Question

A 68-year-old man with a history of cirrhosis presents due to weight gain, increased girth, and shortness of breath. He denies fever or chills, cough, melena, hematemesis, hemoptysis, and confusion. He takes furosemide on a daily basis and has not missed any doses. On physical exam, his blood pressure is 120/80; pulse is 78, and respiratory rate is 18. He is alert and cooperative. Heart exam: regular rate and rhythm without murmurs. Lung exam: decreased breath sounds on right side. Abdominal exam: positive fluid wave, no tenderness to palpation. There is no hepatosplenomegaly appreciated. Chest X-ray shows a right-sided pleural effusion; it is free flowing, as is evidenced on a decubitus film.

What is the etiology of his pleural effusion?

1. Altered permeability of pleural membrane
2. Reduced intravascular oncotic pressure
3. Increased hydrostatic pressure
4. Decreased lymphatic drainage
5. Reduced pressure in pleural space

Answer 1

The pleural effusion in this patient with cirrhosis is most likely caused by reduced intravascular oncotic pressure, which leads to fluid leaking into the pleural space.

Step-by-step explanation:

The etiology of the pleural effusion in a 68-year-old man with a history of cirrhosis is likely due to reduced intravascular oncotic pressure. Cirrhosis can lead to ascites, which is fluid retention in the abdominal cavity, and may also cause fluid to accumulate in the pleural space, forming a pleural effusion. The condition described as ascites is commonly related to portal hypertension and hypoalbuminemia, both of which contribute to a reduction in oncotic pressure. As the liver function deteriorates in cirrhosis, it produces less albumin, which results in decreased oncotic pressure that normally helps retain fluid within the circulatory system, hence allowing fluid to leak into surrounding tissues, including the pleural space.