Fluid backflow into the peritoneal cavity. Peritoneal Fluid Culture: Essential Guide for Diagnosis and Treatment

20.03.202121.07.2023 by alexxlab

What is a peritoneal fluid culture. How is the procedure performed. What are the risks and potential results of this diagnostic test. What conditions can it help diagnose.

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Understanding the Peritoneal Space and Fluid Buildup

The peritoneal space is a crucial area within the human body, situated between the abdominal wall and its internal organs. Under normal circumstances, this space contains minimal fluid. However, certain medical conditions can lead to an abnormal accumulation of fluid, known as ascites. This buildup can result in various complications and may indicate underlying health issues that require prompt attention.

Can fluid buildup in the peritoneal space be dangerous. Yes, if left untreated, it can lead to serious complications such as inflammation of the peritoneum (peritonitis), which can cause severe pain, nausea, vomiting, and constipation. In extreme cases, it may even become life-threatening.

The Purpose and Importance of Peritoneal Fluid Culture

A peritoneal fluid culture is a diagnostic procedure that involves collecting and analyzing a small sample of fluid from the peritoneal space. This test serves several critical purposes:

Identifying the presence of bacteria or fungi causing an infection
Diagnosing peritonitis and its underlying causes
Guiding appropriate treatment strategies
Monitoring the effectiveness of ongoing treatments

Why is early detection of peritoneal infections crucial. Early diagnosis allows for timely intervention, reducing the risk of complications such as sepsis and lung infections. Additionally, it enables healthcare providers to tailor treatment plans to address the specific pathogens causing the infection.

Common Causes and Risk Factors for Peritonitis

Peritonitis, the inflammation of the peritoneum, can occur due to various reasons. Understanding these causes and risk factors is essential for prevention and early intervention:

Primary Causes:

Bacterial or fungal infections entering through blood or lymph nodes
Spread of infection from the biliary or gastrointestinal tract (secondary peritonitis)

Risk Factors:

Liver cirrhosis
Ulcerative colitis
Stomach ulcers
Pelvic inflammatory disease
Weakened immune system
Peritoneal dialysis
Appendicitis
Diverticulitis
Pancreatitis

How does identifying these risk factors help in patient care. By recognizing individuals at higher risk for peritonitis, healthcare providers can implement preventive measures and maintain a higher index of suspicion, leading to earlier diagnosis and treatment.

The Peritoneal Fluid Culture Procedure: Step-by-Step

The peritoneal fluid culture procedure, also known as an abdominal tap or paracentesis, is a relatively straightforward process that can be performed in a doctor’s office or hospital setting. Here’s a detailed breakdown of the procedure:

Patient preparation: Empty the bladder and follow any specific instructions provided by the healthcare provider.
Area preparation: The lower abdomen is cleaned with an antiseptic solution, and if necessary, the area may be shaved.
Local anesthesia: A numbing medication is administered to minimize discomfort during the procedure.
Needle insertion: A needle is carefully inserted 1 to 2 inches into the abdominal cavity. In some cases, a small incision may be necessary to facilitate needle insertion.
Fluid extraction: A syringe is used to withdraw a sample of peritoneal fluid.
Post-procedure care: The needle is removed, and the insertion site is covered with a sterile dressing.

What should patients expect during the procedure. While some pressure may be felt during needle insertion, the use of local anesthesia significantly reduces discomfort. If a large volume of fluid is removed, some patients may experience dizziness or lightheadedness, which should be reported to the healthcare provider immediately.

Risks and Precautions Associated with Peritoneal Fluid Culture

While peritoneal fluid culture is generally a safe procedure, it’s essential to be aware of potential risks and take necessary precautions:

Potential Risks:

Fluid leakage from the insertion site
Accidental puncture of the bowel, bladder, or abdominal blood vessel (rare)
Infection at the insertion site
Allergic reaction to the local anesthetic

Important Precautions:

Inform your doctor about any allergies, especially to numbing medications
Disclose any bleeding disorders or use of blood-thinning medications
Provide a complete list of current medications and supplements, including over-the-counter and herbal products
Inform your healthcare provider if you are pregnant or suspect pregnancy

How can patients minimize risks associated with the procedure. By providing a comprehensive medical history and following pre-procedure instructions carefully, patients can significantly reduce the likelihood of complications.

