection : when épanchement the abdomen is very important is slack, in certain cases one can even observe the presence of a umbilical Hernie.
  • Percussion : when épanchement is not very important, it is mobilizable : one observes a matity slopes characterized by a matity on the level of the sides and a tympanism in the middle of the abdomen: the matity varies with the position of the subject.
  • Palpation : not very useful, sometimes but it makes it possible to observe the Signe of the ice floe on the level of the Foie.

Examinations

  • the abdominal echography: very sensitive to detect the liquid épanchements, it will make it possible to observe a blade of ascite in particular on the level of the sides, inter-hépato-renal Espace (of Morrison) and Cul-de-sac Douglas.
  • Puncture: the purpose of it is the diagnosis of the cause of the ascite like its evacuation. Sampling undergoes several analyzes:
* protein
Rate * Proportioning of the pancreatic Amylase
* Numeration: rate of white Globule S
* Cytology: presence of cells Néoplasique S?
* Bacteriology: setting in culture with the research in particular of the Bacillus of Koch responsible for the Tuberculosis.
  • Laparoscopie : complete inspection of the cavity péritonéale to seek the cause of the ascite using an optical instrument. The laparoscopy bears also the name of Cœlioscopie.
  • the physical Examination:
* the catch of weight (even principle that for the edema S
* sign of flood
* Sign of the ice floe One employs these two signs to make the diagnosis of ascite.

Complications

In front of all ascite, the first invasive gesture to make is the Ponction liquid of ascite (PLA). Why this gesture? In particular one takes the liquid to carry out a series of examinations (see above) and to detect a serious complication: the infection of the liquid of ascite.
  • the infection of the liquid of ascite is defined by the presence of more than 250 Polynucléaire neutrophile S per mm ³, that there is or not a significant rate of bacteria identified with the direct bacteriological examination or after culture. The ILA is treated by a Antibiothérapie.
  • respiratory distress: sometimes revealing of the ascite, this difficulty of breathing is due to the compression of the diaphragm by bulky a ascite. It requires an evacuation of.
  • a Hernia or eventration: an externalization of handle digestive generally by a zone of weakness of the abdominal muscular wall (umbilical, inguinale).

Causes

to note that 95% of the ascites are due either to a hepatic cirrhosis, or with a carcinose péritonéale

  • alcoholic Cirrhosis (protids lower than 25g/L)

  • In the diseases péritonéales:

* Carcinose péritonéale: principal etiology 1/2
which in the absence of former cancer can indicate:
# a Cancer of the ovary
# a Cancer of the digestive tract
* Tuberculosis péritonéale: principal etiology 2/2
* Mésothélium péritonéal: secondary etiology * Pancréatites chronicles
* localized vascular Thromboses with the know-hepatic veins (Syndrome of Budd-Chiari)
* Hypoalbuminémies of the nephrotic syndromes, the exsudatives entéropathies or the denutrition
* Syndrome of hyperstimulation ovarienne.

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