What are the causes of hepatic ascites?

Many people don't know much about ascites. It is mainly a symptom of ascites caused by cirrhosis of the liver. Patients need to be drained at ordinary times. If the condition is serious, surgery must be performed. Common factors causing ascites include the decrease of protein and the penetration of plasma colloids. Other reasons lead to the symptoms of ascites in the liver and abdomen.

The main cause of ascites is (1) decreased plasma albumin: Plasma albumin is synthesized by hepatocytes. In cirrhosis, hepatocyte dysfunction significantly reduces albumin synthesis, thereby reducing plasma colloidal osmotic pressure. With the participation of portal hypertension factors, part of the plasma infiltrates from the portal vessels into the abdominal cavity to form ascites. It is generally believed that plasma albumin 30G/L is a critical value, and ascites often occurs when the albumin level is 30G/L.

The main cause of ascites (2) Increased portal pressure: It is now clear that in cirrhosis, the proliferation of fibrous tissue in the liver causes blockage of blood vessels in the liver, leading to increased portal pressure. In addition, the decrease in plasma colloidal osmotic pressure makes it easier for fluid in the portal system to infiltrate into the abdominal cavity.

The main cause of ascites (3) Increased lymphatic leakage: Regenerative nodules in cirrhosis can cause obstruction of the retrosinusoidal hepatic vein, leading to impaired hepatic lymphatic drainage and increased pressure, resulting in increased lymphatic leakage. Some lymph fluid will undoubtedly enter the abdominal cavity and cause ascites. During the operation, lymph fluid was seen leaking from the portal lymph plexus and the lymphatic vessels under the liver capsule, and the thoracic duct was found to be significantly thickened, sometimes equivalent to the caliber of the subclavian vein. In addition, some people have found that external drainage of lymphatic vessels can shrink the liver, reduce ascites, reduce pressure in the spleen, and stop varicose vein bleeding. Therefore, some people point out that the formation of ascites in cirrhosis is related to excessive production of lymph fluid and insufficient drainage, which is also one of the causes of ascites in cirrhosis.

The main cause of hepatic ascites (4) Increased aldosterone and other factors: Aldosterone (and possibly antidiuretic hormone) are inactivated in the liver under normal circumstances. Liver dysfunction can cause insufficient inactivation of aldosterone and antidiuretic hormone, resulting in secondary increases in aldosterone and antidiuretic hormone. Both hormones can cause increased reabsorption of water and sodium in the distal renal tubules, thereby causing further retention of water and sodium and forming ascites in cirrhosis.