Cirrhosis is a serious liver disease with one of the most common complications being ascites. Ascites refers to the accumulation of fluid in the abdominal cavity, usually due to impaired liver function. This topic will describe the four major factors that contribute to ascites in cirrhosis: portal hypertension, hypoproteinemia, obstruction of blood circulation, and increased intrahepatic sinusoidal pressure.
1. Portal hypertension.
The portal vein is the main blood vessel responsible for transporting blood from digestive organs such as the intestines, spleen, and stomach to the liver. In the case of cirrhosis, due to fibrosis and structural changes in the liver tissue, the portal vein becomes blocked and blood cannot flow properly, resulting in increased pressure. This portal hypertension triggers an increase in pressure in the walls of the blood vessels, which causes fluid to leak into the abdominal cavity and form ascites.
2. Hypoproteinemia.
The liver normally synthesizes an important protein called albumin. Albumin plays an important role in maintaining the osmolality of plasma. However, cirrhosis leads to liver failure that does not produce enough albumin properly, which triggers hypoproteinemia. Hypoproteinemia causes a decrease in plasma osmolality, making it easier for fluid in the blood vessels to penetrate surrounding tissues and form ascites.
3. Obstruction of blood circulation.
Portal hypertension due to cirrhosis can cause obstruction of blood circulation. When portal hypertension occurs, blood does not pass through the liver and flows backwards into other vasculatures. This leads to a disorder of blood circulation in the body, causing the kidneys to activate the renin-angiotensin-aldosterone system (RAAS), which promotes the retention of sodium and water in the body, thereby increasing the formation of ascites.
4. Increased intrahepatic sinusoidal pressure.
Cirrhosis can also lead to increased pressure within the hepatic sinusoids. Hepatic sinusoids are small blood vessels inside the liver that have neatly arranged cells inside. In the case of cirrhosis, the proliferation of fibrous tissue narrows the sinusoids, which leads to an increase in internal pressure. This increased intrahepatic pressure will increase the burden on the liver, further affect liver function, and is also one of the important reasons for the formation of ascites.
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