Interpreting Peritoneal Fluid Culture Results

Once the peritoneal fluid sample is collected, it undergoes laboratory analysis to identify any bacterial or fungal growth. The process typically involves:

Gram’s stain: This technique helps differentiate between types of bacteria based on their cell wall composition.
Culture: The fluid is placed in a growth medium to encourage the proliferation of any present microorganisms.
Sensitivity testing: If pathogens are identified, their susceptibility to various antibiotics is assessed to guide treatment.

What can abnormal results indicate. Abnormal findings from a peritoneal fluid culture may suggest various conditions, including:

Cirrhosis of the liver
Heart disease
Pancreatic disorders
Bowel perforation or damage
Bacterial or fungal infections

It’s important to note that peritoneal fluid culture results should always be interpreted in conjunction with other clinical findings and diagnostic tests for a comprehensive diagnosis.

Treatment Approaches Based on Peritoneal Fluid Culture Results

The results of a peritoneal fluid culture play a crucial role in guiding treatment strategies. Depending on the findings, healthcare providers may recommend various approaches:

For Bacterial Infections:

Targeted antibiotic therapy based on sensitivity testing
Intravenous antibiotics for severe infections
Prolonged course of oral antibiotics for milder cases

For Fungal Infections:

Antifungal medications, either oral or intravenous
Extended treatment duration to ensure complete eradication

Addressing Underlying Conditions:

Management of cirrhosis or heart disease if identified as contributory factors
Surgical intervention for bowel perforations or abscesses
Dietary and lifestyle modifications to support overall health

How does tailoring treatment to specific pathogens improve patient outcomes. By using targeted therapies based on culture results, healthcare providers can enhance treatment efficacy, reduce the risk of antibiotic resistance, and minimize potential side effects associated with broad-spectrum treatments.

Long-term Management and Prevention of Peritoneal Infections

While peritoneal fluid cultures are essential for diagnosing acute infections, long-term management and prevention strategies are crucial for patients at risk of recurrent peritonitis. These approaches may include:

Regular medical check-ups and monitoring
Proper hygiene practices, especially for patients undergoing peritoneal dialysis
Nutritional support to boost the immune system
Management of underlying conditions such as cirrhosis or inflammatory bowel disease
Patient education on recognizing early signs of infection
Prophylactic antibiotics in select high-risk cases

Why is patient education crucial in preventing recurrent peritoneal infections. Empowering patients with knowledge about risk factors, early symptoms, and preventive measures enables them to take an active role in their health management, potentially reducing the incidence of infections and improving overall quality of life.

In conclusion, peritoneal fluid culture is a valuable diagnostic tool in the management of abdominal infections and related conditions. By providing crucial information about the presence and nature of pathogens, it enables healthcare providers to implement targeted and effective treatment strategies. Understanding the procedure, its risks, and the importance of its results empowers patients to actively participate in their care and work towards better health outcomes.

Peritoneal Fluid Culture: Purpose, Procedure, and Results

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Medically reviewed by University of Illinois — By Jaime Herndon, MS, MPH, MFA — Updated on December 24, 2017

Peritoneal fluid culture

The peritoneal space is the area between the abdominal wall and the organs it houses. This space is typically empty, or contains a small amount of fluid. But a buildup of fluid can occur if you have a disease or infection. This fluid is called ascites.

Inflammation of the lining of the abdominal wall, or the peritoneum, can also occur. This can cause pain, nausea, vomiting, and constipation. If left untreated, it can be life-threatening. It can be caused by a variety of diseases, which your doctor can diagnose and treat.

A peritoneal fluid culture is a test that is performed on a small sample of peritoneal fluid. It may also be called an abdominal tap or paracentesis. The laboratory examines the fluid for any bacteria or fungi that may be causing an infection.

When your peritoneum is inflamed, it’s typically because bacteria or fungi have entered the peritoneal space by blood and lymph nodes. Peritonitis means that the peritoneum is inflamed. More commonly, infection spreads to the peritoneal space from your biliary or gastrointestinal tract. This is called secondary peritonitis.

Risks for developing peritonitis include:

scarring of the liver called cirrhosis
ulcerative colitis
stomach ulcers
pelvic inflammatory disease
a weakened immune system
peritoneal dialysis
appendicitis
diverticulitis
pancreatitis

Peritonitis can be dangerous, causing sepsis and lung infections. Sepsis is an infection in the body caused by a reaction to bacteria that are present. If there’s a large amount of fluid in your peritoneum, it can cause abdominal pain. Large amounts of fluid may be removed to ease discomfort.

