Definition

Accumulation of serous fluid in the peritoneal cavity.

Etiology

This affection is secondary to inflammations, or slight extension of inflammations from other organs. It may be due to cancer extending to the peritoneum, tuberculosis of the peritoneum, or portal obstruction or cancer extending from the liver to the peritoneum. Pyemia may be a cause of this affection; also tumors in the abdomen, large fibroids or ovarian tumors, or hydatid disease of the liver.

Ascites becomes a part of the general dropsy brought on from heart enervation. Lung affections, such as emphysema or sclerosis of the lungs, cause dropsy. Ascites occurs also in dropsy brought on from Bright's disease of the kidneys.

Symptoms

Gradual enlargement of the abdomen, sometimes starting with puffiness of the feet and ankles. The history of the case will throw some light upon it and aid in differentiating between ovarian tumor and ascites.

In percussing over an ovarian tumor, the resonant sound peculiar to percussing over the intestine is entirely eliminated. The sound is dull over the lower abdomen, and when the percussing extends above the umbilicus, if there begins to be a resonant sound it will be known that that is the upper part of the tumor. Then, going laterally on each side down into the small of the back, there will be more resonance on both sides, showing that the tumor rests upon the intestine. Sometimes a loop of intestine will rise between the tumor and the wall of the abdomen. In that event it requires a little more skill in diagnosing to determine whether it is a case of ovarian cyst or ascites. The experienced diagnostician, however, will not have much trouble; for, by introducing the finger into the vagina and passing up in front of the neck of the womb with one hand, and then having the other hand placed on the abdomen, the sensations of the two palpating hands or fingers will be carried to each other, showing a continuation of a fluid medium; whereas, if the hand can be placed upon the top of the swelling, above the umbilicus, and pressed down, and, with the finger in the vagina and to the anterior of the neck of the womb, nothing can be felt between--if the percussion wave does not extend to the finger in the vagina--then it will be known that the disease is ascites.

Treatment

For ascites, where the symptom is very distressing, a little palliation may be secured by tapping and drawing off the water; but it will fill up very soon again, and the patient will have to be tapped again and again, until he is worn out and dies from exhaustion. If the affection has not evolved into such a desperate type, fasting will give relief; and, in fact, this is the only hope of carrying a patient back to a reasonable state of health. If the ascites is due to a cancerous extension, there is no hope. If the disease is due to a pyemic infection from, say, liver abscess, if the abscess can be drained there is hope of a betterment, and possibly a cure. In acute peritonitis from extension of pelvic inflammation, the pelvic disease must be corrected as quickly as possible; and if the peritonitis is extensive, there is a possible hope in opening the peritoneum and washing it out, and then draining. These cases are never very promising.