How would you answer this question?
In a patient with alcoholic cirrhosis, ascites may develop as a result of:
a. Increased serum osmolality
b. Over-production of albumin
c. Increased aldosterone production
d. Antidiuretic hormone (ADH) suppression
The correct answer is "c" increased aldosterone production.
Ascites is the development of fluid in the peritoneal cavity and is a poor prognostic indicator of the progression of liver dysfunction. Cirrhosis of the liver causes fatty tissue to become distributed in the liver which causes the liver to swell, resulting in increased pressure on the portal vasculature and portal hypertension. In addition, albumin production is decreased in the liver causing fluid to leak out of the vasculature. The decrease in systemic vascular volume caused by fluid leaking into the peritoneal cavity stimulates aldosterone release and aldosterone stimulates the kidneys to retain fluid. The combination of increased pressure in the splanic (abdominal) vasculature and the low albumin level causes fluid to leak out into the abdomen and produce ascites.
As fluid leaks out of the splanic circulation and into the abdomen, the abdomen grows larger and begins to compress the renal vasculature, abdominal organs, and press upward on the diaphragm. The result is decreased renal function, further losses of fluid into the abdomen, and respiratory compromise.
Acites may be treated with fluid restriction if hyponatremia exists, and with paracentesis to remove excess fluid. Certain medications such as vasopressin antagonists may be helpful in reducing fluid volume retention. If other treatments fail, a transjugular intrahepatic portasystemic shunt (TIPS) can be placed to bypass blood around the liver and decrease portal blood pressure. TIPS can be a lifesaving procedure, but may lead to hepatic encephalopathy from a build up of ammonia.
From: Shah, R. & Fields, J.M. (2009). Ascites. eMedicine.com. Retrieved from http://emedicine.medscape.com/article/170907-overview on August 28, 2010.
Congratulations to Sherri Hanrahan who won an autographed copy of my 101 Tips to Improve Your Nursing Care book for answering this week's question correctly. Congratulations Sherri!
Best wishes,
David W. Woodruff, MSN, RN-BC, CNS, CEN
President, Ed4Nurses, Inc.
This week's question was taken from our Med-Surg Certification Success program.
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