Fluid retention in cirrhosis

Pathophysiology and management

A. Kashani, C. Landaverde, Valentina Medici, Lorenzo Rossaro

Research output: Contribution to journalArticle

49 Citations (Scopus)

Abstract

Accumulation of fluid as ascites is the most common complication of cirrhosis. This is occurring in about 50% of patients within 10 years of the diagnosis of cirrhosis. It is a prognostic sign with 1-year and 5-year survival of 85% and 56%, respectively. The most acceptable theory for ascites formation is peripheral arterial vasodilation leading to underfilling of circulatory volume. This triggers the baroreceptor-mediated activation of renin-angiotensin-aldosterone system, sympathetic nervous system and nonosmotic release of vasopressin to restore circulatory integrity. The result is an avid sodium and water retention, identified as a preascitic state. This condition will evolve in overt fluid retention and ascites, as the liver disease progresses. Once ascites is present, most therapeutic modalities are directed on maintaining negative sodium balance, including salt restriction, bed rest and diuretics. Paracentesis and albumin infusion is applied to tense ascites. Transjugular intrahepatic portosystemic shunt is considered for refractory ascites. With worsening of liver disease, fluid retention is associated with other complications; such as spontaneous bacterial peritonitis. This is a primary infection of ascitic fluid caused by organisms originating from large intestinal normal flora. Diagnostic paracentesis and antibiotic therapy plus prophylactic regimen are mandatory. Hepatorenal syndrome is a state of functional renal failure in the setting of low cardiac output and impaired renal perfusion. Its management is based on drugs that restore normal renal blood flow through peripheral arterial and splanchnic vasoconstriction, renal vasodilation and/or plasma volume expansion. However, the definitive treatment is liver transplantation.

Original languageEnglish (US)
Pages (from-to)71-85
Number of pages15
JournalQJM
Volume101
Issue number2
DOIs
StatePublished - Feb 2008

Fingerprint

Ascites
Fibrosis
Paracentesis
Vasodilation
Liver Diseases
Sodium
Hepatorenal Syndrome
Transjugular Intrahepatic Portasystemic Shunt
Kidney
Low Cardiac Output
Bed Rest
Pressoreceptors
Viscera
Plasma Volume
Renal Circulation
Ascitic Fluid
Sympathetic Nervous System
Renin-Angiotensin System
Vasoconstriction
Peritonitis

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Fluid retention in cirrhosis : Pathophysiology and management. / Kashani, A.; Landaverde, C.; Medici, Valentina; Rossaro, Lorenzo.

In: QJM, Vol. 101, No. 2, 02.2008, p. 71-85.

Research output: Contribution to journalArticle

Kashani, A. ; Landaverde, C. ; Medici, Valentina ; Rossaro, Lorenzo. / Fluid retention in cirrhosis : Pathophysiology and management. In: QJM. 2008 ; Vol. 101, No. 2. pp. 71-85.
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