Chinese Medical Journal
40 THE CHINESE MEDICAL JOURNAL
was 61.1 per cent in the intrahepatic group and 444 per cent in the extrahepatic group. :
3. Ascites. Ascites was present in 25 or 44.6 per cent of our cases. Nine cases were excluded because of insufficient data in the records. Excessive fluid of over 500 to 2,000 ce was found during operation in 4 cases. In an analysis of these cases, the following points in relation to the production of ascites were noted:
a. The role of plasma protein. It is well-known that protein plays an important part in maintaining osmotic pressure in the circulation. The serum albumin has a higher osmotic pressure than globulin because of its smaller molecules and higher concentration. Therefore, it is conceivable that a reduction of serum albumin might be the causative or a contributory factor in the production of ascites in cases of portal hypertension. We found in our present ‘study that an abnormal albuminglobulin ratio was present in most of the patients with marked ascites and that, on the other hand, in those without ascites the plasma protein was usually normal (Fig. 1). It is apparent that abnormal variation of plasma protein may exert a great influence on the production of ascites.
© Cases with normal plasma protein Cases with abnormal plasma protein
~_y o
60 2 50 3 40 s Y £ 30 o Oe 20 10 0 : More than less than nil 500 co 500 cc
Amount of ascitic fluid present
Fig. & The relationship between ascites and plasma protein.
b. Portal pressure. One would expect that ascites is likely to occur in cases of portal hypertension as a consequence of increased hydrostatic pressure within the visceral capillaries owing to portal obstruction. Analysis of our cases (see Fig. 2) shows that the incidence of ascites in general is in proportion to the increase of portal pressure.
c. The type of portal obstruction. In comparing the frequency of ascites occurring in the intrahepatic and extrahepatic groups, we found that ascites occurred in the former about twice as frequently as in the latter (Table 4) and that in none of the cases in the extrahepatic group