Ascites

“ In respect to those instances of diseases of the liver, connected with ascites, in which, in addition to its other morbid states, a partial occlusion of the vena portæ, by the effusion of coagulable lymph into it, is said to have existed, our author remarks, that they are very few in number, occurring, perhaps, in one out of several hundred cases of ascites with hepatic disease ”

“ It is true that the physician would not shrink hopelessly from the treatment of simple chronic peritonitis. But this is one of the rarest causes of ascites. A physician in a long lifetime may not have seen a case. It is true, ascites is a symptom, always a secondary, or even a tertiary, affection; and theoretically there can be no better advice, but practically it cannot amount to much. Then, if the cause cannot be removed, it remains to do our best to relieve the patient of his load and strive to prolong his life to its utmost possible limit. ”

“ SYMPTOMS.—In general, ascites is easily recognized by the swollen state of the bowels: a well-rounded swelling when the patient stands or sits, but spread out in the flanks when he lies on his back; the fulness of the side on which the patient may be lying, and the flattened condition of the opposite side,—belong to this disease, and as a group to no other. ”

“ When in the latter mode, the ascites is usually combined with anasarca, and the disorder generally comes on suddenly, and has a rapid progress. The vascular system is excited, and there is more than usual thirst; the blood when drawn exhibits the buffy appearance; and the urine, when subjected to heat, is found to coagulate strongly, from the large quantity of serum contained in it. In some of the severer cases, the effusion into the abdomen takes place very suddenly, and yet, by a copious bleeding the disease may be at once arrested, and the water be afterwards absorbed. ”

“ Definition.—An accumulation of serous fluid in the peritoneal cavity.
Etiology.—Any obstruction of the portal circulation is a possible cause of ascites, the most frequent being cirrhosis of the liver. Pressure from tumors or neighboring organs may also give rise to it. Peritonitis and valvular diseases of the heart are also responsible for ascites, and chronic pulmonary affections may impair the portal circulation to the extent of producing it. ”

“ Dropsy occurs in a large proportion of cases (nearly one-half) during the advanced stages of the disease. It is due to vascular obstruction occasioned by the pressure of the enlarged pancreas itself or of the secondarily degenerated coeliac glands, and finally by secondary lesions of the liver. The dropsy appears either in the form of ascites or anasarca, is not often extreme in degree, and is subject to variations, disappearing and reappearing at intervals. Ascites is the more common form, but both conditions may exist in the same patient. ”

“ Bristowe finds from hospital records that ascites occurs in about equal frequency in males and females, but, as everybody has noticed, that hepatic dropsy is much more frequent in men than in women. Ascites, he says, is most frequent between the ages of thirty and fifty, and next between twenty and thirty and between fifty and sixty, but is not uncommon above the latter age ”

“ With this object resort may be had, when necessary, to persistent stimulation of the sides of the abdomen, mild blisters and mustard plasters, or friction with turpentine.
The food should be easy of digestion, and of first-rate quality. The most useful drugs comprise mild, unirritating diuretics, general stimulants, and tonics.
Animals affected with incurable lesions should not be treated.
ASCITES. True ascites consists in dropsy of the peritoneum, unaccompanied by inflammation of that membrane, or by the presence of infectious microorganisms in the transuded liquid. ”

“ In ascites there is a gradual enlargement of the abdomen and when pressed upon, the fluid can be felt to flow from side to side and the part with the water gives a dull sound on being struck. Breathing is quicker and impeded and the appetite diminished, but there is no fever. ”

“ Nor does the serous discharge always take place into the abdomen, in every case where these organs are morbidly affected, but only where their peritoneal covering participates in the disease; for the chronic inflammation in those cases, where it occasions ascites, does so by extending from the cellular tissue of the internal structure of the organ, to the serous tissue investing in it. ”

“ Consequently, if there be none in cases of simple ascites, and if it only appears when anasarca supervenes, the only conclusion that may be drawn from these facts, is, that anasarca is the only form of dropsy, in which serum is absorbed, and passed off by the kidneys; and if there be a greater quantity discharged when anasarca is primary, it is only because the disease is more violent, and generally more extensive. ”

