Ascites due to liver cirrhosis

　　All causes that can lead to liver cirrhosis are also the causes of ascites due to liver cirrhosis. The main causes include

　　1. Viral hepatitis: Currently in China, viral hepatitis, especially chronic hepatitis B, is the main factor causing portal cirrhosis.

　　2. Alcoholism: Long-term and excessive alcohol consumption is one of the factors causing liver cirrhosis.

　　3. Nutritional disorders: Most scholars admit that malnutrition can reduce the resistance of liver cells to toxic and infectious factors, thereby becoming an indirect cause of liver cirrhosis.

　　4. Industrial toxins or drugs: Long-term or repeated contact with刺激性 substances can cause them.

　　5. Circulatory disorders: Chronic congestive heart failure and chronic constrictive pericarditis can cause long-term congestion and hypoxia in the liver, leading to liver cell necrosis and fibrosis, known as congestive cirrhosis, also known as cardiogenic cirrhosis.

　　6. Metabolic disorders: Such as hemochromatosis and hepatolenticular degeneration (also known as Wilson's disease).

　　7. Cholestasis: When there is obstruction of the extrahepatic bile duct or cholestasis within the liver, the high concentration of bilirubin has a damaging effect on liver cells, which can eventually lead to cirrhosis. The one caused by intrapulmonary cholestasis is called primary biliary cirrhosis, and the one caused by extrahepatic bile duct obstruction is called secondary biliary cirrhosis.

　　8. Schistosomiasis: During schistosomiasis, due to the stimulation of eggs in the portal area, the connective tissue proliferates to form schistosomal liver fibrosis, which can cause significant portal hypertension, also known as schistosomal cirrhosis.

　　9. Unknown cause: Some cases of liver cirrhosis have an unknown cause and are called cryptogenic cirrhosis.

　　Ascites due to liver cirrhosis should be treated promptly; if not treated effectively, it can also lead to many diseases.

　　1. Peritonitis

　　The abdominal fluid in patients with ascites due to liver cirrhosis is conducive to bacterial growth, especially during abdominal puncture or drainage of ascites, which is more likely to cause secondary infection, leading to the occurrence of secondary or primary peritonitis. When acute peritonitis occurs, it can cause symptoms such as abdominal muscle tension, tenderness, and rebound pain.

　　2. Hypotension or shock

　　Patients with ascites due to liver cirrhosis may experience a decrease in effective circulating blood volume due to the large amount of fluid渗入 the abdominal cavity, causing blood to become concentrated, resulting in increased blood viscosity and slow blood flow, which can lead to hypotension or shock. Particularly when there is a reduction in liver blood flow, it can exacerbate the state of ischemia and hypoxia in the liver, further aggravating liver cell necrosis.

　　3. Abdominal distension and mobile dullness

　　Abdominal distension and mobile dullness are typical symptoms caused by ascites due to liver cirrhosis, and the abdomen may appear like a frog belly, with soft palpation, most without tenderness, and mobile dullness on both sides is symmetrical; however, when there is adhesion in inflammatory ascites, even with a large amount of ascites and abdominal distension, there may be no obvious mobile dullness or asymmetry of mobile dullness on both sides. In addition, ascites caused by abdominal tumors may manifest as localized elevation or palpable mass.

　　4. Liver enlargement or shrinkage

　　Ascites caused by liver cirrhosis, especially that caused by alcoholic cirrhosis, is often accompanied by liver enlargement, which can shrink in the late stage; when liver cirrhosis causes ascites, the liver is large and hard as stone, and the surface may present nodular appearance.

　　In addition, portal hypertension in patients with ascites due to liver cirrhosis can cause dilatation of the lower esophageal, gastric fundus, and anal veins, and ascites often is accompanied by gastric mucosal erosion and ulcerative disease.

　　In general, the early stage of liver ascites will appear symptoms such as fever and abdominal pain, accompanied by chills, fever, abdominal pain, muscle tension, and tenderness, which often suggests peritonitis caused by various reasons. Early symptoms of liver ascites may be accompanied by jaundice, hematemesis, and black stools, which are more common in ascites caused by liver cirrhosis, liver cancer, and other gastrointestinal tumors.

　　With the increase of the duration of liver ascites, when a large amount of liver ascites occurs, the patient's abdomen swells, the abdominal wall becomes tight and shiny, resembling a frog belly, and the patient has difficulty walking. Sometimes the diaphragm is significantly elevated, and symptoms such as rapid breathing and umbilical hernia appear in the early stage of liver ascites. Before the occurrence of liver ascites, patients often have a feeling of abdominal distension, and when a large amount of ascites forms, the abdominal distension becomes more severe, and the abdominal distension can be observed gradually, the abdominal wall becomes tight and shiny, resembling a frog belly, and the enlarged abdominal cavity even affects the patient's daily life and activities, causing difficulty in walking. A large amount of ascites can raise the diaphragm, reduce the volume of the thoracic cavity, compress the lungs, increase the respiratory rate, shallow breathing, even suffocation, and appear sitting breathing and umbilical hernia.

