What to do if you have abdominal distension due to ascites? How to treat it

Ascites is a common liver disease. It is mainly caused by inflammation of the liver, which can lead to a series of pathological causes, causing the fluid accumulation in the abdominal cavity to continue to increase, resulting in the fluid accumulation exceeding the normal range, so that the patient's abdomen will continue to expand. Such situations require prompt treatment.

1. General treatment is the basis for treating ascites caused by cirrhosis, commonly known as hepatic ascites, including removing the cause, bed rest, salt restriction, enhanced nutrition, and eating a high-protein and high-fiber, vitamin-rich, soft and easy-to-digest diet. In the early stages of cirrhosis of the liver, there is sodium and water retention. These patients are intolerant to sodium and water. Intake of 1g of sodium salt can retain 200ml of water. Therefore, limiting sodium salt intake is beneficial to the elimination of ascites. Generally, sodium salt intake is controlled at around 2g88mmol per day. In addition, fluid intake should be controlled as much as possible. Generally, the daily intake of patients with ascites should not exceed 1000ml, and the daily intake of patients with dilutional hyponatremia should be limited to 500ml to reduce sodium and water retention.

2. When serum albumin is lower than 25-30 g/l, the plasma colloidal osmotic pressure decreases, which can easily lead to the occurrence of hepatic ascites. Therefore, treatment should be supplemented through intravenous route, with the method of infusing 10-20g of human albumin each time, 2-4 times a week. In severe cases, it can be done once a day. Supplementing albumin and increasing the colloid osmotic pressure can effectively improve the responsiveness to diuretics and prevent the recurrence of hepatic ascites.

3. When the amount of ascites is large and affects the heart, lung and kidney functions, the ascites can be directly discharged to reduce abdominal pressure and improve kidney function. Generally, the amount of ascites discharged at one time should be 2000-3000ml. When a larger amount of ascites is discharged, such as 4000-6000ml, a larger dose of human albumin, about 40g, needs to be administered at the same time. After discharge, the abdomen should be bandaged with a pressure bandage. Reinfusion of ascites is a safe and effective measure to eliminate ascites. For patients with a large amount of ascites, it can be used 2 to 4 times. It can quickly relieve symptoms, promote diuresis, and help eliminate ascites. For elderly patients without cardiopulmonary insufficiency, liver ascites concentration and re-infusion of ascites can be used for nutrition and treatment.

4. When the amount of ascites is small, it is not necessary to drain the ascites. Diuretics should be given first to achieve the purpose of clearing the ascites.

Active and reasonable treatment should be carried out in the early stage of hepatic ascites, generally based on rest and salt restriction. Those with reduced plasma protein can be infused with human albumin and the plasma osmotic pressure can be corrected. At this time, the ascites often subsides. For patients who are ineffective with the above treatment and whose basal urinary sodium excretion is 50-100mmol/d, a small amount of diuretics can be given as appropriate, generally 100mg/d of spironolactone.

Patients with moderate ascites and low urinary sodium excretion are often accompanied by increased aldosterone. Generally, aldosterone antagonists are used in combination. Usually, after taking spironolactone 100 mg/d for 3 days, an appropriate amount of pan-type diuretics such as hydrochlorothiazide or furosemide 40 mg/d is used in a short period of time. For most patients, spironolactone is taken up to 200 mg/d to accelerate diuresis to 80 mg/d, which can achieve satisfactory sodium excretion and diuresis effects.