Pathophysiology of ascites and renal dysfunction in patients with advanced cirrhosis
Pathophysiology of ascites and renal dysfunction in patients with advanced cirrhosis Cirrhosis Cirrhosis
«Flowchart»

CIRRHOSIS

CIRRHOSIS

CIRRHOSIS

CIRRHOSIS

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Activation of innate
immunity (PRRs)

Activation of innate
immunity (PRRs)

Activation of innate
immunity (PRRs)


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Splanchnic arterial vasodilatation

Splanchnic arterial vasodilatation

Splanchnic arterial vasodilatation

Vasodilator mediators

Vasodilator mediators

Vasodilator mediators

Reduced effective arterial
blood volume

Reduced effective arterial
blood volume

Reduced effective arterial
blood volume


Activation of vasoconstrictor and antinatriuretic systems
(RAAS, SNS, vasopressin)

Activation of vasoconstrictor and antinatriuretic systems
(RAAS, SNS, vasopressin)

Activation of vasoconstrictor and antinatriuretic systems
(RAAS, SNS, vasopressin)


Hepatorenal
syndrome

Hepatorenal
syndrome

Hepatorenal
syndrome

Hepatorenal
syndrome

Ascites

Ascites

Ascites

Ascites

Dilutional
hyponatremia

Dilutional
hyponatremia

Dilutional
hyponatremia

Dilutional
hyponatremia

Sodium retention

Sodium retention

Sodium retention

Solute-free water retention

Solute-free water retention

Solute-free water retention

Renal vasoconstriction

Renal vasoconstriction

Renal vasoconstriction

Bacterial translocation (PAMPs)
Liver injury (DAMPs)

Bacterial translocation (PAMPs)
Liver injury (DAMPs)


Bacterial translocation (PAMPs) Liver injury (DAMPs)

Portal hypertension

Portal hypertension

Portal hypertension

Decreased
cardiac output

Decreased
cardiac output


Decreased cardiac output

Systemic inflammation
(Proinflammatory cytokines, reactive oxygen species)

Systemic inflammation
(Proinflammatory cytokines, reactive oxygen species)

Systemic inflammation
(Proinflammatory cytokines, reactive oxygen species)