Ascites, A Simple Guide To The Condition, Treatment And Related Conditions

By Kenneth Kee

Ascites is the accumulation of fluid in the peritoneal cavity, causing abdominal swelling.
Edema is a symptom defined as excess of fluid in extracellular spaces.
Diseases and conditions that may cause edema include:
1. Congestive heart failure - the main cause
When one or both of the heart's lower chambers lose their ability to pump blood effectively as happens in congestive heart failure the blood can back up in the legs, ankles and feet, causing edema.
2. Liver Cirrhosis - the second cause
Fluid may accumulate in the abdominal cavity (ascites) and in the legs as a result of cirrhosis, a liver disease often caused by alcoholism.
3. Kidney disease.
When you have kidney disease, extra fluid and sodium in the circulation may cause edema.
The edema associated with kidney disease usually occurs in the legs and around the eyes.
4. Kidney damage.
Damage to the tiny, filtering blood vessels in the kidneys can result in nephrotic syndrome.
In nephrotic syndrome, declining levels of protein (albumin) in the blood can lead to fluid accumulation and edema.
4. Weak or damaged leg veins (chronic venous insufficiency).
One-way valves keep the blood in the leg veins moving toward the heart.
If the valves stop working properly, blood can pool in the lower legs and cause swelling.
5. Inadequate lymphatic system.
The body's lymphatic system helps clear excess fluid from tissues.
If this system is damaged for example, by cancer surgery the lymph nodes and lymph vessels draining an area may not work correctly and edema results.
A person with ascites usually has severe liver disease.
Ascites due to liver disease is caused by high pressure in the blood vessels of the liver (portal hypertension) and low albumin levels.
Cirrhosis and any illness that leads to it is a common cause of ascites.
Long-term infections with hepatitis C or B and long-term alcohol abuse are two of the most common causes of cirrhosis.
People with colon cancer, ovarian cancer, endometrial cancer, pancreatic cancer, and liver cancer may develop ascites.
Diagnosis is by Paracentesis or abdominal tap.
Treatment may include:
1. Diuretics, or water pills, to help remove the fluid; usually, spironolactone (Aldactone) is used first, and then furosemide (Lasix) will be added
2. Antibiotics, if an infection develops
3. Limiting salt in the diet (no more than 1,500 mg/day of sodium)
4. Avoiding drinking alcohol
Procedures used for ascites that do not respond to medical treatment include:
1. Placing a tube into the area to remove large volumes of fluid (called a large volume paracentesis)
2. Transjugular intrahepatic portosystemic shunt (TIPS), which helps reroute blood around the liver.
3. Patients who develop end-stage liver disease, and whose ascites no longer respond to treatment will need a liver transplant.
TABLE OF CONTENT
Introduction
Chapter 1 Ascites
Chapter 2 Interesting Facts of Ascites
Chapter 3 Treatment of Ascites
Chapter 4 Portal Hypertension
Chapter 5 Liver Cirrhosis
Chapter 6 Congestive Heart Failure
Chapter 7 Alcoholism
Epilogue

• Language: English
• Publisher: Kenneth Kee
• Release date: Nov 16, 2016
• ISBN: 9781370832903

Kenneth Kee

Medical doctor since 1972.Started Kee Clinic in 1974 at 15 Holland Dr #03-102, relocated to 36 Holland Dr #01-10 in 2009.Did my M.Sc (Health Management ) in 1991 and Ph.D (Healthcare Administration) in 1993.Dr Kenneth Kee is still working as a family doctor at the age of 74However he has reduced his consultation hours to 3 hours in the morning and 2 hours inthe afternoon.He first started writing free blogs on medical disorders seen in the clinic in 2007 on http://kennethkee.blogspot.com.His purpose in writing these simple guides was for the health education of his patients which is also his dissertation for his Ph.D (Healthcare Administration). He then wrote an autobiography account of his journey as a medical student to family doctor on his other blog http://afamilydoctorstale.blogspot.comThis autobiography account “A Family Doctor’s Tale” was combined with his early “A Simple Guide to Medical Disorders” into a new Wordpress Blog “A Family Doctor’s Tale” on http://ken-med.com.From which many free articles from the blog was taken and put together into 1000 eBooks.He apologized for typos and spelling mistakes in his earlier books.He will endeavor to improve the writing in futures.Some people have complained that the simple guides are too simple.For their information they are made simple in order to educate the patients.The later books go into more details of medical disorders.He has published 1000 eBooks on various subjects on health, 1 autobiography of his medical journey, another on the autobiography of a Cancer survivor, 2 children stories and one how to study for his nephew and grand-daughter.The purpose of these simple guides is to educate patient on health disorders and not meant as textbooks.He does not do any night duty since 2000 ever since Dr Tan had his second stroke.His clinic is now relocated to the Buona Vista Community Centre.The 2 units of his original clinic are being demolished to make way for a new Shopping Mall.He is now doing some blogging and internet surfing (bulletin boards since the 1980's) startingwith the Apple computer and going to PC.The entire PC is upgraded by himself from XT to the present Pentium duo core.The present Intel i7 CPU is out of reach at the moment because the CPU is still expensive.He is also into DIY changing his own toilet cistern and other electric appliance.His hunger for knowledge has not abated and he is a lifelong learner.The children have all grown up and there are 2 grandchildren who are even more technically advanced than the grandfather where mobile phones are concerned.This book is taken from some of the many articles in his blog (now with 740 posts) A Family Doctor’s Tale.Dr Kee is the author of:"A Family Doctor's Tale""Life Lessons Learned From The Study And Practice Of Medicine""Case Notes From A Family Doctor"

