A patient with liver cirrhosis and ascites is being assessed. Which of the following physiological changes is not expected?

Appeared in: NORCET 10 Prelims-2026

Explanation

In liver cirrhosis, extensive scarring (fibrosis) obstructs blood flow through the portal vein.
This obstruction leads to a significant increase in pressure within the portal venous system, a condition known as portal hypertension.
Therefore, a decrease in portal pressure is the opposite of the expected physiological change and is inconsistent with a diagnosis of cirrhosis with ascites.

Option A: This is an expected finding. The body perceives a lower effective circulating blood volume due to splanchnic vasodilation and ascites formation.
Option B: This is an expected finding. The same fibrotic process that causes portal hypertension also obstructs blood outflow from the liver into the hepatic veins, increasing pressure in them.
Option D: This is an expected finding. The perceived decrease in effective blood volume activates the Renin-Angiotensin-Aldosterone System (RAAS).

Clinical Relevance

Nursing practice connection: Use the key finding related to Pathophysiology of ascites in liver cirrhosis to guide bedside assessment, documentation, and the next nursing action.
Nurses are responsible for monitoring patients with ascites for changes in fluid status, including daily weights, abdominal girth measurements, and assessing for peripheral edema.
Managing ascites is crucial for patient comfort and preventing complications like Spontaneous Bacterial Peritonitis (SBP) and respiratory distress from pressure on the diaphragm.
Patient education is key, focusing on dietary sodium restriction (typically less than 2g/day) and adherence to diuretic therapy (e.g., spironolactone and furosemide).

How to Approach the Question

First, identify the core condition: liver cirrhosis with ascites.
Next, recognize the negative framing of the question: 'which...is NOT expected?'. This means you are looking for the one option that does not fit the pathophysiology.
Recall the primary pathophysiological consequence of cirrhosis: scarring leads to obstruction of blood flow.
Think about how this obstruction affects pressures. It increases resistance, so pressure in the preceding vessel (portal vein) must increase. This is portal hypertension.
Evaluate each option: Increased ADH, increased aldosterone, and increased hepatic venous pressure are all known consequences. Decreased portal pressure is the direct opposite of portal hypertension.
Therefore, 'Decreased portal pressure' is the physiological change that is not expected.

Concept Tested & Keywords

Concept Tested: Pathophysiology of ascites in liver cirrhosis
Stem keywords: liver cirrhosis, ascites, physiological changes
Lead-in keywords: not expected
Negative lead-in flag: This question uses a negative lead-in ('not expected'), requiring you to identify the finding that is inconsistent with the disease process.

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E6 Medicine Harrison 22e Part 1 p. 369-371

E6 Pathology-Textbook of PATHOLOGYHarsh Mohan Part 3 (515-969) p. 95-97

Practise the full NORCET 10 Prelims-2026

Attempt every question from this paper in a timed mock, then review the full solution for each one.