　　In the late stage of liver ascites, there may be endocrine disorders, bleeding tendency, and anemia. In addition to the large amount of ascites in the abdomen causing abdominal distension, there are often edema of both lower limbs, which is often pitting edema. When spontaneous peritonitis occurs in ascites, there are often symptoms such as fever, abdominal pain, and increased frequency of defecation, which are abdominal stimulation symptoms.

　　Other symptoms: Liver cirrhosis ascites patients may also appear with other complications such as gastrointestinal bleeding and hepatic encephalopathy, and there should be related clinical manifestations such as anemia and abnormal mental state.

　　Effectively preventing the occurrence of liver ascites is also a very important measure to save the patient's life and health.

　　Firstly, liver cirrhosis patients should pay attention to their daily diet. Patients must quit smoking and drinking, because the formaldehyde produced by the alcohol after metabolism is very harmful to the liver. Liver cirrhosis patients already have damaged liver function, and drinking alcohol at this time is undoubtedly adding fuel to the fire, accelerating the speed of disease progression, and is also very likely to form alcoholic liver disease.

　　Furthermore, patients should consume high-protein, high-vitamin, high-carbohydrate, and low-fat foods. High-protein, high-vitamin, and high-carbohydrate foods can provide patients with sufficient energy, supplement the various substances needed in the body, reduce the consumption of the liver, alleviate the burden on the liver, and increase the momentum for the repair and regeneration of liver cells. Eating low-fat foods can avoid patients developing fatty liver due to excessive intake of fat on one hand, and on the other hand, it can also play a role in reducing the consumption of liver cells and improving the recovery speed of liver cells. Patients should adhere to a low-sodium diet in their diet and adopt the method of small and frequent meals to avoid increasing the burden on the digestive system in the body. Patients should choose easily digestible, high-fiber, low-spicy, non-irritating, and soft foods.

　　In addition, patients should strictly limit their intake of water and sodium. A significant part of the reason for the occurrence of ascites is the excessive retention of water and sodium in the body. If liver cirrhosis patients do not pay attention to this, it is easy to cause excessive retention of water and sodium in the body, leading to the occurrence of ascites. It should be noted that patients should pay attention to their daily rest, establish a good rest and work schedule, and can also participate in appropriate exercise to relax their mind and body.

　　In addition to preventive measures in daily diet, chronic hepatitis is also a major cause of liver cirrhosis. Chronic hepatitis is often overlooked because of its subtle symptoms, resulting in persistent viral infection and causing liver cirrhosis.

　　In addition to the patient's daily diet, patients should also go to the hospital in a timely manner, cooperate with the doctor's treatment plan, and establish confidence in overcoming the disease. Only by a complete cure can other complications be prevented, do a good job of prevention, and develop good living habits.

　　The items that need to be checked for patients with liver ascites:

　　1. Alpha-fetoprotein (AFP) test: Electrophoresis method positive or radioimmunoassay determination >400mg/ml; continuous for four weeks and exclude active pregnancy, liver disease, and gynecological embryonic and fetal tumors.

　　2. Other marker tests: Alkaline phosphatase (A1(P)) about 20% of liver cancer patients increase r-glutamyl transpeptidase (r-GT) most liver cancer patients increase 5-nucleotide diphosphatase isoenzyme V (5-PDase-v) most patients have this enzyme appear in metastatic liver cancer patients with a higher positive rate alpha-antitrypsin (alpha-AT) about 90% of liver cancer patients increase iron proteinase 905 liver cancer patients increase the content of carcinoembryonic antigen (CEA) about 70% of liver cancer patients increase abnormal prothrombin >300mg/ml.

　　3. Liver function and hepatitis B antigen-antibody system tests: Abnormal liver function and positive hepatitis B markers suggest a liver disease basis with primary liver cancer.

　　4. Various imaging examinations: Indicate the presence of intrapulmonary space-occupying lesions.

　　5. Laparoscopy and liver biopsy: Laparoscopy can directly display the surface condition of the liver; liver biopsy.

　　Due to individual physical symptoms being different, specific examination items should still be determined according to the degree of the patient's disease.

　　Patients with liver cirrhosis and ascites should pay attention to rest, actively cooperate with treatment, and diet is also an important measure of adjuvant treatment.

