Vascular Physiology in Portal Hypertension with Ascites* Clinical and Experimental Studies and Role of Portacaval Shunt

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Abstract
Patients with ascites are usually mild portal hypertensives, and ascites is the most common complication in the early (Stage I) portal hypertensives. They are characterized by mildly depressed hepatic blood flow and a degree of outflow obstruction from the liver which is not severe. Ascites can be produced in the dog by minor alterations in hepatic hemodynamics. In 9 patients with the most severe (Stage III) portal hypertension, ascites was not present. They are characterized by marked outflow obstruction from the liver and markedly reduced total hepatic blood flow. Factors governing filtration of fluid in the liver and removal via the lymphatic system are incompletely elucidated but appear to be of great importance in the pathogenesis of ascites. Porta-caval shunt may be effective in control of ascites. However, it is potentially harmful to the ascitic patient and should be performed only in carefully selected instances.