Figure 231

Alterations in cardiovascular hemodynamics in hepatic cirrhosis. Hepatic dysfunction and portal hypertension increase the production and impair the metabolism of several vasoac-tive substances. The overall balance of vasoconstriction and vasodilation shifts in favor of dilation. Vasodilation may also shift blood away from the central circulation toward the periphery and away from the kidneys. Some of the vasoactive substances postulated to participate in the hemodynamic disturbances of cirrhosis include those shown here. ANP—atrial natrivretic peptide; ET-1—endothelin-1; CGRP—calcitonin gene related peptide; RAAS—renin/angiotensin/aldosterone system; TNF—tumor necrosis factor; VIP— vasoactive intestinal peptide. (Data from Moller and Henriksen [64].)

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