An increase in the volume of the abdomen is noted during pregnancy, occurs due to diseases of the digestive system, female genital organs. It is observed in some cardiovascular, endocrine, childhood diseases. It is formed against the background of fetal growth, the appearance of fatty deposits, the progression of tumors, an increase in the size of parenchymal or stretching of hollow organs, extraorganic fluid accumulation. The cause is determined according to the examination, ultrasound, radiography, other instrumental and laboratory studies.
Why does the volume of the abdomen increase
Weight gain
The volume of the abdomen often increases with pre-obesity and obesity, which may be due to hereditary predisposition, overeating, lack of mobility, endocrine diseases, side effects of certain drugs. The symptom is pronounced in people with abdominal type of obesity, to some extent present in patients with mixed, less - with gynoid type of obesity.
Physiological conditions in women
A slight increase in the abdomen is often observed in adolescent girls, associated with hormonal changes in the body. Many women note the cyclical appearance of a symptom shortly before the onset of menstruation, especially in the presence of premenstrual syndrome. The beginning of the menopause is often accompanied by weight gain and, as a result, the accumulation of fat.
In women of childbearing age, an increase in the volume of the abdomen is one of the signs of pregnancy. On average, external changes become clearly visible from 15-16 weeks. The early onset of a symptom, too rapid growth of volume during the gestation period may be due to physique or individual metabolic changes against the background of hormonal changes, indicate multiple pregnancy or polyhydramnios.
Secondary changes
Ascites develops in various gastroenterological, gynecological, endocrinological, oncological, cardiological, urological, rheumatological diseases. The amount of fluid in the abdominal cavity increases rapidly or gradually. The patient notices an increase in the volume of the abdomen. There are heaviness, bursting, pain, flatulence, nausea, belching, heartburn.
A characteristic sign of a pathological condition is a change in the configuration of the anterior abdominal wall with a change in body position: in a vertical position, the stomach sags, in a horizontal position it flattens out. Sometimes ascites is part of anasarca, a syndrome in which, along with the accumulation of fluid in the abdominal cavity, hydrothorax, hydropericardium, and generalized edema of the subcutaneous tissue are detected.
Abdominal compartment syndrome is the result of increased intra-abdominal pressure. It develops after operations, with severe diseases and injuries of the abdominal organs, less often with other pathological processes. It is characterized by a deterioration in the patient's condition, an increase in the abdomen, tension in the muscles of the abdominal wall, oliguria, respiratory disorders, and increasing multiple organ failure. Requires urgent surgical intervention.
Hepatomegaly
Hepatomegaly is infrequently accompanied by a visible increase in the volume of the abdomen. As a rule, asymmetric bulging is detected with volumetric formations of a significant size. The cause of the symptom in liver damage is:
- Cyst. A noticeable asymmetry is determined with giant cysts. External changes increase gradually. On palpation, a painless tugoelastic fluctuating formation is determined.
- Polycystic. A hereditary disease characterized by the formation of a large number of cysts. Diagnosed after 4 years. Palpation of the liver is tuberous, sometimes superficial cysts are palpated.
- benign tumors. Adenomas, hemangiomas, cystadenomas, fibromas, lipomas, fibroadenomas can form in the liver. The volume of the abdomen increases slowly over several years.
- Malignant neoplasia. Primary or metastatic liver cancer, sarcoma, hepatoblastoma, angioblastoma, and other malignant tumors are characterized by rapid growth.
An increase in the volume of the abdomen with ascites
Other liver diseases
Along with hepatomegaly, the cause of an increase in the volume of the abdominal cavity in liver diseases can be ascites, which occurs in the later stages of the disease. The accumulation of fluid is accompanied by the following pathologies:
- Alcoholic cirrhosis. It develops against the background of alcoholic liver disease in people who abuse alcohol.
- Primary biliary cirrhosis. A disease of unknown etiology with a hereditary predisposition.
- Secondary biliary cirrhosis. Liver damage against the background of obstruction of the biliary tract.
- Cirrhosis of the liver in children. It is observed in congenital anomalies of the biliary tract, hereditary disorders of bilirubin metabolism, congenital and acquired hepatitis.
