Physiological Adaptation Q 26
A male client with a history of cirrhosis and alcoholism is admitted with severe dyspnea resulting from ascites. The nurse should be aware that the ascites is most likely the result of increased:
A. Pressure in the portal vein
B. Production of serum albumin
C. Secretion of bile salts
D. Interstitial osmotic pressure
Correct Answer: A. Pressure in the portal vein
Enlarged cirrhotic liver impinges the portal system causing increased hydrostatic pressure resulting in ascites. Portal pressure increases above a critical threshold and circulating nitric oxide levels increase, leading to vasodilation. As the state of vasodilatation becomes worse, the plasma levels of vasoconstrictor sodium-retentive hormones elevate, renal function declines, and ascitic fluid forms, resulting in hepatic decompensation.
Option B: There is a decrease in the production of serum albumin in clients with ascites, leading the fluid to leak or escape from the interstitial spaces into the peritoneal cavity. Ascitic fluid protein and albumin are measured simultaneously with the serum albumin level to calculate the serum-ascites albumin gradient (SAAG).
Option C: The function of bile salts is to help process and digest the fats. Bile salts inhibit cholesterol 7alpha-hydroxylase, decreasing the synthesis of bile acids. Despite the increased water solubility of bile salts, they are amphipathic molecules overall. This critical property allows them to effectively emulsify lipids and form micelles with the products of lipid digestion.
Option D: Osmotic pressure is defined as a pressure that must be applied to the solution side to stop fluid movement when a semipermeable membrane separates a solution from pure water. Osmotic pressure is the pressure caused by water at different concentrations due to the dilution of water by dissolved molecules (solute), notably salts and nutrients.