A patient with chronic alcohol abuse is admitted with liver failure. You closely monitor the patient’s blood pressure because of which change that is associated with liver failure?
A. Hypoalbuminemia
B. Increased capillary permeability
C. Abnormal peripheral vasodilation
D. Excess renin release from the kidneys
Correct Answer: A. Hypoalbuminemia
Blood pressure decreases as the body is unable to maintain normal oncotic pressure with liver failure, so patients with liver failure require close blood pressure monitoring. Increased capillary permeability, abnormal peripheral vasodilation, and excess renin released from the kidneys aren’t direct ramifications of liver failure.
Option B: Once ascites is present, most therapeutic modalities are directed on maintaining negative sodium balance, including salt restriction, bed rest, and diuretics. Paracentesis and albumin infusion is applied to tense ascites. Transjugular intrahepatic portosystemic shunt is considered for refractory ascites. With worsening of liver disease, fluid retention is associated with other complications; such as spontaneous bacterial peritonitis.
Option C: Hepatorenal syndrome is a state of functional renal failure in the setting of low cardiac output and impaired renal perfusion. Its management is based on drugs that restore normal renal blood flow through peripheral arterial and splanchnic vasoconstriction, renal vasodilation, and/or plasma volume expansion. However, the definitive treatment is liver transplantation.
Option D: The most acceptable theory for ascites formation is peripheral arterial vasodilation leading to underfilling of circulatory volume. This triggers the baroreceptor-mediated activation of the renin-angiotensin-aldosterone system, sympathetic nervous system, and nonosmotic release of vasopressin to restore circulatory integrity. The result is an avid sodium and water retention, identified as a pre ascitic state. This condition will evolve in overt fluid retention and ascites, as the liver disease progresses.
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