Fluid In Abdominal Cavity Signals Variety of Illnesses
BY R. KNIGHT STEEL
All of us note changes in our appearance as we age. Even if not overweight, we may notice that our abdomen seems to be a little protuberant as we tend to lose muscle strength in our abdominal wall.
A number of organs, including the liver, spleen, pancreas and intestines, as well as a tiny amount of fluid, are found in the abdominal cavity. When the quantity of fluid increases significantly, it is called ascites.
On occasion, there may be so much fluid, the elder has a strikingly protuberant and even tense abdomen. This is not a normal change associated with aging.
There are many causes of ascites, but the most common is cirrhosis, chronic scarring of the liver. Large amounts of alcohol consumed over many years may be responsible. Also, the older person may have become infected with hepatitis C during a blood transfusion decades earlier.
Sometimes, a malignant tumor has seeded the peritoneal cavity, resulting in ascites. The presence of a malignancy may be recognized first when ascites develops, often over a brief period of time.
An infection may cause ascites. An elder may have had tuberculosis that went unrecognized many years previously. After having been quiescent for some time, the bacterium responsible for tuberculosis may seed the peritoneal cavity. It may be associated with other signs of an infection, such as fever.
A number of other diseases may be responsible for ascites. Inflammation of the pancreas may cause fluid to accumulate in the abdomen. Sometimes, this condition is associated with alcohol excess and liver disease, as well. Kidney failure may cause fluid to accumulate throughout the body and may first be recognized by the appearance of ascites. On rare occasions, ascites is caused by low levels of thyroid hormone.
The work-up of ascites begins with a series of questions. A history of blood transfusions or heavy alcohol consumption may point the way to the diagnosis. There may be clues on the physical examination, as well. For example, there may be signs of chronic liver disease, such as reddening of the palms of the hands and striking wasting of the facial muscles. The abdomen may be tender to touch, suggesting acute inflammation. There may be evidence of a malignancy, for example, marked weight loss in spite of an increasing abdomen.
The commonly ordered blood tests may reveal liver disease or kidney failure. If it is not clear if ascites is present, an ultrasound study may be ordered. An abdominal CT scan may reveal changes in the liver and an enlarged spleen, suggesting cirrhosis. If there is doubt as to the cause of ascites, a needle may be inserted into the peritoneal space and some of the fluid removed for study. The white blood cell count in the fluid may be elevated because of an infection and a culture may reveal the organism. A cytologic examination may reveal the presence of tumor cells.
Write to Dr. R. Knight Steel at Hackensack University Medical Center, 30 Prospect Ave., Hackensack, N.J. 07601.