　　1, Water and Sodium: Restricting the intake of water and sodium is an important measure in the treatment of ascites in patients with liver cirrhosis and ascites. For patients with a large amount of ascites and oliguria, the total water intake per day, including intravenous fluid, should be no more than 1500ml, and a salt-free diet should be eaten. When the condition improves and the ascites decreases, and the urine output increases, a low-sodium diet can be eaten, with 2-3g of sodium salt per day.

　　2, Fat: It is better to use vegetable oils containing unsaturated fatty acids. Excessive dietary fat is not only detrimental to digestion but also tends to accumulate in the liver, causing a decrease in liver function.

　　3, Carbohydrates: Providing sufficient carbohydrates can reduce protein consumption and alleviate the burden on the liver; carbohydrates can maintain the glycogen content in liver cells, so that they can be used for the composition and proliferation of liver tissue to protect the liver. Therefore, for patients with liver cirrhosis and ascites, it is not advisable to take too much sugar by mouth, in addition to diet.

　　4, Vitamin: Patients are prone to various vitamin deficiencies. Therefore, patients should often eat more foods rich in vitamins, such as vegetables, fruits, coarse grains, egg yolks, lean meat, and animal livers.

　　5, Protein: Liver cirrhosis ascites often accompanied by hypoproteinemia. High-protein diet can increase plasma protein content, promote the recovery and regeneration of damaged liver cells. For patients with significant liver function decline or signs of hepatic coma, in order to reduce the burden on the liver and reduce the concentration of ammonia in the blood, protein intake should be strictly limited to no more than 20g per day.

　　6, Alcohol-induced liver cirrhosis ascites patients often have esophageal varices, which are prone to esophageal variceal bleeding. Fine, light, and easy-to-digest food should be given, preferably semi-liquid or soft rice, with small and frequent meals. Frying, greasy, hard, and bloating foods should be avoided, and all kinds of alcohol should be avoided.

　　According to traditional Chinese medicine, liver and abdominal hydrocele and spontaneous bacterial peritonitis and other infections are often due to stagnation of Qi in the internal organs, failure of ascending and descending, and accumulation of heat leading to internal heat syndrome, which further leads to the accumulation of heat, toxins, blood stasis, and dampness, resulting in excessive heat-toxin, and disturbance of Qi and blood. It has obvious effects on antibacterial and anti-inflammatory, clearing endotoxins, and enhancing the body's non-specific anti-infection ability.

　　The treatment of liver cirrhosis ascites with traditional Chinese medicine can be from invigorating the spleen and removing dampness, soothing the liver and regulating Qi, promoting Qi and diuretic, softening hardness and dispersing nodules, preventing liver fibrosis, relieving portal hypertension, diuretic as the main method, and can effectively adjust protein ratios, improve liver function, and soften the liver and shrink the spleen.

　　A, for patients with viral carriers and progressive liver function damage, it is advisable to use more清热解毒 (clear heat and detoxify) drugs.

　　B, for patients with liver cirrhosis with ashy or dark yellow complexion, it is not advisable to use too much bitter and cold medicine, and it is advisable to use mild and gentle biliary drugs.

　　C, it can use blood-nourishing drugs to achieve the effects of promoting blood circulation and removing blood stasis, and invigorating Qi and nourishing Yin.

　　D, it can be used to treat symptoms such as fatigue, edema, white greasy tongue coating, and bloating with Dangshen, Huangqi, Baizhu, and Fuling, which can achieve the effect of invigorating the spleen and removing dampness. It can also use Zhike, Chenpi, Xiangfu, etc., to achieve the effect of regulating Qi.

　　E, for patients with liver cirrhosis ascites with bloating and excessive abdominal fluid, on the one hand, promote Yang and diuretic, warm Yang and diuretic, and warm kidney and diuretic, in order to increase the excretion of water and sodium in urine.

　　F, liver cirrhosis in the late stage: At this time, the patient often injures liver Yin and kidney Yin, so it is possible to use Biejia, Guiban, He Shou Wu, Huang Jing, etc., to achieve the effects of nourishing Yin and clearing heat, softening hardness and dispersing nodules, nourishing Yin and hiding Yang, and benefiting the kidney and strengthening the bones.

　　According to traditional Chinese medicine, liver and abdominal hydrocele and spontaneous bacterial peritonitis and other infections are often due to stagnation of Qi in the internal organs, failure of ascending and descending, and accumulation of heat leading to internal heat syndrome, which further leads to the accumulation of heat, toxins, blood stasis, and dampness, resulting in excessive heat-toxin, and disturbance of Qi and blood. It has obvious effects on antibacterial and anti-inflammatory, clearing endotoxins, and enhancing the body's non-specific anti-infection ability.