Ascites Is the Most Prominent Clinical Manifestation of Portal Hypertension in Liver Cirrhosis

Among the various complications associated with liver cirrhosis and portal hypertension, ascites is the most prominent and frequently observed clinical manifestation. In fact, more than 75% of patients with decompensated cirrhosis develop ascites. This condition results from a combination of reduced liver function and increased pressure within the portal venous system.

The primary mechanisms behind ascites formation include excessive sodium and water retention, elevated portal pressure, and decreased plasma colloid osmotic pressure. Additionally, reduced inactivation of substances such as prostaglandins and estrogen can lead to diminished renal blood flow and impaired sodium excretion, further contributing to fluid accumulation. Ascites may develop either suddenly or gradually, with abdominal distension being the primary symptom.

Many individuals only become aware of ascites when they notice an increase in abdominal girth. This swelling may also be accompanied by edema in the lower extremities. Other common symptoms include fatigue, poor appetite, and overall malnutrition. In severe cases, significant abdominal enlargement can cause elevation of the diaphragm and restricted chest movement, potentially leading to shortness of breath.

It's important to note that in rare instances, the presence of ascites in cirrhotic patients may indicate additional underlying conditions such as tuberculosis or malignancy. Clinically, the management of ascites typically involves dietary sodium restriction, combined use of potassium-sparing and potassium-losing diuretics, and therapeutic paracentesis along with albumin infusion to prevent circulatory dysfunction.

Early recognition and appropriate treatment are essential for improving patient outcomes and quality of life. Monitoring for signs of ascites should be a key component in the regular evaluation of individuals with liver cirrhosis and portal hypertension.