Ascites.
—Synonyms.—Dropsy of the Peritoneum; Abdominal Dropsy.
Definition.—An accumulation of serous fluid in the peritoneal cavity.
Etiology.—Any obstruction of the portal circulation is a possible cause of ascites, the most frequent being cirrhosis of the liver. Pressure from tumors or neighboring organs may also give rise to it. Peritonitis and valvular diseases of the heart are also responsible for ascites, and chronic pulmonary affections may impair the portal circulation to the extent of producing it.
Pathology.—The quality and character of the fluid show great variation, from a few pints to several gallons, and from a straw or lemon tint to a brownish or greenish hue. It may be blood stained, and occasionally clean and transparent. It is usually watery in character.
Treatment.—Use the trocar method. Insert the trocar through the umbilicus and draw off all the ascitic fluid from the abdomen, then surround the organs with a quantity of fluid sufficient to preserve them. Or if you desire, use the direct incision and after the ascitic fluid has been drawn off, surround the organs with a hardening compound.
The body in general should be preserved through an arterial injection of normal fluid for the first 64 ounces, then one and one-quarter strength for all subsequent bottles. This, if attended by copious drainage from a large vein, will preserve all portions of the body excepting possibly the epidermis of the posterior abdominal wall, which, by gravitation of the ascitic fluid, will become separated from the derma, producing skin slip, and causing the formation of blisters.
Previously to placing the body on the embalming board for treatment, a rubber cover should be placed over the board so that drippings of all kinds can be made to flow into a bucket at the lower end of the embalming board. When the above mentioned blisters are cut and their contents disposed of by gravitation into the bucket, a strong solution of formaldehyde should be applied to the affected skin to harden it and to prevent any further progress toward decomposition.
In ascitic cases the casket should be lined with rubber or oil cloth to a point three or four inches above the bottom. In addition to this precaution, the use of sawdust is favored so that any unlooked for breaking of blisters may not be attended by a flow of the ascitic liquid from the casket. Many embalmers do not protect themselves against contingencies of this kind and are frequently criticized by the friends and family of the deceased.