Primary Biliary Cirrhosis (cont.)
In this Article
Edema and ascites
As cirrhosis of the liver develops, signals are sent to the kidneys to retain
salt and water. This excess fluid first accumulates in the tissue beneath the
skin of the ankles and legs (due to the pressure of gravity). This accumulation
of fluid is called edema or pitting edema. Pitting edema refers to the
observation that pressing a fingertip against a swollen ankle or leg causes an
indentation that persists for some time after release of the pressure. Actually,
any type of sufficient pressure, such as from the elastic part of socks, can
produce pitting edema. The swelling often is worse at the end of the day and may
lessen overnight. As more salt and water are retained and liver function
decreases, fluid may also accumulate in the abdomen. This accumulation of fluid
(called ascites) causes swelling of the abdomen.
Bleeding from varices
In cirrhosis, the scar tissue (fibrosis) and the regenerating nodules of
hepatocytes block (obstruct) blood flow in the portal vein in virtually all
patients. The portal vein carries blood from the intestines, spleen, and other
abdominal organs to the liver on the way back to the heart and lungs. The
build-up of pressure caused by the blockage in the portal vein is called portal
hypertension. When pressure in the portal vein becomes high enough, it causes
blood to flow through alternative vessels (paths of lesser resistance.) Often,
these vessels include veins in the lining of the lower part of the esophagus and
the upper part of the stomach.
When these veins distend (dilate) because of the increased blood flow and
pressure, they are referred to as esophageal or gastric varices, depending on
where they are located. So, portal hypertension and varices develop in PBC after
cirrhosis is established. Only a minority of patients with PBC develops portal
hypertension and varices before cirrhosis occurs. The higher the portal
pressure, the larger are the varices (distended veins).
Accordingly, patients with large varices are at risk for the varices to burst and bleed into
the gut. It is recommended, therefore, that patients with PBC have an upper
endoscopy done at the time of diagnosis and approximately every three years
thereafter to detect and then, if necessary, treat the varices. An upper
endoscopy is a direct look with a tubular instrument (an upper endoscope) into
the esophagus and stomach.
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