An elderly female with a history of alcoholic disease develops jaundice and marked anasarca. Which of the following is the most likely pathophysiology of her persistent edema?
Hepatic failure occurring in cirrhosis reduces the capacity of the liver to synthesize sufficient quantities of plasma proteins (mostly albumin) necessary to maintain plasma oncotic pressure. Low plasma oncotic pressure allows fluid from the intravascular fluid component to move into the interstitial space, producing plasma volume contraction and edema. Lymphatic obstruction occurs as a result of mechanical blockage of lymphatics by tumor, inflammatory processes, or ceain parasitic infections. Cirrhosis does not lead to lymphatic obstruction. Reduced central venous pressure does not cause edema. Conversely, increased central venous pressure, which may arise with congestive hea failure, thrombosis, or cirrhosis can lead to increased hydrostatic pressure and edema. Sodium retention is an impoant cause of edema in patients with poor renal perfusion. The kidneys respond by retaining sodium and increasing plasma volume in an effo to increase renal blood flow. Sodium retention in cirrhosis is secondary to the decrease in plasma oncotic pressure and consequent decrease in plasma volume. Ref: Geller D.A., Goss J.A., Tsung A. (2010). Chapter 31. Liver. In F.C. Brunicardi, D.K. Andersen, T.R. Billiar, D.L. Dunn, J.G. Hunter, J.B. Matthews, R.E. Pollock (Eds), Schwaz's Principles of Surgery, 9e.
Lymphatic obstruction
Reduced central venous pressure
Reduced plasma oncotic pressure
Sodium retention