In order to treat peritonitis, the underlying cause needs to be determined. A peritoneal fluid culture can help make a diagnosis.

You don’t have to do anything special for this procedure, other than follow your doctor’s instructions. If necessary, the area will be shaved prior to the insertion of the needle.

Tell your doctor if you:

are allergic to any numbing medication or other drugs
have a bleeding disorder
are taking any medications or supplements, including herbal medications and over-the-counter drugs
are pregnant or think you might be pregnant

A peritoneal fluid culture can be performed in your doctor’s office or a hospital. You’ll be asked to empty your bladder before the procedure. A spot on your lower abdomen will be cleaned with an antiseptic, and you will receive local anesthesia to numb the area.

A needle will be inserted 1 to 2 inches into your abdominal cavity. A small incision may be necessary if there is difficulty inserting the needle. Fluid is removed through a syringe.

During the procedure, you might feel pressure. If a lot of fluid is being removed, dizziness or lightheadedness is not uncommon. If you feel discomfort or dizziness, tell your doctor.

You’ll be asked to sign a consent form before the procedure. There’s a small chance of leaking fluid after the procedure. The bowel, bladder, or an abdominal blood vessel can also be punctured, but this is rare. As with all invasive procedures, there’s also a risk of infection.

Once the culture is done, it’s sent to a laboratory where a Gram’s stain and culture are performed. A Gram’s stain is used to show the differences in the types of bacteria. Abnormal results might show:

cirrhosis
heart disease
pancreatic disease
a damaged bowel
an infection

Once your doctor gets the results, they can start treating the underlying condition. In some cases, additional follow-up tests may be needed.

Last medically reviewed on December 24, 2017

How we reviewed this article:

Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

Mayo Clinic Staff. Peritonitis. (2015, March 31). Retrieved from
mayoclinic.com/health/peritonitis/DS00990/
Peritonitis. (2014, December 9)
umm.edu/altmed/articles/peritonitis-000127.htm
Program for abdominal and pelvic health (n.d.). Abdominal tap
rush. edu/services/abdominal-and-pelvic-health-program

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Medically reviewed by University of Illinois — By Jaime Herndon, MS, MPH, MFA — Updated on December 24, 2017

Peritoneal fluid culture Information | Mount Sinai

Culture – peritoneal fluid

Peritoneal fluid culture is a laboratory test performed on a sample of peritoneal fluid. It is done to detect bacteria or fungi that cause infection (peritonitis).

Peritoneal fluid is the fluid in the peritoneal cavity, a space between the wall of the abdomen and the organs inside.

A peritoneal culture is a procedure where peritoneal fluid is withdrawn with a needle from the peritoneal cavity. The peritoneal cavity is the space between the two membranes lining the abdominal cavity. The test is done to determine the cause of ascites, fluid accumulation in the peritoneal space.

How the Test is Performed

A sample of peritoneal fluid is needed. This sample is obtained using a procedure called an abdominal tap (paracentesis).

A sample of fluid is sent to the laboratory for Gram stain and culture. The sample is checked to see if bacteria grows.

How to Prepare for the Test

Empty your bladder before your abdominal tap procedure.

How the Test will Feel

A small area in your lower abdomen will be cleaned with germ-killing medicine (antiseptic). You will also receive local anesthesia. You will feel pressure as the needle is inserted. If a large amount of fluid is withdrawn, you may feel dizzy or lightheaded.

Why the Test is Performed

The test is done to find out if there is an infection in the peritoneal space.

Normal Results

Peritoneal fluid is a sterile fluid, so normally no bacteria or fungi are present.

What Abnormal Results Mean

The growth of any microorganism, such as bacteria or fungi, from peritoneal fluid is abnormal and indicates peritonitis. If you have cirrhosis and bacteria are found in your peritoneal fluid, you may have spontaneous bacterial peritonitis (SBP). This is a life-threatening infection that must be treated with antibiotics.

Risks

There is a small risk of the needle puncturing the bowel, bladder, or a blood vessel in the abdomen. This may result in bowel perforation, bleeding, and infection.

Considerations

The peritoneal fluid culture may be negative, even if you have peritonitis. The diagnosis of peritonitis is based on other factors, in addition to the culture.

Bush LM, Levison ME. Peritonitis and intraperitoneal abscesses. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 74.

Solà E, Ginès P. Ascites and spontaneous bacterial peritonitis. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 93.