Book preview

Ascites,

A

Simple

Guide

To

The Condition,

Treatment

And

Related Conditions

By

Dr Kenneth Kee

M.B.,B.S. (Singapore)

Ph.D (Healthcare Administration)

Copyright Kenneth Kee 2014 Smashwords Edition

Published By Kenneth Kee at Smashwords.com

Dedication

This book is dedicated

to my wife Dorothy

and my children

Carolyn, Grace

and Kelvin

This book describes the disease Ascites and Its Treatments and Related Diseases or in vernacular terms

(What You Need to treat Ascites)

This eBook is licensed for the personal enjoyment only. This eBook may not be re-sold or given away to other people. If you would like to share this book with another person, please purchase an additional copy for each reader.

If you’re reading this book and did not purchase it, or it was not purchased for your use only, then please return to Smashwords.com and purchase your own copy.

Thank you for respecting the hard work of this author.

Introduction

Ode to Ascites

Ascites is the accumulation of fluid in the peritoneal cavity

Excess fluid may also accumulate in the legs due to gravity

Other causes are due to water load from congestive heart failure

It can also result from increased portal arterial pressure

Ascites may also be associated with Kidney dialysis

The most cause however is due to liver cirrhosis

Other causes are metastatic carcinoma in the abdominal cavity

Even the loss of protein in protein losing enteropathy

Many people with ascites have abdominal swelling.

As a result there may be difficulty in breathing

One indicator of ascites is the presence of shifting dullness

The fluid in the abdominal cavity is causing the fullness

Treatment is by treating the underlying disease.

Removal of ascites is with use of diuretic relief

The swelling is reduced through passing out the urine

Therapeutic paracentesis can help the fluid draining.

-An original poem by Kenneth Kee

Interesting Tips about the Ascites

A Healthy Lifestyle

1. Take a well Balanced Diet

2. Treatment of any underlying cause of Ascites.

a. A diet with salt diet restricted to <90 mmol/day (5.2 g of salt/day) is useful, especially in cirrhosis but is unlikely to be effective in other etiologies such as malignancy.

b. Avoiding alcohol

c. Limiting fluid intake

Medicines from the doctor

The first line of management of ascites is medical treatment (sodium restriction and diuretic therapy) and is effective in the majority of cirrhotic patients with non-refractory ascites.

a. Diuretics:

Spironolactone is the best initial choice in cirrhosis

Start cautiously with, for example, furosemide 40 mg/day, although up to 160 mg/day may be used.

High doses cause severe electrolyte disturbance particularly hyponatremia.

b. Catumaxomab

Catumaxomab is a trifunctional bispecific monoclonal antibody with a clear clinical benefit for patients with malignant ascites secondary to epithelial cancers, especially gastric cancer, and is generally well tolerated with an acceptable safety profile.

c. Antibiotics for infections

Surgical

a. Therapeutic paracentesis

Patients with large or refractory ascites generally benefit from therapeutic paracentesis.

3. Keep bones and body strong

Bone marrow produces our blood

Eat foods rich in calcium like yogurt, cheese, milk, and dark green vegetables.

Eat foods rich in Vitamin D, like eggs, fatty fish, cereal, and fortified milk.

Eat food rich in Vitamins B and C such as green vegetables and fruits

Zinc and other minerals are important to the body

4. Get enough rest and Sleep

Avoid stress and tension

5. Exercise and stay active.

It is best to do weight-bearing exercise such as walking, jogging, stair climbing, dancing, or lifting weights for 2½ hours a week.

One way to do this is to be active 30 minutes a day at least 5 days a week.

Begin slowly especially if a person has not been active.

6. Do not drink more than 2 alcohol drinks a day for a man or 1 alcohol drink a day for a woman.

Alcohol use also increases the chance of falling and breaking a bone.

Alcohol can affect the neurons and brain cells.

7. Stop or do