Overview of edema caused by cirrhosis of the liver

The article is professionally consulted by Master. Doctor II Phan Thi Minh Huong - Gastroenterologist - Department of Medical Examination & Internal Medicine - Vinmec International General Hospital Da Nang.

Cirrhosis is a condition in which the cells and tissues of the liver are damaged and no longer secrete the hormones that regulate the body. Cirrhosis increases portal pressure, causing many dangerous symptoms and complications, among them edema due to cirrhosis.

Edema is a symptom that occurs when fluid in the blood vessels because of an abnormal cause or mechanism escapes, accumulates in surrounding tissues and causes edema.
Common locations of edema are 2 lower extremities (instep, ankle, front leg), 2 upper extremities, eyelids or generalized edema.
Edema can be a manifestation of many different diseases, the most common being heart failure (especially right heart failure), kidney failure, cirrhosis of the liver, malnutrition or diseases of the venous system...

When the liver cells become fibrosis, scarring and loss of normal function, portal vein pressure increases. At that time, the pressure from the veins of the small intestine and the splenic vein also gradually increases because these are the veins that drain into the portal vein. The result is ascites (intra-abdominal edema), prominent veins under the skin, and edema of the lower extremities.

The liver is the site of synthesis of many important proteins for the body, among which is Albumin. This is a substance that helps form colloidal pressure, whose main function is to hold water in the blood vessel. When liver function declines due to fibrosis, it leads to decreased albumin synthesis, reduced colloidal pressure, and water in the blood vessels easily escapes, causing edema symptoms due to cirrhosis.

Cirrhosis of the liver will cause dilation of the visceral and peripheral arteries, reducing blood supply to organs including the kidneys. Thereby activating the RAA system (Renin-Angiotensin-Aldosteron); increases the reabsorption of salt and water in the renal tubules, increases the volume of intravascular fluid and causes more edema and ascites. The liver is also a place to excrete and break down many hormones, including Aldosteron. An excess of this substance inadvertently increases the reabsorption of salt and water and contributes to fluid retention in the body, combined with other mechanisms that aggravate edema caused by cirrhosis.

Edema caused by cirrhosis is soft edema, pressing concave (when pressed, it will leave the concave and after 1-2 minutes the skin will stretch again), white blood is pressed when pressed, no pain when pressed.
The onset of edema is usually in the legs, often in the close bone sites such as the ankle, the front of the leg. In the final stage, there may be systemic edema, abdominal edema forming ascites, which is very specific in patients with cirrhosis.
In addition to edema, patients with cirrhosis also have different symptoms such as: Jaundice, yellow eyes, collateral circulation, hemorrhoids, gastrointestinal bleeding due to rupture of esophageal veins...

Cirrhosis is a serious disease that is difficult to treat. The current radical treatment of cirrhosis includes: Liver transplantation and stem cell culture.
Some measures to make patients more comfortable with edema caused by cirrhosis:
Limit salt intake: Eat plain, limit foods that are too salty such as canned foods, processed foods or use a lot of spices. taste when seasoning. Balance the amount of water in and out: Based on the amount of urine and invisible water loss (about 500ml per day) to maintain water intake, do not drink too much or too little water. Elevate your legs when lying down, when sleeping to increase the amount of venous blood flowing to the heart, avoiding blood stasis for too long, causing edema. Exercise moderately, increase circulation in the body. Avoid standing or sitting for too long in one place. Limit the use of some drugs that cause fluid retention such as corticosteroids, some non-steroidal pain relievers...