A patient with liver problem develops edema because of?

Appeared in: HPSSC Staff Nurse - 2021

Explanation

The liver is responsible for producing albumin, the main protein that maintains colloid osmotic (oncotic) pressure in the blood.
In severe liver disease, albumin production decreases, leading to hypoalbuminemia (low blood albumin).
This reduction in albumin causes a fall in plasma osmotic pressure.
With lower osmotic pressure holding fluid inside the blood vessels, fluid leaks into the interstitial spaces, causing generalized edema.

Option A: A fall in hydrostatic pressure would decrease the force pushing fluid out of the capillaries, which would reduce or prevent edema, not cause it.
Option B: While a rise in hydrostatic pressure does occur in liver disease (known as portal hypertension), it is the primary cause of ascites (fluid in the abdomen), not generalized body edema. The systemic edema is driven by the fall in osmotic pressure.
Option D: A rise in osmotic pressure would increase the force pulling fluid into the blood vessels, which would actively reduce edema.

Clinical Relevance

Nursing practice connection: Use the key finding related to Pathophysiology of edema in liver disease to guide bedside assessment, documentation, and the next nursing action.
Nurses must assess patients with liver disease for edema by checking for pitting in the extremities, measuring abdominal girth daily for ascites, and monitoring daily weights.
Monitoring serum albumin levels is crucial, as it directly reflects the patient's risk for edema and their nutritional status.
Nursing interventions include implementing a sodium-restricted diet, administering diuretics as prescribed, and providing meticulous skin care to edematous areas to prevent breakdown.

How to Approach the Question

First, identify the core concepts in the question: 'liver problem' and 'edema'.
Recall the liver's major functions, specifically its role in synthesizing proteins like albumin.
Remember the two main forces that govern fluid movement across capillaries: hydrostatic pressure (pushes fluid out) and osmotic pressure (pulls fluid in).
Connect the dots: A failing liver produces less albumin.
Less albumin in the blood means lower plasma osmotic pressure.
Lower osmotic pressure means less force holding fluid inside the vessels, leading to leakage and edema. This identifies 'Fall in osmotic pressure' as the correct cause.

Concept Tested & Keywords

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E6 Pathology-Textbook of PATHOLOGYHarsh Mohan Part 1 (1-214) p. 184-186

E6 PATHOLOGY QUICK REVIEWBased on Harsh Mohan Textbook of PATHOLOGY p. 43-45

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

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