ASCITES IN SOIylPEDS. 



Causes : follows peritonitis, obstruction of portal vein, tumors, hepatic 

 diseases, pressure on posterior cava, dilated right.heart, heaves, ovarian dis- 

 ease, nephritis or kidney degeneration, hydrocemia. Symptoms : slow ad- 

 vance, pot-bellied, with fluctuation, hollow above, dropsy in limbs, sheath 

 and under belly, percussion sound flat below, weakness, debility, no fever. 

 Diagnosis : Absence of fever, and of fibrine, cells and granules in effusion. 

 Lesions: those of primary disease, amount and composition of effusion. 

 Treatment : treat primary disease glandular swelling or actinomysosis, 

 iodide of potassium, remove diseased ovary or tumor, draw off fluid, com- 

 press abdomen, saline laxatives, diuretics, iodides, pilocarpine electricity, 

 bitters. 



Causes. Ascites may be a remnant of a pre-existing chronic 

 peritonitis, or it may occur from any obstruction of the portal 

 vein, such as compression by organized false membranes, throm- 

 bus, in the vessel, or pressure by lympadenoma in the portal fissure, 

 melanosis, sarcoma and other tumors. It results from cirrhosis 

 and other diseases of the liver which retard its circulation, from 

 pressure on the posterior vena cava, from insufficienc}' of the 

 right auriculo-ventricular valves, from dilatation of the right 

 heart, and from heaves or other obstruction in the pulmonic cir- 

 culation. Other causes are cystic or other disease of the ovary, 

 diseases of the kidney and hydroaemia, the latter two tending to 

 general oedema as well as ascites. 



Symptoms. The disease comes on slowly and insidiously and 

 at first it usually passes unnoticed. When more fully developed 

 the abdomen is distended but somewhat pendent (pot-bellied), 

 fluctuating below, with falling in beneath the lumbar transverse 

 processes. Later the whole abdomen may be full rounded 

 smooth and tense, and the hind limbs oedematous to above the 

 fetlocks or hocks. There may be oedema of the sheath or lower 

 wall of the abdomen. Fluctuation can still be felt as a shock 

 when an assistant makes sudden concussion with the fist on the 

 opposite side from that on which the hand is pressed. This may 

 be felt even more distinctly by the hand introduced into the rectum. 

 Percussion gives a flat sound below and more or less resonant 

 above. The pulse is small, weak, and accelerated, heart-beats irri- 

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