JAMES E. BREDFELDT, M.D.
To the editor: In their review of cirrhotic ascites, Rocco and Ware (1) suggest that systemic arteriovenous fistulae play a role in the various hemodynamic and humoral abnormalities seen in ascitic patients. They also describe a relationship between arteriovenous fistulae and the hyperdynamic systemic circulation (increased cardiac output and decreased peripheral vascular resistance) in patients with portal hypertension.
A hyperdynamic systemic circulation is a well-described phenomenon in patients with portal hypertension, both with and without ascites. Our present concept of the hemodynamic alterations in portal hypertension suggests that hyperemia in the splanchnic vasculature may be responsible for the hyperdynamic systemic
BREDFELDT JE. Cirrhotic Ascites and Hyperemia in the Splanchnic Vasculature. Ann Intern Med. 1987;106:328–329. doi: 10.7326/0003-4819-106-2-328_2
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Published: Ann Intern Med. 1987;106(2):328-329.
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