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Refractory Ascites and Hepatic Hydrothorax 

Refractory Ascites and Hepatic Hydrothorax
Chapter:
Refractory Ascites and Hepatic Hydrothorax
Author(s):

Su Min Cho

and Ali Al-Khafaji

DOI:
10.1093/med/9780199768899.003.0004
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date: 22 February 2020

Patients with end-stage liver disease (ESLD) can present with several symptoms-related to the presence of fluid in the pleural (hydrothorax) or abdominal cavity (ascites). Hepatic hydrothorax can result from the passage of ascites from the peritoneal to the pleural cavity through small defects in the tendinous portion of the diaphragm. Tense ascites can lead to atelectasis merely from the pressure effect of the fluid on the diaphragm. Even with the presence of minimal amount of ascites, the negative intrathoracic pressure generated during spontaneous inspiration leads to the passage of fluid from the abdomen to the pleural space. Thus, many patients have only mild or no clinically detectable ascites.

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