- Chronic viral hepatitis. Ascites is detected with a long-term severe course, indicates the development of widespread fibrosis and cirrhosis, and is more often found in hepatitis D.
- Toxic hepatitis. It is noted in case of poisoning with benzenes, tetrachloride hydrocarbons, arsenic, poisonous mushrooms.
In addition, an increase in the abdomen due to the accumulation of fluid is determined by circulatory disorders in the liver:
- portal hypertension. Manifested by dyspeptic disorders, hepatosplenomegaly, persistent ascites, dilatation of the saphenous veins of the abdomen in the form of a "jellyfish head".
- Peliosis of the liver. Until the development of portal hypertension is asymptomatic, then the same symptoms appear as in the previous case.
- Venocclusive disease of the liver. It is more often observed after bone marrow transplantation, occurs acutely, is characterized by intense pain in the right hypochondrium, progressive ascites, and blood clotting disorders.
- Budd-Chiari syndrome. It is provoked by obstruction of the veins of the liver. Accompanied by severe pain, nausea, vomiting, ascites, moderate jaundice.
- Thrombosis of the portal vein. Polyetiological condition, most often detected in patients with cirrhosis. Ascites is typical for the stem form of the disease.
- Pylephlebitis. Occurs with bacteremia against the background of inflammatory processes in the abdominal cavity (appendicitis, cholecystitis, pancreatitis), sometimes provokes portal hypertension, ascites.
Bowel disease
In intestinal pathologies, an increase in volume can be acute or gradual, permanent or transient. Determined in the following cases:
- Chronic constipation. The symptom appears as a result of the accumulation of gases and feces with a long break between bowel movements. It is expressed unsharply, supplemented by bloating, pain, a feeling of heaviness, disappears after bowel movement.
- Flatulence . It occurs as a result of taking certain products, infectious and non-infectious diseases of the intestine. The volume of the abdomen increases for a short time, the increase is more disturbing in the afternoon, disappears after defecation.
- Diverticular disease of the large intestine. Often asymptomatic, may be accompanied by periodic spasms. The abdomen of patients increases with a tendency to constipation.
- Megacolon. Congenital or acquired expansion of all or part of the colon. More often chronic, manifested by progressive constipation, bloating, thinning of the abdominal wall, visible peristalsis.
- Pseudomembranous colitis. Severe inflammation of the intestine against the background of dysbacteriosis caused by taking medications. Accompanied by an increase in the case of megacolon formation.
- Paresis of the intestine. It develops with intra- and retroperitoneal inflammatory processes, some other pathologies. The increase in volume is associated with swelling, gradually increases, correlates with the severity of the disorders.
- Intestinal obstruction. Asymmetry, bloating, visible peristalsis, unbearable pain, nausea, and vomiting are revealed.
- Ulcerative necrotic enterocolitis. A life-threatening disease of newborns, in which there is overdistension of the intestine, intestinal obstruction.
- colorectal cancer. The symptom is explained by flatulence or intestinal obstruction.
In diseases of the stomach, this manifestation is observed less frequently than in intestinal pathologies. One of the possible reasons for the increase in volume is the acute expansion of the stomach. Pathology develops suddenly. The upper abdomen is enlarged, the lower part, the iliac regions look sunken. There are sharp pains, nausea, hiccups, indomitable vomiting, dehydration. In patients with gastrointestinal tumors, the symptom is associated directly with an increase in neoplasia or with ascites.
Eosinophilic gastritis may be accompanied by a visual change in volume when the inflammatory process spreads to the small intestine. The abdomen becomes swollen and, at the same time, flabby due to ascites. Other signs include nausea, heartburn, vomiting, asymmetry, a feeling of fullness in the epigastric and middle sections of the abdominal cavity.
Other abdominal tumors
The cause of the symptom is the growth of a neoplasm or the development of ascites. Changes are provoked by the following neoplasias:
- Tumors of the spleen. Asymmetry with an increase in the volume of the left upper quadrant is noted with large formations. Patients are concerned about the feeling of heaviness in the left hypochondrium, pain, loss of appetite, weakness, weight loss.
