The cause of ascites in cirrhosis of the liver is?

HPSSC - 2015

Medical & Surgical Nursing

Medium

Appeared in: HPSSC - 2015

Explanation

In liver cirrhosis, extensive scarring (fibrosis) physically obstructs blood flow through the portal vein.
This blockage leads to a significant increase in pressure within the portal venous system, a condition called portal hypertension.
The high pressure forces fluid to leak from the surface of the liver and intestines into the abdominal cavity, resulting in the accumulation of fluid known as ascites.
This mechanism makes portal obstruction the primary and initiating cause of ascites in cirrhosis.

Option A: Vitamin deficiencies are common in patients with cirrhosis due to malabsorption and impaired liver function, but they do not directly cause the fluid shift that leads to ascites.
Option B: Fluid imbalance is a description of the condition of ascites itself, not its cause. It is the result of the underlying pathology, not the trigger.
Option C: Kidney malfunction, specifically hepatorenal syndrome, is a severe complication of advanced cirrhosis. It contributes to worsening fluid retention but is a consequence of the systemic circulatory changes caused by portal hypertension, not the initial cause of ascites.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Pathophysiology of ascites in liver cirrhosis as background academic context rather than a clinical decision trigger.
Nurses play a vital role in monitoring for ascites by performing daily weights, measuring abdominal girth, and assessing for fluid waves and shifting dullness.
Patient education is crucial, focusing on dietary sodium restriction (typically less than 2g/day) and adherence to diuretic therapy (e.g., spironolactone and furosemide) to manage fluid volume.
What if? If a patient with cirrhotic ascites develops a sudden fever, abdominal pain, or confusion, the nurse must suspect Spontaneous Bacterial Peritonitis (SBP). This is a medical emergency requiring immediate diagnostic paracentesis and initiation of antibiotic therapy.

How to Approach the Question

First, identify the core of the question: it asks for the primary 'cause' of a specific complication (ascites) in a known disease (cirrhosis).
Recall the fundamental pathophysiology of liver cirrhosis, which is scarring and fibrosis.
Think about how scarring would affect the liver's primary functions, especially its role in blood circulation via the portal vein.
Evaluate each option to determine if it is a cause, a consequence, or a description of the condition.
Option D, 'Portal obstruction,' directly relates to the physical blockage caused by cirrhosis scarring, making it the most fundamental cause.
Eliminate other options: 'Fluid imbalance' is the result, not the cause. 'Kidney malfunction' and 'Vitamin deficiency' are complications or contributing factors, not the initial trigger.

Concept Tested & Keywords

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E6 Pathology-Textbook of PATHOLOGYHarsh Mohan Part 3 (515-969) pp. 121-123, 122-124

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