Last reviewed on: 11/2/2022

Reviewed by: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Tense ascites: the first signs, diagnosis and treatment of ascites at Euroonco

Tense ascites is an excess amount of fluid in the abdominal cavity, requiring emergency treatment.

The peritoneum of a healthy person produces more than a glass of serous fluid to reduce friction during natural organ movements Some diseases cause excess fluid production without changing the rate of its removal – this is ascites.

With intense ascites, the effusion is already so much that the compression of the organs leads to the work of the body at the limit of its capabilities.

General information

All ascites can be divided into three main groups: tumor or carcinomatous, effusions in diseases of a non-tumor nature and mixed. Mixed ascites is characteristic of liver cancer against the background of cirrhosis. The fundamental differences are due to different mechanisms of exudate accumulation in the abdominal cavity and different prognosis, while the diagnosis, clinical manifestations and basic treatment are similar.

Exudate in cancer and non-tumor processes has one fundamental difference – the presence of malignant cells with a slight difference in other components, primarily protein fractions and blood cells.

In cancer, the bulk of the liquid is produced by metastases scattered over the sheets of the peritoneum.

Risk factors

The leading risk factor is the presence of a malignant tumor. The peritoneum, which is a serous, that is, a sheet covered with a mucous membrane, is an ideal place for the development of metastases:

Through an abundant network of blood vessels, cancer cells and entire colonies that have come off the maternal tumor are brought into the abdominal cavity, and metastasis appears, forcing the serosa to excess fluid production.
Malignant cells circulating in the lymph settle in the lymphatic vessels, which grow and block the vessel, disrupting the absorption of intraperitoneal exudate.
It is very difficult to detect a pathological change in the peritoneum – the thinnest sheet is not visible on CT and MRI, with a targeted study, a tumor larger than 5 mm can be found. Therefore, in the diagnosis of carcinomatosis, an excessive accumulation of fluid is first detected and only after that they try to detect metastases.

Additional factors contributing to the production of fluid when it is not sufficiently removed by the lymphatic system in cancer:

liver metastases or cirrhosis, when pressure in the portal vein increases due to compression of the intrahepatic vessels and varicose wall changes, this leads to the extrusion of plasma into the abdominal cavity;
violation of liver function as a result of chronic disease or toxic hepatitis, including drug-induced, changes the permeability of the vascular wall and increases the level of aldosterone, which increases pressure;
heart disease with reduced functionality slows blood flow, causing blood stasis, which may be a concomitant age-related pathology or the result of cardiotoxic chemotherapy;
violation of the excretory function of the kidneys as a result of chemotherapy with platinum drugs contributes to fluid retention and changes in the rheological characteristics of the blood;
excessive thrombosis of abdominal vessels associated with metastasis and malignant tumors of the gastrointestinal tract;
changes in the protein composition of the blood during malnutrition due to carcinoma of the gastrointestinal tract or cancerous cachexia, leads to the release of plasma from the vessels into the abdominal cavity.

In most cases, peritoneal metastasis is the predominant share in the formation of effusion, other risk factors only complement the pathological mechanism.

As a rule, highly aggressive neoplasms with low cell differentiation are characterized by a high rate of intracavitary fluid production.

Causes

The largest percentage of ascites is due to liver pathology, mainly cirrhosis. Of 100 patients with ascites, 80 were diagnosed with end-stage cirrhosis with liver failure. The second most common etiological cause is malignant diseases – no more than 15% of all, and 5% are caused by heart disease and other non-tumor nosologies.

In cancer, the leading cause of effusion is peritoneal metastases or peritoneal carcinomatosis.

The largest cohort of patients with ascites are those suffering from ovarian cancer, due to the high incidence – more than 14 thousand annually and the latent course of the malignant process. At the time of detection of the tumor, two out of three patients have metastases in the abdominal cavity with concomitant ascites, however, a tumor lesion of the peritoneum does not transfer the process to stage 4, unlike the vast majority of malignant processes in other organs. Due to the complexity of differentiation of tumor processes inside the abdominal cavity, the commonality of diagnosis and treatment, ovarian cancer was even combined with primary peritoneal cancer.

With carcinoma of the stomach or of the pancreas , ascites at the time of cancer detection is found in 30–40% of patients, in the terminal stage of the disease, effusion in one form or another is found in almost all patients. Several mechanisms lead to excessive fluid synthesis, except for carcinomatosis: the “liver” component in the form of metastases in the liver itself and its lymph nodes, increased thrombus formation and impaired blood rheology.

