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Dropsy; Ascites
Is your waistline increasing without you consuming more calories than before? Do you feel uncomfortable pressure from the inside of your stomach and do you suffer from abdominal pain? Flatulence builds up all the time without eating flatulent foods like beans or onions? Are there even breathing problems and circulatory problems? Then it is possible that dropsy plagues you, in technical jargon ascites. It is a pathological accumulation of fluid in the abdomen.
The cause is 80% of cases of liver damage, especially cirrhosis of the liver. We then speak of portal ascites. Other causes include tumors, inflammation of the internal organs, or an impaired drainage of the lymphatic fluid. So almost always there are serious health problems. Diseases that can lead to dropsy in the abdomen include: heart failure, liver failure, liver cirrhosis, liver cancer, liver metastases, stomach cancer, inflammation of the pancreas, inflammation of the peritoneum and ovarian cancer.
The balance of body fluid
Most of our bodies are made up of water that is distributed to the cells, the spaces between the organs and the blood vessels. In a functioning organism, only a small part of the liquid gets into the tissue, these absorb the lymph channels and bring the water back into the veins.
Water that collects in the abdomen or other body tissue shows that the balance is upset. For example, more fluid presses into the surrounding tissue when the veins are pressed. In addition to dropsy in the abdomen, edema can also develop in the legs or face. Most people also find the latter particularly unaesthetic.
Why does water collect in the stomach?
A common cause of abnormal water accumulation is increased pressure within the blood vessels, which occurs particularly with cirrhosis of the liver but also with heart failure.
A second cause is protein deficiency. With hunger there is the notorious water belly, as it is known from documentaries about hunger disasters in Ethiopia or India. This is not primarily due to a lack of calories, but an extraordinary lack of proteins. The water belly also develops in people who eat enough calories or are even overweight, but whose one-sided diet contains too little protein. Examples of this are the people in Asia who feed almost exclusively on rice, or indigenous people in the Amazon who eat almost exclusively on cassava.
A third cause is weak cell walls. These become permeable and the liquid enters the surrounding tissue. This is particularly the case with inflammations that damage the cell structure, especially through viruses and bacteria.
The fourth cause is a lymphatic drainage disorder. This is particularly due to scarring or tumors that block the lymphatic system.
What role does the kidney play?
A water belly is often exacerbated by misinformation that the kidney absorbs. If fluid enters the abdomen, the receptors in the vessels report that there is a lack of fluid because the level inside the vessels drops due to the water penetrating into the abdomen. This also lowers blood pressure. The kidney responds by excreting less urine and releasing hormones that raise blood pressure. This then leads to even more fluid getting into the abdomen.
All kinds of dropsy
Dropsy has several forms. We differentiate them depending on how the fluid that penetrates the abdomen is composed.
1) Non-inflammatory ascites: If the blood drain does not work, for example, in the case of cirrhosis of the liver or weakness in the right ventricle, then fluid enters the abdomen without cells being inflamed. This also applies to protein deficiency or tumors. However, such non-inflammatory dropsy can irritate the peritoneum and lead to inflammation of the peritoneum in an emergency. Such inflammation can be fatal.
2) Inflammatory ascites: Here the inflammation is not a consequence but the cause of the accumulation of fluid. If the abdominal cavity has become inflamed, the organs and vessels become permeable and fluid can pass through. The accumulation of liquid is cloudy here and the doctor can detect the pathogen.
3) Chylous ascites: If the lymphatic drainage is disturbed, a milky fluid collects in the abdominal cavity.
4) Hemorrhagic Ascites: Strictly speaking, this accumulation is not an accumulation of water, but of blood. Internal injuries, bleeding from internal organs, small wounds in the abdomen, which do not close due to anticoagulants, cause the abdomen to swell. In this case, you must go to a doctor or go to the hospital immediately. There is a risk of fatal bleeding. Ascites are an indication of tumor disease as the cause.
Possible diseases
Liver diseases are the most common cause of non-inflammatory dropsy in the abdomen. The portal vein collects the used blood and brings it to the liver, where it is detoxified and returned to the metabolism. Cirrhosis of the liver and thrombosis now cause extreme pressure on this vein.
Medusa head and liver congestion
Such a blood congestion can also be seen externally. The fluid not only collects in the abdomen, but the blood also looks for other drains. These can be recognized as the "head of the medusa" on the abdominal surface.
A weakness in the right part of the heart causes the blood to build up back in the liver and destroy the cells there. In addition to jaundice, this leads to a disorder of blood clotting and to abdominal dropsy.
Alcoholism and viral hepatitis are the main causes of cirrhosis. In this disease, useless nodular tissue takes the place of healthy lung tissue. The liver feels hard and becomes small.
Liver coma and kidney failure
If the liver can no longer fulfill its functions, high pressure will develop in the port vein. In the end there is the liver coma, the kidneys are running at full speed due to the water retention, which wrongly assess the water penetrating into the abdominal cavity as a lack of fluid and produce less urine. If the kidneys fail in addition to the liver, the disease can no longer be cured and almost certainly leads to death.
