Home >> Practical Treatise On Disease In Children >> Acute Infantile Spinal Paralysis to Chronic Brights Disease >> Ascites_P1


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accumulation of fluid is sometimes met with in the peritoneal cavity in the child as a result of various causes, and it is not always easy to refer the symptom to its true origin.

Causation.—In childhood, as in after life, ascites may be the consequence of peritoneal inflammation ; of obstruction to the flow of blood through the portal vein ; and of causes which influence the systemic circulation.

In peritonitis the quantity of fluid is rarely great, and sometimes it is so small that it is with difficulty detected. Even in the subacute perito nitis which is the result of tuberculosis of the serous lining of the abdomen, there is rarely great excess of fluid. In both cases, the symptoms connected with the belly may be so little characteristic that the disease passes com pletely unnoticed, and is only discovered after death.

The circulation of blood through the portal vein may be obstructed by causes which act within the liver substance or affect the venous channel be fore its entrance into the organ. Cirrhosis of the liver may cause great im pediment to the portal circulation ; and there is every reason to believe that this form of disease is less uncommon in the child than was at one time supposed. So, also, hepatic induration resulting from congestion of the or gan may be attended by the same result. A hydatid of the liver, if placed near to the concave surface of the gland, may cause sufficient interference with the flow of blood from the abdominal viscera to lead to serous effusion. In the rare cases in which the liver is the seat of a malignant disease, ascites may also occur ; and I have known it to be produced by syphilitic gum mata of the liver in a young baby.

Of causes lying outside the liver, the most common is the presence of a mass of caseous glands in the hepatic notch. This will press upon the por tal vein as it enters the transverse fissure. Pressure may also be exercised upon the vein by malignant or lymphomatous growths of the mesentery, but these are very rarely met with.

Of the causes which act through the general circulation, heart disea8e takes the first place. It is common in cardiac lesions to find ascites com

bined with general oedema, and very often serosity is poured out, not into the peritoneum and subcutaneous tissue, but also into the pleural cavity. Disease of the lungs seldom gives rise to ascites in young subjects ; and in cases of Bright's disease, although general dropsy is common, abdominal effusion is more rarely seen. Extreme anmmia is sometimes attended by ascites, but this is not a frequent result of mere impoverishment of blood.

Symptoms.—In a marked case of ascites, the belly is distended and globular. As the child lies on his back the outline of the abdomen is more rounded than in the erect position, for the fluid gravitates and tends to col lect in the flanks and swell them out. The skin of the belly is smooth and shining, and may be tense. The umbilicus is generally prominent, and often the superficial veins of the abdominal wall are unnaturally visible. When the observer places his hands one on each side of the belly, a slight tap of the finger sends a distinct impulse through the fluid to strike against the hand in contact with the opposite wall of the abdomen. This sense of fluctuation is not stopped by pressure made in the middle line of the belly.

On percussion, the note is clear over the upper part of the belly, and dull in the flanks. The dulness varies according to the position of the child, as the fluid always sinks to the most depending part of the abdomi nal cavity. Consequently, the side turned uppermost always gives a reso nant note. If the amount of fluid be very large, the dulness may be general, except, perhaps, over the region of the stomach and transverse colon. In such cases there is usually dyspncea from interference with the action of the diaphragm ; and this is often so distressing that the child cannot lie down in his bed. It may be accompanied by a certain amount of collapse of the bases of the lungs. The pressure of the accumulated fluid may also set up oedema of the lower extremities and genitals, and this quite irrespect ive of cardiac disease.

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