For colon cancer effusion is not typical – the frequency is not more than 10%, many times inferior to metastasis to the liver, lungs and lymph nodes.

Hepatocellular carcinoma can be complicated by ascites of cirrhotic origin, its share is minimal in the general structure of malignant processes complicated by effusions.

Peritoneal mesothelioma, is usually accompanied by effusion, but the disease is extremely rare.

The total number of Russians suffering from ascites is unknown, because statistics do not take into account the frequency of symptoms of a malignant disease.

How intense ascites is formed

The accumulation of ascitic fluid is extended over time, the organs have time to adapt to changes in intraperitoneal pressure, so the effusion is detected by the enlarged abdomen and symptoms of hemodynamic disturbances and functions of internal organs.

The International Ascites Society (IAS) has identified three grades of effusion without taking into account the severity of clinical manifestations and prognosis, only on the basis of the presence of fluid and the method of its detection:

Grade 1 – effusion is found on abdominal ultrasound, because the volume of fluid is minimal and does not affect the patient’s condition, “diagnostic finding”.
2nd degree – the presence of exudate is indicated by the appearance of the patient, whose stomach is evenly enlarged, they say about this – “frog”, the volume is measured in liters, in this severity ascites can no longer affect the patient’s well-being.
Grade 3 – intense ascites, clinical manifestations are pronounced and the patient’s condition is severe.

Ascites passes through all stages to the maximum degree of tension, their duration is individual. The volumes of peritoneal metastatic lesions do not correlate with the rate of formation and volume of effusion: microscopic tumor nodules are capable of synthesizing liters of exudate in a week, while tumor deposits that increase the thickness of the peritoneum up to several centimeters in mesothelioma lead to an effusion of less than one or two liters over a very long observation period.

On the other hand, a massive cancerous lesion in a limited volume of the abdominal cavity can simulate intense ascites with an exudate of 3-5 liters. In most cases, with tense ascites, there is more than 10 liters of fluid in the cavity.

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Symptoms of tense ascites

Tense ascites is a huge belly, uniform and smooth, the navel protrudes outward. In the supine position, the stomach is somewhat flattened, but it is difficult for the patient to lie down – cardiopulmonary insufficiency increases. The patient cannot move, sits, leaning on his hands with the torso tilted forward, facilitating the respiratory movements of the chest.

The patient’s face is puffy, the skin is pale and moist, the nasolabial triangle and the lips are bluish.

Grade 3 ascites significantly worsens the patient’s condition due to compression of the internal organs and displacement of the diaphragm separating the chest and abdominal cavity.

The mediastinal organs and the heart change their location, and symptoms of cardiac and respiratory disorders come to the fore: severe weakness, shortness of breath at rest, palpitations and various arrhythmias, weak pulsation of vessels in the periphery and a decrease in blood pressure, swelling of the legs.

All patients have pronounced congestion in the lungs, in some patients ascites is combined with non-tumor effusion into the pleural cavity. With high intra-abdominal pressure, the diaphragm shifts the lungs upward, the lower lobes are compressed and lose their airiness – atelectasis is formed. Against the background of swelling of the lung tissue and atelectasis, the bacterial microflora is activated, which manifests itself as sluggish pneumonitis with fever and cough.

As a rule, the appearance of fluid in the abdomen manifests an increase in waist circumference, which is combined with a decrease in body weight, so the scales show the same kilograms as before. In fact, the body loses weight, and the person loses weight. The increasing pressure of the fluid in the abdominal cavity literally flattens the stomach, reducing its size, causing the gastric contents to reflux into the esophagus, which is manifested by constant heartburn and loss of appetite. With intense ascites, the patient can neither drink nor eat – everything is thrown out by the compressed esophagus and stomach. The chair is unstable – constipation is interspersed with liquid feces, flatulence and seething.

As the fluid accumulates, the pains change localization, their intensity is low, they mainly complain of heaviness in the lower back.

Tension ascites is a life-threatening condition, so action must be taken without delay.

Diagnosis

Diagnosis of ascites is not difficult, and the progressive deterioration of the patient’s condition does not allow for a long examination.

The diagnosis is made already during the medical examination, then it is necessary to quickly determine the volume of the effusion, sometimes a huge cyst of the abdominal cavity, for example, an ovarian one, mimics under ascites, or large multiple tumor nodes are combined with a small effusion.

