RELATION OF PLASMA PROTEINS TO ASCITES AND EDEMA IN CIRRHOSIS OF THE LIVER

In cirrhosis of the liver the accumulation of fluid in the peritoneal cavity is generally associated with a high degree of portal obstruction. This has been demonstrated repeatedly, but in a most convincing manner by McIndoe.¹ However, clinical observations suggest that other factors play important parts. The spontaneous variation of the amount of peritoneal fluid, the diminution of the ascites following the administration of diuretics and the changes subsequent to an alcoholic bout or an attack of dysentery are difficult to explain on the basis of portal obstruction alone.

Dependent edema of varying degree is frequently observed in patients with cirrhosis of the liver and portal obstruction. The edema of these patients has been explained on a basis of increased intraabdominal pressure, causing obstruction of the venous return from the legs, or as a manifestation of cardiac failure. There are many patients concerning whom these explanations are inadequate. Edema