A malnourished client with cirrhosis presents with nausea, ascites, and GI bleeding. What is the primary cause of the ascites?

A malnourished client with cirrhosis presents with nausea, ascites, and GI bleeding. What is the primary cause of the ascites?

• A. Decrease in vitamins to maintain cell coenzyme functions
• B. Decrease in iron to maintain adequate hemoglobin synthesis
• C. Decrease in sodium to maintain its concentration in tissue fluid
• D. Decrease in plasma protein to maintain adequate capillary-tissue circulation

Answer: (D)

This question centers on how ascites develops in liver cirrhosis. The main factor is that the diseased liver can’t produce enough plasma protein, especially albumin, which keeps fluid inside blood vessels through oncotic pressure. When albumin levels fall, plasma oncotic pressure drops, allowing fluid to leak into the interstitial spaces and accumulate in the peritoneal cavity—producing ascites. Malnutrition makes this worse by further limiting protein synthesis. Other issues like vitamin or iron deficiencies don’t directly explain the fluid shift into the abdomen, and while portal hypertension and sodium retention can aggravate ascites, the fundamental mechanism here is decreased plasma protein leading to reduced oncotic pull that keeps fluid in the vessels.

This question centers on how ascites develops in liver cirrhosis. The main factor is that the diseased liver can’t produce enough plasma protein, especially albumin, which keeps fluid inside blood vessels through oncotic pressure. When albumin levels fall, plasma oncotic pressure drops, allowing fluid to leak into the interstitial spaces and accumulate in the peritoneal cavity—producing ascites. Malnutrition makes this worse by further limiting protein synthesis.

Other issues like vitamin or iron deficiencies don’t directly explain the fluid shift into the abdomen, and while portal hypertension and sodium retention can aggravate ascites, the fundamental mechanism here is decreased plasma protein leading to reduced oncotic pull that keeps fluid in the vessels.