Causes Of Severe Ascites In End-Stage Liver Cirrhosis

Ascites, the accumulation of fluid in the abdominal cavity, is a common complication in patients with end-stage liver cirrhosis. The development of significant ascites can be attributed to several interrelated physiological mechanisms.

Portal Hypertension As A Primary Factor

One of the main contributors to ascites formation is portal hypertension. When pressure within the portal venous system rises, it increases the hydrostatic pressure in the splanchnic circulation. This elevated pressure forces fluid out of the blood vessels and into the peritoneal cavity, leading to fluid buildup in the abdomen.

The Role Of Hypoalbuminemia

Albumin plays a crucial role in maintaining oncotic pressure in the bloodstream. In advanced liver disease, the liver's ability to synthesize albumin diminishes significantly. When serum albumin levels fall below 32g/L, oncotic pressure drops, reducing the blood's ability to retain fluid within the vascular space. This imbalance promotes fluid leakage into the abdominal cavity.

Bacterial Infections Exacerbate Fluid Accumulation

Intestinal mucosal edema and increased permeability in cirrhotic patients allow bacteria to translocate from the gut lumen into the peritoneal cavity. This can lead to spontaneous bacterial peritonitis (SBP), an infection that worsens inflammation and makes ascites more difficult to manage.

Portal Vein Thrombosis Intensifies Symptoms

Sluggish blood flow through the portal system due to chronic liver damage increases the risk of thrombosis. When clots form in the portal vein, they further elevate portal pressure, accelerating fluid leakage and making ascites more severe.

Additionally, hepatorenal syndrome often develops in late-stage cirrhosis, characterized by progressive kidney dysfunction and reduced urine output. This condition creates a vicious cycle where excessive fluid retention aggravates ascites, while large-volume ascites can, in turn, trigger or worsen hepatorenal syndrome. Managing this complex interplay requires comprehensive medical intervention to address both renal impairment and fluid accumulation.