“ Trasbot gives the excessive atrophy of the temporal and masseter muscles as pathognomonic. Ascites is a usual complication. Enlargement of the liver, as shown by percussion of the right hypochondrium, and, in case of flaccid abdomen, by manipulation, and attendant signs of tenderness are corroborative. Variability or loss of appetite, and vomiting is not uncommon, and in case of primary or secondary deposits in other organs in the abdomen, thorax or elsewhere, the symptoms resulting from functional derangement of such organ may be found. Treatment is hopeless. ”

“ I use it in the Ascites, Anasarca, and Hydrops Pectoris; and so far as the removal of the water will contribute to cure the patient, so far may be expected from this medicine: but I wish it not to be tried in ascites of female patients, believing that many of these cases are dropsies of the ovaria; and no sensible man will ever expect to see these encysted fluids removed by any medicine. ”

“ Dropsy of the ovary is another incysted dropsy, which seldom admits of cure. It is distinguished from ascites by the tumour and pain, especially at the beginning, occupying one side, and the fluctuation being less distinctly perceptible. When it happens to young subjects it is less liable to be mistaken for ascites. It affects women of all ages, either married or virgins; and is produced by cold, fear, hunger, bad food, and other debilitating causes. I saw an elegant young lady, who was shortly to have been married to a sensible man, with great prospect of happiness ”

“ PHYSICIANS' TREATMENT for Ascites.—First treat the disease causing it. Sometimes it is necessary in order to prolong life to repeatedly tap the patient as in cirrhosis of the liver. When it is caused by the heart or kidneys, give cathartics that carry away much liquid, hydragogue cathartics. One dram of jalap at night followed by a big dose of salts before breakfast. Cream of tartar and salts are good, equal parts. Or cream of tartar alone, one to two drams, with lemon juice in water in repeated doses. Digitalis and squill, of each one grain to cause great flow of urine. ”

“ Coming on in the course of some chronic affection of the liver or some obstructing cause exterior to the organ, there soon follow ascites, nausea and vomiting, hæmatemesis, bloody stools of a liquid character, enlargement of the spleen, distension of the abdominal veins, and the distressing symptoms produced by an excessive accumulation of fluid in the peritoneal cavity. ”

“ As a rule there is a little jaundice, as there is a decrease in the production of bile, instead the skin takes on an earthy, sallow tint. There is generally ascites, swelling of the feet and legs, which increases until the abdomen and the lower extremities become of an enormous size. The nutrition of the body suffers, the skin is dry and harsh. The blood is altered in quantity, and coagulates quickly. ”

“ Even a simple ascites seldom admits of a radical cure. Almost all that can be done is, to let off the water by tapping, which seldom affords more than a temporary relief.
376When the disease comes suddenly on, and the patient is young and strong, there is reason however to hope for a cure, especially if medicine be given early. But if the patient be old, has led an irregular or a sedentary life, or if there be reason to suspect that the liver, lungs, or any of the viscera are unsound, there is great reason to fear that the consequences will prove fatal. ”

“ In tympanites, purgatives and every medicine which wastes the body must be rejected, and also the more drastic diuretics; and we must use both externally and internally such things as can attenuate and dissipate the flatus; and dry-cupping may be frequently applied over the whole belly. When those who have ascites are not benefited by any of the remedies already described, we must have recourse to paracentesis, which does not apply to any of the other varieties of dropsy. ”

“ For several years, I have given the infusion in a variety of cases, where there was a deficiency in the secretion of the urine, with the greatest success. In recent obstructions, I do not recollect many failures. In anasarcous diseases, and in the anasarca, when combined with the ascites; in swellings of the limbs, and in diseases of the chest, when there was the greatest reason to believe an accumulation of serum, the most beneficial consequences have followed from its use. ”

