Ascites Formation and Changes of Microcirculation in the Liver : Symposium on Intrahepatic Microcirculation: Methods for the Study of Intra- or Extra-lobular Circulation; Hemodynamic and Morphological Aspects

On the basis of these experimental findings, the following sequence of events can be postulated as the mechanism of ascites formation : increased permeability of sinusoids resulting from disturbance of postsinusoidal out-flow leads to an increase in production of the lymphatic fluid, to the extent that the capability of lymphatic drainge from the liver into the thoracic duct is exceeded and part of the lymphatic fluid is regurgitated through the capsule of the liver into the peritoneal cavity. The increase of thoracic duct pressure also causes congestion of lymphatic vessels and of small veins in the mesenterium peritoneum and intestinal wall which result in increased extravasation and decreased resorption of the ascitic fluid. This sequence of events, in conjunction with other factors as mentioned in the beginning of this article, contributes to establishment of a viscious cycle which makes ascites sometimes very resistant to treatment. It seems that the supression of sinusoid permeability and the acceleration of a drainage of hepatic lymph into the vein are the most important and essential in the treatment of the hepatogenous ascites formation.