Right heart failure
With a right heart weakness, the heart can no longer pass the used blood into the right ventricle and from there into the lungs. Instead of enriching the blood with oxygen and bringing it back into the bloodstream, the blood accumulates back into the liver. In addition to dropsy in the abdomen, the fluid now collects in the legs.
Lack of protein
When the protein in the blood plasma drops, the osmotic pressure in the vessels decreases, which means that they cannot hold the liquid and it escapes into the tissue through the vessel walls. The cause is malnutrition, which is often accompanied by malnutrition. There is a "hunger belly", which is known from the miserable areas of the Third World. In this country, anorexics are often affected.
Hunger belly
However, it is not only underweight people who suffer from this protein deficiency. Even and especially overweight people who feed on one side eat too little protein. For example, from India, water retention in the belly of overweight children is known, which does consume many calories, but which consist almost entirely of carbohydrates.
Kidney disease
If the kidney bodies become ill and therefore proteins are increasingly excreted in the urine, this can also lead to dropsy. Here too, the low osmotic pressure is the cause of the ascites. Sometimes the mucous membrane in the stomach and intestines absorbs too much protein. Then dropsy also occurs, as well as severe diarrhea and weight loss.
Tumors
If cancer tumors form in the abdominal cavity, these often block the lymphatic drainage and thus cause water in the abdomen. Liver cancer triggers dropsy from the damaged organ and can cause any type of water retention: inflammatory, non-inflammatory, clear, bloody or lymphatic.
The following types of cancer are often associated with dropsy: gastric, colon and liver cancer, metastases on the peritoneum and ovarian cancer.
When does it go to the doctor?
They usually have no dropsy when their belly girth increases. Flatulence or digestive problems are often the cause. However, these usually go away on their own after a few days. Above all, people who are already affected by diseases of the liver and heart develop real dropsy in the abdomen. This also applies to people who develop ascites as a result of cancer or peritonitis. The accumulation of water is almost never the first noticeable symptom here.
Patients usually know about their underlying illness when they see the doctor for their dropsy. However, they also only notice the water in the abdomen when the abdominal volume increases steadily - the small amounts of water at the beginning often go unnoticed. If you suspect dropsy, be sure to see a doctor. Abdominal dropsy can cause the peritoneum to become inflamed spontaneously. If the volume of the liquid increases, the breath can be interrupted.
Diagnosis
The doctor often recognizes a larger accumulation of water at first glance. If you report a feeling of pressure in the abdomen and the doctor knows about a history of heart and liver diseases, it would almost be a mistake not to check for dropsy. The doctor knocks and feels the stomach. If there are large accumulations of water, wave movements can be felt. The diagnosis after an ultrasound analysis is certain. In this way, even small amounts of liquid of 50 milliliters can be recognized. More importantly, the doctor also sees which organic disease is the cause of dropsy because he gets an accurate picture of the heart and liver.
A blood test will clarify which disorders of the heart, liver or pancreas are present. Sometimes the doctor also performs a puncture: he takes a sample of the liquid and uses the color and consistency of the secretion to determine whether it is a problem of the liver or heart (clear), disorders of the lymphatic flow (milky) or internal bleeding (bloody) acts. It can also identify bacteria. He sets the course for the subsequent therapy.
Treatment
The doctor mainly treats the underlying disease. But he also has to reduce the volume of water in his stomach. In the case of liver diseases, he therefore treats those affected with diuretics, and the patients have to eat dishes without table salt. Large amounts of water require a small operation, the liquid is drained through a cut. An infection or bleeding can occur. However, the complaints end immediately.
What can you do yourself?
If you suffer from abdominal dropsy, reduce your salt intake to less than 4.5 grams a day until the problems go away. Nevertheless, you should consume enough calories, even though you feel full because of the "full belly". Lie down as much as you can. At rest, the vessels in the abdominal cavity are compressed and the kidney is given the sign of excreting fluid. (Dr. Utz Anhalt)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Dr. phil. Utz Anhalt, Barbara Schindewolf-Lensch
Swell:
- German Cancer Society: Malignant Ascites: Abdominal Drops as a Result of Cancer, (accessed 06.09.2019), Cancer Society
- Steven K. Herrine: Ascites, MSD Manual, (accessed September 6, 2019), MSD
- Felicitas Witte: Learn case-oriented: Ascites, thieme, (accessed on September 6, 2019), thieme
- German Cancer Research Center (DKFZ): Ascites in Cancer, (accessed September 6, 2019), DKFZ
- Alexander L. Gerbes et al .: S2k guideline - complications of liver cirrhosis, update of the S2k guideline of the German Society for Gastroenterology, Digestive and Metabolic Diseases (DGVS), (accessed September 6, 2019), AWMF
- A. L. Gerbes et al .: S3 guideline "Ascites, spontaneous bacterial peritonitis, hepatorenal syndrome", German Society for Digestive and Metabolic Diseases (DGVS), (accessed on September 6, 2019), DGVS
ICD codes for this disease: R18ICD codes are internationally valid encodings for medical diagnoses. You can find yourself e.g. in doctor's letters or on disability certificates.
