Page 71 of 73 DISEASES of the PERITONEUM of Anomaly of a structure of a peritoneum
Inborn commissures of a peritoneum can cause impassability of intestines; in development there are also other anomalies of a peritoneum which do not have, however, clinical value. Vnutribryunshchnny hernias can arise. owing to education by commissures of a peritoneum of ring-shaped "windows". Lack of an epiploon or its duplikatur belongs to rare anomalies. Cysts or torsion of an epiploon sometimes cause the acute abdominal crises demanding a laparotomy.
The term "ascites" means accumulation of liquid in an abdominal cavity; usually it is about serous liquid. Ascites most often arises at diseases of kidneys (nephrosis) and hearts. It is observed at a chronic commissural pericardis, and also serves one of manifestations of a polyserositis at a Pick's disease. Besides, ascites arises as complication of portal hypertensia at cirrhosis (section 12.101), a hyperadenosis, tumors and thrombosis, and also peritoneum tuberculosis, rheumatic peritonitis and a prelum of a splenic vein.
The stomach is stretched sometimes so that the navel is stuck out outside. At a palpation fluctuation of liquid in an abdominal cavity is defined. If to place hands of the doctor on both sides of a stomach, and to press a hand of the assistant to the average line, then the push on one half of a stomach is transferred to other party. Shift of percussion dullness is often noted.
Ascites needs to be differentiated with other states causing increase in a stomach. The meteorism, accumulation of fecal masses at megacolon, tumoral educations, including mesentery cysts, acute or chronic peritonitis concern to them, intra belly bleeding, hyperdystension of a bladder and, at last, obesity.
The current, the forecast and treatment of ascites completely depend on primary disease.
Accumulation of a lymph in an abdominal cavity — a rare form of ascites. It can arise at the child of any age, and sometimes is inborn. True chyle ascites is caused by some anomalies, damages or a prelum of belly part of the chest canal. In case of anomalies of a channel ascites is available already at the time of the birth or arises soon after it. Perhaps simultaneous development of chyle pleurisy (sections 7.30 and 12.101). The channel can be squeezed by a tumor or the increased lymph nodes. Chyle liquid resembles superficially milk as contains a lot of fat. At chronic peritonitis liquid in an abdominal cavity has approximately the same color owing to disintegration of elements of an inflammation.
The forecast at chyle ascites adverse, however also recovery is possible. The expiration of a lymph can be slowed down if to provide the diet containing triglycerides with average chains; these fats are absorbed directly in portal system. As with chyle liquid a large amount of proteins is lost, contents them in food has to be high. If attempts to influence process by means of a diet do not yield result, then the laparotomy with the purpose to find the place of "leak" is justified.