The Curious Clinicians 119 - While My Liver Gently Weeps
Nov 27, 2025
Dive into the intriguing world of cirrhosis and its effects on ascites! Discover why cirrhosis leads to high SAAG levels despite leaky capillaries. Explore where ascites originates and the 'weeping liver' hypothesis that explains fluid dynamics. Learn about the impact of portal hypertension and how TIPS procedures can alleviate symptoms. The discussion highlights fascinating medical findings and clarifies the complexities surrounding liver conditions.
AI Snips
Chapters
Transcript
Episode notes
Sinusoids Are The Liver's Leakiest Capillaries
- Liver sinusoids are the leakiest capillaries and normally allow free passage of proteins like albumin.
- These sinusoidal capillaries are distinct from continuous and fenestrated capillaries and are found in the liver, spleen, and bone marrow.
The SAAG Paradox In Cirrhosis
- Cirrhosis with portal hypertension typically produces a high SAAG because ascites albumin is low relative to serum.
- This contrasts with the expectation from leaky sinusoids, which would predict similar albumin in plasma and ascites.
Location Of Obstruction Matters For Ascites
- The site of vascular obstruction determines ascites likelihood: hepatic or post-sinusoidal block causes more ascites than portal vein thrombosis.
- Budd–Chiari (hepatic vein thrombosis) produces much more ascites than portal vein thrombosis because sinusoids see higher pressure.