CIRRHOTIC ASCITES

Definition: - Ascites is defined as the accumulation of fluid in the periyoneal cavity. It is common clinical finding, with various extra peritoneal and peritoneal causes, but it most often results from liver cirrhosis.

The development of ascites in a cirrhotic patient generally heralds deterioration in clinical status and portends a poor prognosis.

Pathogenesis

Contributing factors:

(1) portal hypertension,

(2) hypoalbuminemia,

(3) hepatic lymph,

(4) renal sodium retention–secondary to hyperaldosteronism, increased sympathetic nervous system activity (renin-angiotensin production). Initiating event may be peripheral arterial vasodilation triggered by endotoxin and cytokines and mediated by nitric oxides.

COMPLICATIONS: -

-Spontaneous Bacterial Peritonitis

-Suspect in cirrhotic patient with ascites and fever, abdominal pain, worsening ascites, ileus, hypotension, worsening jaundice, or encephalopathy; low ascitic protein concentration (low opsonic activity) is predisposing factor.

DIAGNOSTIC PROCEDURE: -

Diagnosis suggested by ascitic fluid PMN cell count >250/μL; confirmed by positive culture (usually Escherichia coli and other gut bacteria; however, gram-positive bacteria including Streptococcus viridans, Staphylococcus aureus, and Enterococcus spp. also can be found).Risk is increased in pts with variceal bleeding and prophylaxis against spontaneous bacterial peritonitis is recommended when a pt presents with upper GI bleeding.

COMPLICATIONS: -

The complications may be:-

• Bacterial peritonitis.
• Any serious infections.
• Malnutrition
• Weight loss.
• Weakness

HOMEOPATHIC MANAGEMENT: -

The medicines that can be thought of use are:-

• Arsenicum album
• Apocyanum
• Apis mel
• Digitalis
• China
• Lycopodium
• Senecio aureus.