At the first stage, it is enough to do an ultrasound of the abdominal cavity and an x-ray of the chest organs, determining the number and localization of intraperitoneal neoplasms using high-tech CT and MRI is postponed until the patient’s condition improves. Almost in parallel with the ultrasound, blood is taken for an urgent general and biochemical analysis.

At the second stage, therapeutic and diagnostic laparocentesis is performed – removal of exudate through a puncture of the anterior abdominal wall, the resulting fluid sample is sent for cytological examination to detect malignant cells.

With a long history of ascites with repeated removal of fluid and previously obtained verification of the metastatic process, repeated microscopy of the exudate is performed only if bacterial infection is suspected.

Treatment

With ascites, laparocentesis is the most effective therapeutic measure, already in the process of exudate removal, the patient’s condition improves, moving from severe to moderate.

During paracentesis, a rapid change in intraperitoneal pressure “puts” the organs in their anatomical places, but this happens too quickly. During the accumulation of fluid, the organs slowly changed their dislocation, adapting to the new conditions of existence. When ascites is evacuated, their location changes rapidly, to which the cardiovascular system reacts with a sharp drop in blood pressure. After paracentesis, the patient needs to spend several days in bed so that the organs adapt to the new conditions. The lying position reduces the tone of the nerve endings of the internal organs and the production of hormones responsible for the tone of the vascular wall.

Diuretics and a salt-free diet are prescribed to reduce exudation. With ascitic fluid, a large amount of protein leaves the body, which is replenished by intravenous injections and therapeutic nutrition using enriched nutrient mixtures. Missing trace elements are also introduced with droppers and with food.

The effectiveness of ascites relief is based on the therapy of the underlying process. With ascites in the debut of the disease and at the metastatic stage, systemic chemotherapy is prescribed. The treatment of effusion in primary ovarian cancer is especially effective, recurrence is not treated so successfully.

In case of ascites in the terminal stage with progression on the background of chemotherapy, the possibilities of drug therapy are limited, therefore intraperitoneal administration of cytostatics is advisable. To optimize the paracentesis procedure, a port system is installed in the abdominal cavity, which allows exudate to be removed and chemotherapy drugs to be administered without repeated punctures of the abdominal wall.

Good results in ascites are obtained by HIPEC technology – local chemotherapy in combination with intracavitary – intraperitoneal hyperthermia, but short-term surgical intervention is required.

Diet for tense ascites

Forced fasting for tense ascites leads to an imbalance of the digestive system with the development of anorexia-cachexia syndrome. Insufficient intake of essential nutrients from food – proteins, fats, carbohydrates and trace elements is combined with accelerated breakdown of muscle proteins and oxygen starvation of tissues.

In a short time it is necessary to restore the nutritional status, normalize the level of proteins lost during paracentesis, and all this against the background of salt and fluid restriction. One teaspoon of salt retains up to one and a half liters of fluid, which is unacceptable for ascites. But food is bland without salt, so there is only one way out – to replace salt with seasonings, onions, garlic, lemon. Canned food, marinades and fast food are excluded, they always have an excess of salt. It’s hard to give up salt, but it’s possible with the right motivation.

The lack of protein must be compensated not only with droppers, but also with the diet, it is food protein that is easily and maximally absorbed. An oncological patient needs protein at the rate of 1.5 grams per kilogram of weight, that is, a patient weighing 70 kg should receive more than 100 grams of protein per day, if concomitant chronic diseases allow. Energy needs are covered by fats and carbohydrates.

The patient’s diet should include special nutrient mixtures with a high content of missing nutrients. What a particular patient needs will be shown by a blood test, and a nutritional support program will be compiled by a Euroonco specialist.

Complications

Complications of ascites are both short-term and long-term.

Quite often, ascites is combined with effusion in the pleural cavity of a non-tumor nature, more often on the right side. After removal of ascites , pleurisy regresses on its own.

Airless areas in the lower lung – atelectasis straighten out when the domes of the diaphragm are lowered immediately after paracentesis, but sometimes drugs are required to suppress sluggish inflammation.

High intra-abdominal pressure causes expansion of the diaphragmatic opening with the formation of a hernia and the reflux of gastric contents into the esophagus. Chronic burn of the mucosa is complicated by inflammation – esophagitis with the formation of erosions . Inflammation is stopped by drugs and dietary nutrition, hiatal hernia does not regress, and you will have to adhere to the rules all your life: do not overeat, do not lie down after eating, do not abuse spicy and sour.

