All of the following statements regarding cirrhotic ascites are true except:
Currently, the vasodilator theory for development of cirrhotic/poal hypeensive ascites is the most widely accepted one. Peripheral vasodilatation results in underfilling of the aerial tree. When this result is hemodynamically significant, a baroreceptor-mediated increased release of renin, aldosterone, vasopressin, and norepinephrine occurs, resulting in fluid retention and deteriorating renal function. At the extreme end of the spectrum, the hepatorenal syndrome can develop with oliguria, marked salt retention, and essentially normal renal morphology, Ascites formation also depends on the presence of poal hypeension. The increased hydrostatic pressure will cause an increased leakage of fluid from the very permeable hepatic sinusoids into the space of Disse. Fluid subsequently leaks from the space of Disse into the peritoneal cavity. The lymphatics are overwhelmed, and ascites forms. There are several facets to therapy. Although as little as 700 mg of sodium may be excreted daily in the cirrhotic state, a diet of less than 2 g of sodium daily is unpalatable and impractical. Therefore, in most instances of significant ascites, diuretics are necessary. Spironolactone, by inhibiting aldosterone, may be effective in mobilizing ascitic fluid 1 to 2 weeks after initiating therapy. Therefore, furosemide is usually begun concomitantly. Careful attention to serum potassium and renal function is required. High-volume paracentesis with or without IV albumin is very effective and seldom causes renal compromise. Peritoneovenous-jugular shunts are effective in mobilizing ascitic fluid but can result in congestive hea failure or variceal bleeding in susceptible individuals. Shunt occlusion is a common complication. Peritoneal fluid should be evaluated with simultaneous ascitic fluid and serum samples for albumin. A gradient of greater than 1.1 between the serum and the ascitic fluid (serum-ascitic) is consistent with poal hypeension. If it is less than 1.1, then an inflammatory/infectious or malignant cause must be sought.
The serum albumin minus the ascites albumin is usually less than 1.1
Cirrhotic ascites may in pa be related to splanchnic vasodilation.
Spironolactone and furosemide are mainstays of therapy
High-volume paracentesis is an acceptable form of therapy