The Symptoms of Abdominal Dropsy or Ascites

Abdomen enlarged; skin tense and shiny; a sensation of fluid when felt by the hand; short breath; generally swelling of the lower extremities; weakness; emaciation, especially of the upper part of the body; loss of appetite; sleeplessness; patient cannot lie down on account of disturbance of breathing.

Dropsy of the abdomen is not itself a real disease, being simply a symptom of disease. It is most commonly found in general dropsy, but in this connection we refer to cases in which it is present without general dropsy. These cases are the result either of obstruction to the portal circulation from disease of the liver, obliteration of the portal vein, or degeneration of the peritoneal membrane, as in cancer or tuberculosis of the peritoneum. The most common cause of abdominal dropsy is hardening or cirrhosis of the liver, or other forms of degeneration of that organ, which most commonly result from the use of alcoholic liquors. Abdominal dropsy should be carefully distinguished from simple accumulations of fat in the abdominal walls, which is very frequent in advanced life in people of a lymphatic temperament, accumulations of gas in the intestines, and, in females, ovarian dropsy We have met with cases in which each one of these conditions has been mistaken for dropsy of the abdomen. The first condition is very easy to distinguish from accumulations of fluid in the abdominal cavity. The same is true of accumulations of gas in the intestines. By simply placing one hand on the abdominal wall and tapping upon one finger with the finger of the other hand, a drum-like resonance will be observed which indicates the presence of gas instead of fluid. Care should be taken, however, to observe whether the resonance extends to the space between the lower ribs and the upper part of the hip-bone. When no fluid is present there is resonance at this point on both sides of the body, but in cases of dropsy of the abdomen the water settles down into this part as the patient lies on his back, the inflated intestines floating and producing a resonance only at the upper part. It is most difficult to distinguish cases of ovarian dropsy or cystic tumor of the ovary from this disease. The best distinctive sign is a reversal of the order just described, the fullness being at the upper part of the abdomen, while resonance is found in the space described between the hip-bone and lower ribs, showing that the fluid is inclosed in a sac separate from the general cavity of the abdomen. In cases in which there is any doubt as to the presence of fluid in the abdominal cavity the question can be easily settled by means of a hypodermic syringe.

It is sometimes difficult to decide which one of the two principal causes of abdominal dropsy is active in any particular case. It may be said, however, that when there are other evidences of disturbed action of the liver it is safe to attribute the dropsy to disease of this organ. Disease of the liver is frequently indicated by dark-colored urine which upon chemical examination is found to contain bile. In cases in which none of these symptoms occur, the dropsy is generally due to degeneration of the peritoneum.