What Is the Relationship Between Cirrhosis and Ascites?

Cirrhosis ascites is commonly known as hepatic ascites. Cirrhosis ascites is a chronic liver disease that degenerates, necrosis, and regenerates from massive, nodular, and diffuse types of hepatocytes; regeneration and necrosis promote tissue fibrous hyperplasia and shrinkage of scars, resulting in hardening of the liver and cirrhosis. Cirrhosis of the liver causes hypotension of the portal vein and forms ascites.

Basic Information

English name

hepatic ascites

Visiting department

Gastroenterology

Common locations

Abdominal cavity

Common causes

Viral hepatitis, cirrhosis, liver tumors, hepatic vein obstruction syndrome, portal vein thrombosis, inferior vena cava obstruction syndrome, hypothyroidism, etc.

Causes of liver and ascites and common diseases

The etiology of cirrhosis and ascites is related to the following factors: increased portal vein pressure (over 300mmH2O), hypoalbuminemia, albumin below 30g / L), and excessive liver lymphatic fluid production (normal 1-3L, at this time 7-11L ), Secondary aldosterone and antidiuretic hormone increase, effective circulating hemolytic volume is insufficient (sympathetic excitability increases, prostaglandin, atrial peptide and kallikrein decrease). Abdominal swelling caused by a large amount of ascites, showing frog belly, drooping belly.

Liver disease

(1) Viral hepatitis.

(2) Cirrhosis.

(3) Liver tumors.

2. Hepatic vascular disease

(1) Hepatic vein obstruction syndrome.

(2) Portal vein thrombosis.

(3) Inferior vena cava obstruction syndrome.

3. Hypoproteinemia

(1) Chylous ascites.

(2) Hypothyroidism.

(3) Meigs syndrome.

Differential diagnosis of liver and ascites

1. Identification from ascites protein

In malignant ascites due to peritoneal inflammation and increased microvascular permeability, the protein content of ascites increases, often above 30 g / l, and the ratio of ascites / serum albumin is mostly> 0.5, or the serum-ascites albumin concentration gradient becomes smaller, often <1.1, Patients with simple liver cirrhosis have larger albumin concentration gradients. However, ascites protein can also increase in a few patients with liver cirrhosis, and the serum albumin ratio or concentration gradient of non-cancerous inflammation ascites can also occur in a similar manner.

2. Identification from the pH of ascites

Most of them had ph <7.3, malignancy> 7.4 during inflammation.

3. Identification from ascites tumor markers

Carcinoembryonic antigen (cea)> 15 g / l, found in malignant ascites, and revealed adenocarcinoma; elevated ascites alpha-fetoprotein (afp), revealed primary liver cancer metastasis.

4. Identification from ascites lysozyme

Cancer cells do not contain lysosomes, and no lysozyme is produced. Therefore, those with no increase in lysozyme (<23mg / l) in exudative or inflammatory ascites often indicate malignant ascites.

5. Identification from bloody ascites

If gross blood or ascites red blood cells> 100,000 / l, red blood cells: white blood cells> 10: 1, suspect malignant ascites caused by rupture of liver cancer, peritoneal metastasis or other tumors; if it is pale blood or red blood cells <100,000 / l, consider Spontaneous bloody ascites in patients with benign inflammation (tuberculosis, sbp) or cirrhosis.

6. Identification of karyotype from ascites

Malignant ascites has more chromosome divisions, showing hyperdiploid aneuploidy abnormalities or aberrations, and non-cancerous ascites has no mutation. This test has higher specificity, sensitivity and practical value for identifying benign ascites, and its significance is better than that of general cytology.

7. Identification from ascites ferritin

Exudative ascites such as> 500 g / l or ferritin ascites / serum ratio> 1.0 often indicates malignant ascites.

8. Identification from ascites cholesterol

Ascites cholesterol> 1.24mmol / l, the possibility of tumor is high. But tuberculous peritonitis can also increase, it is worth noting when identifying.

Liver and ascites examination

1. Alpha-fetoprotein (AFP)

Convection electrophoresis was positive or radioimmunoassay> 400mg / ml; it lasted for four weeks and excluded active liver disease of pregnancy and gonad embryogenic tumor.

2. Other laboratory inspections

Alkaline phosphatase: increased in about 20% of patients with liver cancer; r-glutamyl transpeptidase (r-GT): increased in most patients with liver cancer; -antitrypsin (-AT): about 90% Of patients with liver cancer increased; transferrin: increased content of patients with liver cancer; carcinoembryonic antigen (CEA): 70% of patients with liver cancer increased, abnormal prothrombin> 300mg / ml.

3. Liver function and hepatitis B antigen antibody system check

Abnormal liver function and positive hepatitis B markers suggest that there is a liver disease basis for primary liver cancer.

4.Various image inspections

Prompt for intrahepatic space occupying lesions.

5. Laparoscopy and liver puncture

Laparoscopy can directly display the surface of the liver; liver biopsy.

Principles of liver and ascites treatment

1. Treatment of primary disease

Treatment options for ascites should depend on the primary disease. Such as tuberculous peritonitis should be given anti-tuberculosis treatment; purulent peritonitis caused by abdominal organ perforation should be surgically treated; tumorous ascites should be given surgical resection, chemotherapy, radiotherapy or interventional treatment according to the condition.

2. Basic treatment

This includes bed rest and diet therapy. Ascites indicates the severity of the disease. Regardless of the cause of ascites, basic treatment cannot be ignored.

3. Bed rest

Bed rest is extremely important for the recovery of heart, liver, and kidney functions, and is conducive to the resolution of ascites. Bed rest can increase liver blood flow, reduce liver metabolic load, and promote reabsorption of ascites through the lymphatic space of the diaphragm; on the other hand, it can increase renal blood flow, improve renal perfusion, and eliminate water and sodium retention.

4. Diet therapy

Abundant nutrition and sufficient calories are necessary for the recovery of the disease. The content of replenishment should be different according to the disease, such as protein and vitamins when hypoproteinemia; for severe renal and liver failure, protein should be limited, mainly carbohydrates; for liver ascites, should be Have enough calories, ensure that the calories are above 2000Kcal daily, mainly carbohydrate supplements, protein 1 to 1.2g / kg per day, and protein in liver encephalopathy should be limited to about 0.5g / kg per day. Should be supplemented with an appropriate amount of fat. In order to reduce catabolism, patients with liver cirrhosis should encourage eating between meals.

5. Chinese medicine treatment

The clinical treatment of liver and ascites in traditional Chinese medicine is based on classification and syndrome differentiation.