Cirrhosis And The Development Of Ascites: Understanding The Main Causes

Ascites, the accumulation of fluid in the abdominal cavity, is one of the most common complications in patients with liver cirrhosis. This condition develops due to several interconnected physiological changes that occur as liver function deteriorates. Understanding these underlying mechanisms is crucial for effective management and treatment planning.

One of the primary causes of ascites in cirrhosis is elevated pressure within the portal venous system, known as portal hypertension. This increased pressure reduces blood flow back into the inferior vena cava, forcing fluid to leak out of blood vessels and into the abdominal cavity.

Another significant factor is hypoalbuminemia, or low levels of albumin in the blood. Albumin helps maintain plasma oncotic pressure, which keeps fluid inside blood vessels. When albumin levels drop, this pressure decreases, allowing fluid to escape into surrounding tissues, including the peritoneal space.

Additionally, changes in kidney function play a key role in fluid retention. Reduced renal perfusion caused by ascites leads to increased secretion of antidiuretic hormone and aldosterone. These hormonal shifts promote sodium and water retention, further exacerbating fluid buildup and reducing urine output.

Lastly, impaired lymphatic drainage contributes to ascites formation. As liver structure becomes increasingly scarred, lymphatic channels become obstructed, preventing the normal reabsorption of excess fluid from the abdominal cavity.

Managing ascites typically involves a combination of dietary adjustments and medical interventions. A moderate reduction in sodium intake is often recommended, though overly restrictive diets should be avoided. For patients with hypoalbuminemia, intravenous administration of human albumin or oral protein supplementation may be used to increase serum albumin levels and reduce fluid leakage. Early diagnosis and targeted treatment can significantly improve quality of life and slow disease progression.