Systemic and portal hemodynamics in patients with schistosomal hepatic fibrosis: relation to sodium retention and ascites formation

ABSTRACT

Systemic and portal haemodynamics determined by Doppler ultrasonography were evaluated in 30 patients with schistosomal hepatic fibrosis; 18 of them with and 12 without ascites and in 10 healthy subjects. All patients had significant decreases in systemic vascular resistance increases in stroke volume and cardiac index. These haemodynamic changes might be related to the significant increase in plasma substance-P level, an endogenous vasodilating compound, observed in this work. The development of ascites was associated with significant decreases in urinary sodium excretion and mean arterial blood pressure despite the significant increases in plasma volume and left atrial size. These findings may provide evidence that the initial event triggering sodium and water retention is, probably, an "effective" arterial underfilling as the arterial vascular compartment is disproportionately enlarged. Patients with ascites also had significant increases in portal blood flow volume and with indirect evidence of splanchnic arterial vasodilation forming splanchnic compartmentation which could explain the predilection of the retained fluid to transudate into the peritoneal cavity. It can, therefore, be concluded that a relationship exists between changes in systemic and portal haemodynamics and renal sodium and water retention with subsequent ascites formation. Practical clinical implications for the management of ascites should be further investigated