“ But sometimes from hardness of the peritoneum and of the uterus in women, or from scirrhus, on the contrary, a great collection of fluid with a very small proportion of air is formed in the same parts, being confined as it were in a bladder, when the dropsy is named ascites, and is occasioned by the afore-mentioned causes; but, for the most part, it arises from hardness and scirrhus about the spleen and liver, and from chronic defluxions about the intestines; whereby it happens that the belly is swelled, while the rest [570] of the body is melted owing to its not being nourished. ”

“ The animal has suffered materially from mange, which has been apparently cured: the itchiness and eruption altogether disappear, but many weeks do not elapse ere ascites begins to be seen, and the abdomen is gradually distended with fluid. When this appears in young and healthy animals, it may be conquered; but when there has been previous disease of almost any kind, comparatively few patients permanently recover. Irritability of the stomach, and a small and accelerated pulse, are unfavourable. ”

“ We next turn to the treatment of hydrothorax and ascites. As the existence of hydrothorax in its early stage is difficult to ascertain, and as what have been called premonitory symptoms are only those proper to the mildest forms of the disease, and not of that condition of the parts which gives rise to the effusion, the treatment is somewhat difficult, and, in too many instances, our remedies are directed, not to the disease itself, but to one of its effects. Faithful to his view of the pathology of dropsy, Dr. ”

“ The abdomen may enlarge from causes other than pregnancy. Pregnancy and ascites, or ovarian dropsy, may coexist in the same patient, and the diagnosis be rendered anything but easy. The enlargement of the abdomen may lead to unfounded suspicions detrimental to the happiness and health of the unfortunate object of them. ”

“ Ascites. Diagnosis: trauma, gastric or intestinal lesion, followed by specific symptoms. Lesions: trauma, rupture and escape of ingesta, congestion, ecchymoses, false membranes, adhesions, liquid effusion, bloody, pink, or straw colored, albuminous, fibrinous, granules, cells, salts, bacteria, pus, fœtor, bowels tympanitic, later fibrous bands, strangulations, degenerations. Prevention: fatal in solipeds, avoid abdominal congestions, inflammations, traumas, infections, accumulation of serum, blood, etc., also debility, ill health, chill. ”

“ Not infrequently adhesions exist between the stomach and surrounding organs. Exceptionally, a diffuse growth of fibrous tissue may invade the greater part of the peritoneum, particularly the visceral layer, and cause a thickening similar to that existing in the stomach. In such cases ascites is usually a marked symptom.
PROGNOSIS.—The prognosis of cirrhosis of the stomach is grave. The disease runs a chronic course, and usually terminates in death by asthenia. There is no reason to believe that the stomach can ever be restored to its [p. 615] normal condition. ”

“ The cavity of the abdomen much distended from ascites; the contained fluid was to the extent of about six Scotch pints of a straw colour; the viscera much compressed, and matted together, with light brown exudation. The peritoneum was rough, and coated with the same exudation. The stomach and all the intestines correspondingly contracted; the mesentery appeared healthy; the liver was much enlarged, and darker than usual; the inferior lobe extending downwards, near to crest of ileum; the whole organ loaded with inky-coloured blood; the substance easily torn. ”

“ As in the thorax, the tuberculous lesions seldom produce extensive liquid exudation, so that ascites does not occur, but on palpation the abdominal walls appear to have entirely lost their pliability and 696to be unyielding and greatly thickened, a point which is the more remarkable as the animals are thinner.
The wall of the abdomen is stiff, incapable of being depressed as in ordinary subjects, and gives to the fingers the sensation of a thick hard covering, through which the subjacent organs and their contents, that is, the rumen, intestine and alimentary material, can no longer be felt. ”

“ The support afforded to persons who have been tapped in Ascites is another instance. I have also lately met with a case in which a morbidly relaxed state of the bowels had harassed the patient for several years, and set at defiance every astringent medicine; upon the application, however, of a tight bandage around the abdomen, the healthy action of the intestines has been completely restored. Sir Gilbert Blane has suggested the trial of mechanical compression of the head in the cure 208of Hydrocephalus, and several cases, apparently favourable, have been published. ”