A 51-year-old man comes to the emergency department because of fatigue, worsening abdominal discomfort, and progressive swelling of his legs for 3 months. The swelling is worse in the evenings. The patient does not smoke and drinks 2-3 beers each weekend. His temperature is 36.0°C (96.8°F), pulse is 88/min, respirations are 18/min, and blood pressure is 130/80 mm Hg. Pulmonary examination shows no abnormalities. Abdominal examination shows a mildly distended abdomen with shifting dullness. The liver is palpated 2-3 cm below the right costal margin. When pressure is applied to the right upper quadrant, the patient's jugular veins become visibly distended for 15 seconds.. This patient's ascites most likely developed due to which of the following changes in portal capillary exchange parameters?

Question

A 51-year-old man comes to the emergency department because of fatigue, worsening abdominal discomfort, and progressive swelling of his legs for 3 months. The swelling is worse in the evenings. The patient does not smoke and drinks 2-3 beers each weekend. His temperature is 36.0°C (96.8°F), pulse is 88/min, respirations are 18/min, and blood pressure is 130/80 mm Hg. Pulmonary examination shows no abnormalities. Abdominal examination shows a mildly distended abdomen with shifting dullness. The liver is palpated 2-3 cm below the right costal margin. When pressure is applied to the right upper quadrant, the patient's jugular veins become visibly distended for 15 seconds.. This patient's ascites most likely developed due to which of the following changes in portal capillary exchange parameters?

Quizplus · Accepted Answer

Eductional Objective: Right-sided heart failure promotes the formation of ascites due to increased central venous pressure, which is transmitted to the hepatic sinusoids, leading to increased capillary hydrostatic pressure.  Capillary permeability is unaffected.  Although chronic passive congestion may eventually result in hepatic synthetic dysfunction (hypoalbuminemia) with low oncotic pressures, the oncotic pressure will remain normal for several weeks at least.

A 51-Year-Old Man Comes to the Emergency Department Because of Fatigue