ASCITES IN SOLIPEDS.
Causes: follows peritonitis, obstruction of portal vein, tumors, hepatic diseases, pressure on posterior cava, dilated right heart, heaves, ovarian disease, nephritis or kidney degeneration, hydroæmia. Symptoms: slow advance, pot-bellied, with fluctuation, hollow above, dropsy in limbs, sheath and under belly, percussion sound flat below, weakness, debility, no fever. Diagnosis: Absence of fever, and of fibrine, cells and granules in effusion. Lesions: those of primary disease, amount and composition of effusion. Treatment: treat primary disease glandular swelling or actinomycosis, iodide of potassium, remove diseased ovary or tumor, draw off fluid, compress abdomen, saline laxatives, diuretics, iodides, pilocarpin, electricity, bitters.
Causes. Ascites may be a remnant of a pre-existing chronic peritonitis, or it may occur from any obstruction of the portal vein, such as compression by organized false membranes, thrombus, in the vessel, or pressure by lympadenoma in the portal fissure, melanosis, sarcoma and other tumors. It results from cirrhosis and other diseases of the liver which retard its circulation, from pressure on the posterior vena cava, from insufficiency of the right auriculo-ventricular valves, from dilatation of the right heart, and from heaves or other obstruction in the pulmonic circulation. Other causes are cystic or other disease of the ovary, diseases of the kidney and hydroæmia, the latter two tending to general œdema as well as ascites.
Symptoms. The disease comes on slowly and insidiously and at first it usually passes unnoticed. When more fully developed the abdomen is distended but somewhat pendent (pot-bellied), fluctuating below, with falling in beneath the lumbar transverse processes. Later the whole abdomen may be full, rounded, smooth and tense, and the hind limbs œdematous to above the fetlocks or hocks. There may be œdema of the sheath or lower wall of the abdomen. Fluctuation can still be felt as a shock when an assistant makes sudden concussion with the fist on the opposite side from that on which the hand is pressed. This may be felt even more distinctly by the hand introduced into the rectum. Percussion gives a flat sound below and more or less resonant above. The pulse is small, weak, and accelerated, heart beats irritable (sometimes palpitating), and respiration labored and with lifting of the flank. From first to last there is no hyperthermia.
If the cause is irremediable the issue is necessarily fatal sooner or later.
Diagnosis from peritonitis depends largely on the absence of hyperthermia, and of abdominal tenderness, and on the nature of the ascitic fluid which is incoagulable, and comparatively destitute of leucocytes cells and granules.
Lesions. The quantity of effused liquid is often enormous (50 qts. Reynal, 80 qts. Woodger, 150 qts. Friedberger and Fröhner). It is very watery and poor in salts and albuminoids, of a density near 1012, neutral or slightly alkaline, does not coagulate spontaneously, and is not associated with false membranes. The peritoneum shows no congestion, but is pale, and, like the abdominal walls, infiltrated. Tumors, cysts and venous obstructions referred to under causes may be found.
Treatment. When ascites depends on actinomycosis or glandular enlargement a course of iodide of potassium may remove the cause. In other cases an operation may remove the offending tumor or ovary. Too often, however, the cause is beyond remedy and palliative treatment only is available. The most urgent indication is the removal of the accumulated fluid, and paracentesis under proper antiseptic precautions is the readiest means to this end. Compression by a tight bandage is necessary to prevent the sensation of vacuity and tendency to fainting which come from the removal of the fluid and to counteract the disposition to the instant effusion of more. Even with the compress it is judicious not to draw off all of the fluid at once in bad cases, but to make two or three operations and allow the patient to become accustomed to the change in the intervals. These may be repeated as circumstances demand. Saline purgatives, or diuretics (saltpetre 1 oz., digitalis 25 grs., squill 3 ozs., iodide of potassium 2 drs.), are useful, and pilocarpin is the most efficient agent of this kind, but also dangerous by reason of the extreme depletion which it causes. Electricity has been employed with alleged advantage, also poultices of digitalis applied over the loins.
Cholagogues are also recommended especially in cases of liver disease. Bitters may prove useful.