Ascites provokes the formation of hernias of the abdominal wall and inguinal canal, which is facilitated by muscle atrophy against the background of a malignant process.

Severe complication – spontaneous peritonitis due to microscopic disorders of the intestinal wall and decreased immunity against the background of changes in the intestinal microflora.

Prognosis

Ascites is a severe complication of a generalized metastatic process. Survival of patients is determined by the degree of aggressiveness of the tumor and its sensitivity to drug therapy. The course of ascites is relatively favorable in platinum-sensitive primary ovarian cancer.

Prevention

Prevention of ascites – early detection of a malignant tumor and adequate therapy, regular monitoring after radical cancer treatment. Ascites can develop many years after malignant tumor therapy; high-tech imaging technologies help to detect effusion in a timely manner.

Despite the apparent simplicity and rapid effectiveness of laparocentesis, the treatment of ascites is an extremely complex problem that has been successfully solved by Euroonco specialists for many years.

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References

rurgia. — 2003 — № 4
2. Ivashkin V.T., Maevskaya M.V. / Treatment of complications of liver cirrhosis: guidelines for doctors //- M.: Litterra. — 2011 — 64 p.
3. Bosch J., Berzigotti A., Garcia-Pagan J.C., Abraldes J.G. /The management of portal hypertension: rational basis, available treatment and future options // J. Hepatol. – 2008 – Vol. 48 – P. 68–93.
4. European Association for the Study of the Liver. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis // J. Hepatol. 2010Vol. 53 No. 3 P.
5. Lin C.H., Shih F.Y., Ma M.H., et al. /Should bleeding tendency to deter abdominal paracentesis?// Dig Liver Dis 2005; 37.
6. Pentheroudakis G., Pavlidis N. / Serous papillary peritoneal carcinoma: unknown primary tumor, ovarian cancer counterpart or a distant entity? A systematic review// Crit Rev Oncol Hematol; 2009, Nov 6.

Bleeding into the abdomen. What is Bleeding into the Abdominal Cavity?

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Bleeding into the abdominal cavity is the outflow of blood into the peritoneal cavity or retroperitoneal space due to a violation of the integrity of the blood vessels located here, parenchymal or hollow organs. With bleeding into the abdominal cavity, weakness, pallor, cold sweat, rapid pulse, drop in blood pressure, abdominal pain, fainting or shock develop. The main role in the diagnosis of bleeding into the abdominal cavity is played by the examination of the patient, the dynamics of hemoglobin and hematocrit levels, laparocentesis and laparoscopy. Surgical treatment of bleeding into the abdominal cavity – laparotomy with revision of internal organs; in parallel, anti-shock, hemostatic and transfusion therapy is carried out.

Causes of bleeding into the abdomen
Symptoms of bleeding into the abdomen
Diagnosis of bleeding into the abdominal cavity
Treatment of bleeding into the abdomen
Prices for treatment

General

Bleeding into the abdominal cavity (intra-abdominal bleeding, hemoperitoneum) in gastroenterology can be a symptom of any disease or damage to internal organs and tissues. The danger of bleeding into the abdominal cavity, like any internal bleeding, lies in its latent nature, which can pose a threat to the life of the patient. As a result of bleeding into the abdominal cavity, hemoperitoneum occurs – an accumulation of blood in the peritoneal cavity and retroperitoneal space. Bleeding into the abdominal cavity is complicated by the development of hypovolemic and neurogenic shock. Hypovolemic shock is associated with a rapid decrease in circulating blood volume (by 25% or more) and hemodynamic disturbances; neurogenic (traumatic) shock is associated with excessive pain impulses.

Bleeding into the abdomen

Causes of bleeding into the abdominal cavity

At the heart of bleeding into the abdominal cavity are the causes of traumatic and non-traumatic nature. Bleeding into the abdominal cavity may be due to mechanical trauma to the chest and trauma to the abdomen: closed – upon impact, compression; open – with a gunshot or stab wound, as well as injuries associated with abdominal operations. In this case, a traumatic rupture of the parenchymal or hollow organs of the gastrointestinal tract, the genitourinary system, as well as blood vessels located in the folds of the peritoneum, thicker than the mesentery and the greater omentum occurs. Bleeding into the abdominal cavity in the postoperative period is usually associated with slipping (eruption) of the ligature applied to the vessels of the mesentery or organ stump.

