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Intravascular volume in cirrhosis. Reassessment using improved methodology
1Gastroenterology Division, Denver General Hospital, Colorado 80204-4507.
Digestive Diseases and Sciences
|April 1, 1988
Summary
Accurate blood volume (BV) measurement in cirrhosis is crucial. This study refined BV assessment, finding increased BV correlates with esophageal varices and sodium retention, supporting the "overflow" theory of ascites.
Area of Science:
- Hepatology
- Cardiovascular Physiology
- Renal Physiology
Background:
- Previous blood volume (BV) studies in cirrhosis lacked precise adjustments for body size and timing of plasma volume measurements.
- Inaccurate hematocrit ratios have also confounded BV calculations in prior research.
Purpose of the Study:
- To accurately measure blood volume (BV) in cirrhosis patients, accounting for body size and extravascular albumin shifts.
- To re-evaluate determinants of vascular volume and its relationship with sodium retention in cirrhosis.
Main Methods:
- Calculated BV using plasma volume extrapolated to time zero and a corrected whole body-peripheral hematocrit ratio (0.82).
- Expressed BV per kilogram of "dry" body weight, adjusting for ascites mass measured by isotope dilution.
- Correlated measured BV with esophageal variceal size and pressures (portal, atrial, vena caval, arterial).
Main Results:
- Accurately measured BV showed a strong correlation with esophageal variceal size (r=0.87, P<0.05).
- Patients with sodium retention exhibited significantly greater BV compared to those without.
- No significant correlation was found between BV and portal, atrial, vena caval, or arterial pressures.
Conclusions:
- Vascular capacity, likely influenced by portasystemic collateral circulation, is the primary determinant of vascular volume in cirrhosis.
- Increased BV in patients with sodium retention supports the "overflow" theory of ascites formation.