Ascites, demonstrating as an abdominal bulge and weight gain, is a rather common complication of cirrhosis. Ascites is excessive fluid that builds up in the abdominal cavity.
Now we need a little anatomy lesson. The peritoneum is the inner lining of the abdominal cavity that also folds over to cover the organs inside the abdomen such as the liver, gallbladder, spleen, pancreas and intestines. Ascites develops because of a combination of two factors:
Increased pressure in the vein system that carries blood from the stomach, intestines and spleen to the liver (portal hypertension); and
A low level of the protein albumin in the blood (hypoalbuminemia). Albumin, which is the predominant protein in the blood and that helps maintain blood volume, is reduced in cirrhosis primarily because the damaged liver is not able to produce enough of it.
Other consequences of portal hypertension include dilated veins in the esophagus (varices), prominent veins on the abdomen and an enlarged spleen. Each of these conditions is due primarily to the increased pressure and accumulation of blood and excess fluid in the abdominal blood vessels.
Peripheral edema, which is usually seen as pitting edema of the legs and feet, also occurs in cirrhosis. The edema is a consequence of the low albumin levels and the kidneys retaining salt and water. The presence or absence of edema in patients with cirrhosis and ascites is an important consideration in the treatment of the ascites.
In patients with ascites without edema, diuretics must be given with extra caution. Diuresis (induced excretion of urine by use of diuretics) that is too aggressive or rapid in these patients can lead to a low blood volume (hypovolemia), which can cause kidney and liver failure.
In contrast, when patients who have both edema and ascites undergo diuresis, the edema fluid in the abdomen serves as somewhat of a buffer against the development of low blood volume. The excess fluid moves into the blood vessels to rapidly replenish the depleted blood volume. _____________________________________________________________________________
We apologize for some rather blatant plagiarism in this post! Part of this post is our summarization of information that we found on MedicineNet.com. A good portion of the bottom of this post is copied completely as we really didn’t want to mess up the details.