Causes: follows peritonitis, obstruction of portal vein, tumors,
hepatic diseases, pressure on posterior cava, dilated right heart,
heaves, ovarian disease, nephritis or kidney degeneration, hydroæmia.
Symptoms: slow advance, pot-bellied, with fluctuation, hollow above,
dropsy in limbs, sheath and under belly, percussion sound flat below,
weakness, debility, no fever. Diagnosis: Absence of fever, and of
fibrine, cells and granules in effusion. Lesions: those of primary
disease, amount and composition of effusion. Treatment: treat primary
disease glandular swelling or actinomycosis, iodide of potassium,
remove diseased ovary or tumor, draw off fluid, compress abdomen,
saline laxatives, diuretics, iodides, pilocarpin, electricity,
bitters.
_Causes._ Ascites may be a remnant of a pre-existing chronic
peritonitis, or it may occur from any obstruction of the portal
vein, such as compression by organized false membranes, thrombus, in
the vessel, or pressure by lympadenoma in the portal fissure,
melanosis, sarcoma and other tumors. It results from cirrhosis and
other diseases of the liver which retard its circulation, from
pressure on the posterior vena cava, from insufficiency of the right
auriculo-ventricular valves, from dilatation of the right heart, and
from heaves or other obstruction in the pulmonic circulation. Other
causes are cystic or other disease of the ovary, diseases of the
kidney and hydroæmia, the latter two tending to general œdema as
well as ascites.
_Symptoms._ The disease comes on slowly and insidiously and at first it
usually passes unnoticed. When more fully developed the abdomen is
distended but somewhat pendent (pot-bellied), fluctuating below, with
falling in beneath the lumbar transverse processes. Later the whole
abdomen may be full, rounded, smooth and tense, and the hind limbs
œdematous to above the fetlocks or hocks. There may be œdema of the
sheath or lower wall of the abdomen. Fluctuation can still be felt as a
shock when an assistant makes sudden concussion with the fist on the
opposite side from that on which the hand is pressed. This may be felt
even more distinctly by the hand introduced into the rectum. Percussion
gives a flat sound below and more or less resonant above. The pulse is
small, weak, and accelerated, heart beats irritable (sometimes
palpitating), and respiration labored and with lifting of the flank.
From first to last there is no hyperthermia.
If the cause is irremediable the issue is necessarily fatal sooner or
later.
_Diagnosis_ from peritonitis depends largely on the absence of
hyperthermia, and of abdominal tenderness, and on the nature of the
ascitic fluid which is incoagulable, and comparatively destitute of
leucocytes cells and granules.
_Lesions._ The quantity of effused liquid is often enormous (50 qts.
Reynal, 80 qts. Woodger, 150 qts. Friedberger and Fröhner). It is very
watery and poor in salts and albuminoids, of a density near 1012,
neutral or slightly alkaline, does not coagulate spontaneously, and is
not associated with false membranes. The peritoneum shows no congestion,
but is pale, and, like the abdominal walls, infiltrated. Tumors, cysts
and venous obstructions referred to under causes may be found.
_Treatment._ When ascites depends on actinomycosis or glandular
enlargement a course of iodide of potassium may remove the cause. In
other cases an operation may remove the offending tumor or ovary. Too
often, however, the cause is beyond remedy and palliative treatment only
is available. The most urgent indication is the removal of the
accumulated fluid, and paracentesis under proper antiseptic precautions
is the readiest means to this end. Compression by a tight bandage is
necessary to prevent the sensation of vacuity and tendency to fainting
which come from the removal of the fluid and to counteract the
disposition to the instant effusion of more. Even with the compress it
is judicious not to draw off all of the fluid at once in bad cases, but
to make two or three operations and allow the patient to become
accustomed to the change in the intervals. These may be repeated as
circumstances demand. Saline purgatives, or diuretics (saltpetre 1 oz.,
digitalis 25 grs., squill 3 ozs., iodide of potassium 2 drs.), are
useful, and pilocarpin is the most efficient agent of this kind, but
also dangerous by reason of the extreme depletion which it causes.
Electricity has been employed with alleged advantage, also poultices of
digitalis applied over the loins.
Cholagogues are also recommended especially in cases of liver disease.
Bitters may prove useful.