Bleeding into the abdominal cavity of non-traumatic origin develops spontaneously in the complicated course of certain diseases and pathological processes of internal organs. Bleeding can be observed with tumors of the abdominal organs; conditions leading to a decrease in blood clotting; ectopic pregnancy; rupture of an aneurysm of the abdominal aorta, rupture of the spleen in malaria, rupture of a cyst and ovarian apoplexy. Bleeding into the retroperitoneal space is much less common.

Symptoms of bleeding into the abdomen

The clinical picture of bleeding into the abdominal cavity is determined by the severity of blood loss – its intensity, duration and volume.

Signs of intra-abdominal bleeding are pallor of the skin and mucous membranes, general weakness, dizziness, cold perspiration, a sharp drop in blood pressure, severe tachycardia (pulse rate – 120-140 beats per minute), local or diffuse pain in the abdomen, aggravated by movement. A patient with bleeding into the abdominal cavity is trying to take a sitting position to reduce abdominal pain (a symptom of “roly-up”).

If the diaphragmatic peritoneum is irritated by accumulated blood, the pain may radiate to the chest, shoulder blade and shoulder; with bleeding into the retroperitoneal space, pain in the back is noted. In the case of profuse bleeding into the abdominal cavity, the pain syndrome becomes intense, loss of consciousness is possible; with acute massive blood loss, a collapse develops.

Diagnosis of bleeding into the abdominal cavity

A patient with suspected bleeding into the abdominal cavity is subject to urgent examination in a hospital. An examination of the abdomen is carried out to identify the characteristic signs of injury (open wounds, abrasions, bruising).

Surface-orienting palpation reveals softness and slight soreness of the anterior abdominal wall, its limited participation in breathing, and mild symptoms of peritoneal irritation. Deep palpation is carried out carefully, as it causes sharp pain in the area of the damaged organ or the entire abdominal wall. Percussion of the abdomen in the presence of bleeding into the abdominal cavity is very painful, due to the accumulation of blood, there is a dullness of sound in sloping places. Abdominal auscultation showed a decrease in bowel sounds. When a hollow organ is ruptured, local manifestations of bleeding into the abdominal cavity may be masked by signs of incipient peritonitis.

Digital rectal and vaginal examinations reveal swelling and sharp pain in the anterior wall of the rectum and posterior vaginal fornix. If a disturbed tubal pregnancy is suspected, an important diagnostic value is assigned to the puncture of the abdominal cavity through the wall of the posterior fornix of the vagina. A laboratory blood test for bleeding into the abdominal cavity shows an increasing decrease in hemoglobin, red blood cell count and hematocrit.

Plain x-rays in the case of internal bleeding help to determine the presence of free fluid (blood) in the abdominal cavity. Ultrasound of the pelvic organs and ultrasound of the abdominal cavity reveals the source of bleeding in the internal organs and the accumulation of anechoic fluid. The main methods for diagnosing bleeding into the abdominal cavity are endoscopic studies – laparocentesis (puncture of the abdominal cavity with the connection of a rummaging catheter) and diagnostic laparoscopy.

The differential diagnosis of bleeding into the abdominal cavity is carried out with a perforated gastric and duodenal ulcer, retroperitoneal hematoma and hematoma of the anterior abdominal wall. If necessary, narrow specialists are involved in the diagnosis – a gynecologist, a traumatologist, a thoracic surgeon, a coloproctologist, a hematologist, etc.

Treatment of bleeding into the abdomen

A patient with suspected bleeding into the abdominal cavity is immediately hospitalized in compliance with the general rules: position – lying on his back, cold on the stomach, exclusion of water and food intake. In a surgical hospital, careful dynamic monitoring of the pulse rate and the value of blood pressure, hemoglobin and hematocrit levels is carried out. Until an accurate diagnosis is established, the use of painkillers (narcotic) drugs is contraindicated.

In case of acute blood loss and a sharp drop in blood pressure, anti-shock and anti-hemorrhagic infusion therapy is carried out: transfusion of blood substitutes (or reinfusion of blood that has recently leaked into the abdominal cavity), administration of analeptic drugs. This helps to increase and replenish BCC, improve the rheological properties of blood and microcirculation.

When establishing the fact of bleeding into the abdominal cavity, an emergency surgical intervention (laparotomy) is indicated, including a revision of the abdominal organs to detect the source of bleeding and stop it, and eliminate existing injuries.

The prognosis for bleeding into the abdominal cavity is quite serious, depending on the cause and intensity of bleeding, as well as the speed and volume of surgical intervention.