Ascites and Peritoneal Cavity Fluid
Ascites build up inside the abdomen in a membrane called the peritoneum. This membrane consists of two layers, one that lines the abdominal wall and one that encloses the organs of the abdomen. The peritoneum produces a fluid that serves as a lubricant allowing the organs of the abdomen to glide easily over one another. Usually this fluid is present in a very small quantity. Ascites is the build up, or overabundance of this fluid and is often the first tangible indication that mesothelioma is present in the body, it the most common early sign of peritoneal mesothelioma.
The symptoms of ascites are unpleasant. Usually the stomach becomes bloated and sometimes pain, and nausea accompanies this bloating. Its not uncommon for patients to experience a loss of appetite, or for sitting, standing, and walking to become restricted and uncomfortable. Fatigue, lethargy and breathlessness are also possible symptoms.
When ascites is first detected, the treating doctor will drain the fluid in a procedure known as a Paracentesis. By draining the fluid doctor's can reduce symptoms caused by the build up as well as gather a sample to learn the reason for its occurrence. A paracentesis is a relatively easy procedure that can take place in the hospital bed or in the outpatient clinic. Occasionally doctors will perform the procedure in the ultra sound department so that they can more easily locate the fluid build up. Ultra sounds are particularly useful when fluid has collected in multiple pockets, as will sometimes occur when the ascitic build up is smaller.
After the doctor injects the patient with a local anesthesia he will make a small incision in the abdomen wall in order to pass a cannula into the abdomen. The cannula is a thin tube that is attached to drainage bag for the paracentesis. Using gentle suction the doctor will draw the ascitic fluid from the abdomen into the drainage bag. If there is only a small amount of ascitic fluid the procedure can usually be accomplished in an outpatient setting, if there is a larger amount, however, the drain may remain in place for two to three days.
At the beginning of the paracentesis up to a liter of fluid may be drained quickly and safely. After this initial amount, however, the drain must be performed slowly because a sudden release of abdominal pressure may cause blood pressure to drop as well. During the procedure doctors will monitor the heart rate of the patient to make sure this doesn't occur. Sometimes during the procedure the drain will become blocked, but often the solution is just a matter of the patient repositioning him or herself (sitting up, lying back etc.). Occasionally the cannula can be a source of infection (a variation in blood pressure will tell doctors if this is the case).
If a patient has been diagnosed with ascites but the cause has not yet been determined, it is very possible that the ascites is not a result of mesothelioma. Cirrhosis is the most common cause of the ascites build up, accounting for 80% of its occurrences. Tuberculosis, endometriosis, Familial Mediterranean fever, Whipple's disease, are all possible causes of ascites. Generally speaking cancer is the cause of ascitic build up only 10 % of the time.
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