- Benign tumors of the peritoneum. They are asymptomatic for a long time, when they reach a large size they cause an asymmetric increase in the abdomen.
- Intra-abdominal lymphangioma. The abdomen is more often enlarged in children. The tumor is painless, there are no other manifestations.
- Mesothelioma of the peritoneum. Malignant neoplasia progresses rapidly, ascites or intestinal obstruction becomes the cause of the symptom.
- Peritoneal carcinomatosis. Multiple foci in the peritoneum appear secondarily against the background of neoplasms of other organs. An increase in volume is formed due to ascites, which is often the only sign of pathology.
Women's diseases
The diameter of the abdomen changes in the presence of volumetric formations. Most often, the symptom is a consequence of Meigs' syndrome - a special form of polyserositis. Benign tumors and tumor-like processes that cause an increase in volume include:
- ovarian cyst (usually dermoid);
- ovarian cystoma (pseudomucinous, papillary);
- paraovarian cyst;
- Brenner's tumor;
- mature ovarian teratoma;
- other benign ovarian neoplasias.
The list of malignant neoplasms with the development of ascites or polyserositis includes:
- uterine adenocarcinoma;
- fallopian tube cancer;
- ovarian carcinoid;
- immature ovarian teratoma;
- granulosa cell tumor of the ovary;
- metastatic ovarian cancer;
- Krukenberg's metastasis;
- germ cell tumors.
Pathologies of the heart and blood vessels
Anasarca is observed in patients with heart failure caused by the following diseases:
- severe angina;
- condition after myocardial infarction;
- dilated cardiomyopathy;
- congenital and acquired heart defects;
- arterial hypertension.
Childhood diseases
In pediatric patients, the cause of an increase in the volume of the abdomen is:
- Kwashiorkor - severe malnutrition against the background of protein starvation. An enlarged abdomen contrasts with thin limbs, edema is detected.
- Hunter syndrome is an inherited metabolic disorder. The symptom is combined with growth retardation, osteoarticular changes, macrocephaly, mental retardation.
- Cholestasis of the newborn is a polyetiological condition. Accompanied by a violation of the outflow of bile, jaundice, secondary hepatomegaly, manifested by a slight increase in the abdomen.
In addition, in children, a symptom can be observed with cardiomyopathy, congenital hepatitis, cirrhosis of the liver.
Endocrine pathologies
The list of endocrine diseases with an increase in the abdomen includes:
- metabolic syndrome. It is a combination of diabetes mellitus, obesity, hypertension and coronary artery disease.
- Myxedema. Develops with severe hypothyroidism. Puffiness is more noticeable in the upper half of the body, extends to the stomach in severe cases of the disease.
- Incidentalomas. Hormonally inactive adrenal tumors may not manifest themselves in any way until they reach a large size and cause an increase in the volume of the abdomen.
Other reasons
Other provoking factors are some diseases of the veins, infectious pathologies. With thrombosis of the splenic vein, an increase in the abdomen is explained by ascites. In patients with visceral leishmaniasis, the symptom occurs against the background of edema, ascites, and hepatosplenomegaly.
Measuring the volume of the abdomen
Diagnostics
The diagnosis is often made by gastroenterologists. Less often, the participation of gynecologists, oncologists, cardiologists, and other specialists is required. In the course of the survey, they find out the time, circumstances of the onset of the symptom, the dynamics of the development of the pathology. During the examination, external changes are detected, palpation and percussion are performed. Depending on the detected changes, the following diagnostic procedures can be prescribed:
- Abdominal ultrasound. The basic examination method used to assess the size and structure of parenchymal and hollow organs, determine the localization and volume of pathological foci.
- Ultrasound of the pelvic organs. Indicated for gynecological diseases. It is carried out using abdominal, vaginal or combined access. Visualizes cysts, tumors, inflammatory changes, structural abnormalities.
- X-ray studies . In case of pathologies of the upper gastrointestinal tract, an x-ray of the stomach may be prescribed. If intestinal obstruction is suspected, irrigoscopy is performed. X-ray techniques make it possible to assess the width of the lumen, the peristalsis of hollow organs, to detect neoplasms, areas of stretching, megacolon.
