[The pathophysiology of ascites formation in cirrhosis of the liver].
Ascites is the most common complication in cirrhotic patients. The presence of ascites predisposes the cirrhotic patients to complications that significantly increase their morbidity and mortality. These include spontaneous bacterial peritonitis and the hepato-renal syndrome. The ascitic process has different stages, from the diuretic responsive ascites through the unresponsive ascites to the development of the hepato-renal syndrome. Until a few years ago there was a controversy regarding the pathophysiology of ascites in portal hypertension. Nowadays, the peripheral vasodilatation theory is accepted as the mechanism responsible for the development of the ascites. This theory proposes that elevated blood levels of vasodilators cause a systemic vasodilatation, that leads to the development of a hyperdynamic circulation. This vasodilatation causes activation of compensatory vasoconstrictive mechanisms. The vasoconstrictors cause functional kidney damage, which leads to the retention of sodium and water, and thus to the development of ascites.
Benjaminov
Fabiana S
FS
Departments of Gastroenterology and Internal Medicine E, Sapir Medical Center, Meir Hospital, Kfar-Saba.
D001201:Ascites / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology*; D009017:Morbidity; D014664:Vasodilation