Chinese Medical Journal

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PORTAL HYPERTENSION ; 4.

was ascites present in any marked degree. Liver damage evidently plays an important part in the production of ascites.

Table 4. The relationship between ascites and types of portal obstruction

Ascites Nil Under 500 cc Over 500 cc Intrahepatic 26 19 4 Extrahepatic 6 2 0

To summarize, it may be said that an alteration of the plasma protein level, the degree of portal hypertension and the presence of liver damage are all closely related to the pathogenesis of ascites, but no single factor can be considered as decisive. Recently, Hyatt and Smith(2) have reported that the ascitic fluid mainly originates from the liver, and they believe that sodium retention plays an important part; but other authors have emphasized also the importance of increase of permeability of the capillary wall, impedance to the lymphatic flow and excessive production of the antidiuretic hormone by the pituitary, etc. The fact is that the true mechanism in the production of ascites is not yet known. We believe that the cause of ascites is manifold and that alteration of the plasma protein level, elevation of the portal pressure and liver damage are important. Once ascites is formed, there is diminution in the excretion of sodium, and as a result ascites tends to persist or continue to progress in a vicious circle. Therefore, the treatment should be directed to the elimination of the above factors.

4. Blood picture. Another important finding is hypersplenism, which takes the form of anemia, leukopenia and thrombocytopenia accompanied with prolongation of both the bleeding and coagulation time. We studied the blood pictures of all the 65 cases before operation and observed varying degrees of pancytopenia and bleeding tendency (Table 5). Among these, leukopenia was the most constant and striking feature.

Table 5. Blood picture

Hep em per No. of Percent- RBC million No. of Percent- as pone No. of Percent-

ee cases age per cu mm cases age aera cases age

Less Less Less than 5 8 12.3 than 2 6 9.2 than 2 10 15.4 5-10 27 41.5 2-3 17 26.1 2-4 42 64.6 10-12 18 27.7 3-4 34 52.3 4-5 8 12.3 Above 12 12 18.5 Above 4 8 12.3 5-6 5 TAT,

Above 6 0 0