- Other visualization methods . To detail the results of basic non-invasive techniques, CT, MRI, less often PET-CT, SPECT, and scintigraphy are prescribed.
- Endoscopic techniques . In diseases of the digestive system, a colonoscopy, gastroscopy or laparoscopy is performed. With gynecological pathologies, it is possible to perform hysteroscopy, diagnostic laparoscopy. During the procedure, the state of internal organs is assessed, material is taken for morphological analysis.
- Laparocentesis. A diagnostic and treatment technique that makes it possible to confirm the presence of ascites, determine the nature of the contents of the abdominal cavity, remove fluid, and establish drainage.
- Laboratory tests . In the course of laboratory studies, liver tests are performed, tests for tumor markers are prescribed, feces are examined to identify pathological impurities, and biopsy specimens are examined to clarify the nature and degree of malignancy of neoplasms.
With cardiovascular diseases, an ECG is performed, with endocrine pathology, the level of hormones is determined, with the infectious nature of the pathological process, cultures are made on nutrient media to detect the pathogen.
Treatment
Help at the prehospital stage
Self-elimination of an increase in the abdomen is possible with constipation and flatulence. In the first case, laxatives are shown, in the second - carminatives, restriction of products that promote gas formation. The frequent occurrence of these conditions is a reason for consulting a gastroenterologist. The remaining cases of abdominal enlargement, with the exception of alimentary obesity, require urgent diagnosis and treatment by a specialist. With suddenly developed ascites, intestinal obstruction, it is necessary to call an ambulance.
Conservative therapy
Patients with diseases of the digestive tract are prescribed a special diet. The scheme of drug therapy is determined by the nature of the pathology:
- Diseases of the liver . Apply hepatoprotectors, enteroseptics, means for the normalization of intestinal microflora.
- Conditions with portal hypertension . ACE inhibitors, beta-blockers, nitrates, glycosaminoglycans are recommended.
- Pathology of the stomach and intestines . The list of medicines includes enzymes, preparations for the restoration of microflora, motility regulators, adsorbents, laxatives.
- Gynecological diseases . For many diseases, including cysts, hormonal agents are effective. Patients are also prescribed vitamin therapy.
- Cardiovascular Diseases . They use antihypertensives, nitrates, diuretics, antiarrhythmics, beta-blockers, antiplatelet agents, cholesterol-lowering drugs.
- Endocrine Disorders . Shown hormone therapy.
- Oncological diseases . In some cases, drugs from the group of cytostatics are required.
For some non-tumor pathologies, drug therapy is supplemented with physiotherapeutic procedures: acupuncture, balneotherapy, electrical stimulation. In case of tumor processes, along with chemotherapy, radiation therapy can be prescribed.
Surgery
With ascites of any genesis, resistant to conservative therapy, laparocentesis is performed. During one procedure, no more than 5-6 liters of fluid are removed from the abdominal cavity. Massive ascites is an indication for the placement of a peritoneal catheter. To eliminate the causes of an increase in the abdomen, to combat the complications that have arisen, the following interventions are performed:
- Liver diseases : liver cyst surgery, various resection options, tumor enucleation, drainage and removal of bile duct strictures.
- Portal hypertension : endoscopic ligation, sclerosis of the dilated veins of the esophagus, porto-caval, mesenteric-caval and selective splenorenal shunting, embolization of the splenic arteries.
- Intestinal diseases : elimination of intestinal obstruction, dissection of adhesions, resection of the intestine, hemicolectomy, total colectomy, removal of diverticula.
- Extraorganic tumors of the abdomen : excision of the mesentery, omentectomy, peritonectomy, removal of extraorganic formations.
- Gynecological pathologies : removal of a paraovarian cyst or ovarian cystoma, removal of an ovarian cyst, ovarian resection, oophorectomy or adnexectomy, amputation of the uterus, hysterectomy or panhysterectomy.
- Endocrine diseases : removal of a tumor of the adrenal glands.