Since 2017, 49-year-old Brother Yan has repeatedly distended his abdomen, which has lasted for 6 years. On December 3, 2023, Brother Yan had symptoms such as a large belly like being pregnant in October, difficulty breathing, inability to lie flat, lack of urine, black stool, fatigue, and irritability. The patient had a history of liver cirrhosis, the abdomen was extremely distended, B-ultrasound showed a large amount of ascites effusion, lying down, and the ascites was up to 130mm.
At the time of admission, the patient's condition was extremely critical, in the advanced stage of liver cirrhosis, spontaneous peritonitis led to septic shock, gastrointestinal bleeding, acute renal failure, **difficult, Peng Zhujun, director of the intensive care medicine department (central ICU), and his team after research and discussion, developed a strict diagnosis and treatment plan, blood transfusion**, hemofiltration**, oral hemostatic drugs, protection of gastric mucosa, albumin transfusion, anti-infection and other traditional Chinese and Western medicine **, combined with the use of antibiotics during the drainage period to flush the abdominal cavity to fight infection. After 6 days of continuous abdominal drainage, intermittent clamping and irrigation, the patient's abdominal circumference was reduced from 116cm to 86cm, and finally nearly 20 kg of pus was drained, and the big belly at admission disappeared magically!
For the care of pipes, ** and psychology during the release of ascites, Hu Xuebing, the head of the ICU of the center, also made important guidance. The patient's indications have gradually improved, and he has been transferred out of the Intensive Care Unit (ICU) for continuation**.
Intraperitoneal drainage of pus.
Health science. 1. What is cirrhosis ascites?
Ascites is one of the most common complications of decompensated liver cirrhosis, so it is of great significance for patients to correctly understand and scientifically manage ascites in liver cirrhosis to improve their quality of life and prognosis.
Under normal physiological conditions, there is about 20ml-50ml of clear and transparent liquid in our peritoneal cavity, which lubricates intestinal peristalsis. However, in some pathological conditions, the amount of fluid in the peritoneal cavity will increase significantly, which may exceed 200ml, and even appear manifestations such as increased abdominal circumference and abdominal distention.
2. Why does ascites occur?
The occurrence of ascites in patients with liver cirrhosis is often associated with portal hypertension and hypoproteinemia, and the occurrence of ascites in patients is one of the important landmark events of the progression of liver cirrhosis from compensated to decompensated.
Patients with cirrhosis need to seek medical attention as soon as ascites develops.
3. What should I do if a patient with liver cirrhosis has ascites?
Salt-restricted diet promotes resolution of ascites.
Patients with cirrhosis and ascites often have varying degrees of water and sodium metabolism disorders, and the increase in sodium will lead to water retention, thereby aggravating ascites. Sodium-restricted diets (< 4 to 6 g a day) can accelerate resolution of ascites. For patients with serum sodium less than 120 mmol, it is also necessary to limit water intake.
Keep an eye on your weight for accurate** and monitoring.
Patients with cirrhosis and ascites often require diuresis**, and for patients with large amounts of ascites or refractory ascites, peritoneal puncture and albumin infusion** may also be required. In the process, it is necessary to record the daily inflow and output in detail, but the more objective indicator of the monitoring effect is the change in weight, therefore, patients with cirrhosis and ascites need to pay attention to and master the regular monitoring of weight.
Surgery**. For ascites in end-stage liver disease, patients can choose transjugular intrahepatic portosystemic stent shunt (TIPS) or liver transplantation according to the doctor's recommendation and their own conditions**.
Hunan Medical Chat Special Author: Luo Xin, Department of Critical Care Medicine (Central ICU), Hunan Provincial Hospital of Traditional Chinese Medicine, follow @Hunan Medical Chat to get more health science information!
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