Figure 234

Mechanisms of sodium (Na) retention in cirrhosis. A primary decrease in systemic vascular resistance (indicated by dark blue arrow), induced by mediators shown in Figure 2-31, leads to a decrease in arterial pressure. The reduction in systemic vascular resistance, however, is not uniform and favors movement of blood from the central ("effective") circulation into the peripheral circulation, as shown in Figure 2-32. Hypoalbuminemia shifts the interstitial to blood volume ratio upward (compare the interstitial volume with normal [dashed line], and low [solid line], protein levels in the inset graph). Because cardiac output increases and venous return must equal cardiac output, dramatic expansion of the extracellular fluid (ECF) volume occurs.

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