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.
ASCITES IN RUMINANTS.
Causes: as in horse, tuberculosis, in sheep distomatosis, chills when heated and fatigued. Symptoms: pot-belly, fluctuating on percussion, gives flat sound, debility, pallid mucosæ, sunken eyes, superficial dropsies on belly, in limbs, and under jaw, in distomatosis, great emaciation, weakness, paperskin, ova of distoma in fæces. Diagnosis: from ruptured bladder by passage of urine, and perhaps by sex, and absence of urinous odor in liquid, from hydrometra by fluctuation over whole belly. Lesions: those of solipeds, also tubercles or enlarged gall ducts with distomata. Treatment: as for solipeds. Tuberculosis demands separation or destruction, distomatosis, prevention.
Causes. These are in the main those which operate in the horse and need not be repeated. In cattle, however, the affection is to a large extent the result of abdominal tuberculosis, while in sheep it is a constant result of advanced distomatosis. Gellé says it is common in working oxen, which are turned out, hot and perspiring, to pass the night in cold and wet.
Symptoms. The belly is enlarged and pendent, bulging out back of the ribs, with fluctuation and dullness on percussion. The animal is in very low condition, the mucosæ pale or yellowish white, the eyes dull and sunken, panting and palpitations may be roused on the least exertion, and swellings often appear along the lower aspect of the body and between the branches of the lower jaw. In distomatosis it is common to find dropsy of the chest, pallor and attenuation of the skin, complete absence of the subcutaneous fat (paperskin), and great emaciation and weakness. Ova of the distoma can be found in the fæces. (See distomatosis). By turning the sheep on its back or setting it up on its croup the percussion dullness will be made to shift, always to the dependent part of the abdomen.
Diagnosis. From rupture of the bladder it is distinguished, by its occurrence in females as well as males, by the absence of fever, and of the complete suppression of urine and emptiness and tenderness of the bladder which characterize the latter. Liquid drawn from the abdomen has no urinous odor. From hydrometra, pyometra, and hydramnios it is distinguished by the fact that the water accumulates in the lower part of the abdomen, and is not confined to the womb. On rectal exploration the outline of the empty womb is made out.