the vicious cycle of chronic congestive heart failure n.
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The Vicious Cycle of Chronic Congestive Heart Failure. Spironolactone. Overflow and Underfilling Hypotheses of Sodium and Water Retention in Cirrhosis. PERIPHERAL ARTERIAL VASODILATION HYPOTHESIS. Peripheral Arterial Vasodilation Plasma Hormones (AVP, Renin, Aldosterone, NE) Plasma Volume.

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peripheral arterial vasodilation hypothesis
PERIPHERAL ARTERIAL VASODILATION HYPOTHESIS

Peripheral Arterial

Vasodilation

Plasma Hormones

(AVP, Renin,

Aldosterone, NE)

Plasma Volume

COMPENSATED CIRRHOSIS

(No Ascites)

DECOMPENSATED CIRRHOSIS (Ascites)

Hepatorenal Syndrome

Normal

i have ascites and have desire for water although i know this water will kill me rami 1226 1294 a d
“I have ascites and have desire for water, Although I know this water will kill me.” Rami (1226-1294 A.D.)
effect of v1 vasopressin antagonist on arterial blood pressure in experimental cirrhosis in rats
Effect of V1-Vasopressin Antagonist on Arterial Blood Pressure in Experimental Cirrhosis in Rats
aldosterone antagonism promotes weight loss and disappearance of ascites in decompensated cirrhosis
ALDOSTERONE ANTAGONISM PROMOTES WEIGHT LOSS AND DISAPPEARANCE OF ASCITES IN DECOMPENSATED CIRRHOSIS

PARAMETER

Death

Weight loss (lb)

Disappearance

of ascites

CIRRHOTIC PATIENTS

CONTROL

(n-22)

7

6 + 2

4

SPIRONOLACTONE

(n=21)

5

24 + 4

16

Gregory et al., 1977

slide19
Increased Distal Tubular Sodium Delivery with Mannitol Resulted in a Marked Natriuresis During ANP Infusion
mean arterial pressure is increased by immersion plus norepinephrine but not by immersion alone
Mean Arterial Pressure is Increased by Immersion Plus Norepinephrine but not by Immersion Alone
slide24
Effect of Increased Arterial Circulatory Integrity to Normalize Renal Water Excretion in Decompensated Cirrhotic Patients
slide25
Correlation Between Increase in Systemic Vascular Resistance and an Increase in Water Excretion in Cirrhotic Patients
effect of chronic nos inhibition on systemic vascular resistance in cirrhotic rats with ascites
Effect of Chronic NOS Inhibition on Systemic Vascular Resistance in Cirrhotic Rats with Ascites
slide30
Effect of NOS Inhibition for 7 Days on eNOS Protein Expression in Aortas and Mesenteric Arteries in Cirrhotic Rats with Ascites
slide32
Effect of NOS Inhibition for 7 Days on Plasma Arginine Vasopressin and Atrial Natriuretic Peptide in Cirrhotic Rats with Ascites
slide34
Effect of NOS Inhibition for 7 Days on Plasma Renin Activity and Aldosterone in Cirrhotic Rats with Ascites
slide37
Chronic L-NAME Treatment in Day 14 Pregnant Rats Returns Cardiac Output and SVR to Nonpregnant Levels
pathophysiology of water metabolism in edematous disorders
PATHOPHYSIOLOGY OF WATER METABOLISMIN EDEMATOUS DISORDERS

CONGESTIVE CARDIAC FAILURE

CIRRHOSIS

PREGNANCY

Nitric Oxide

 CARDIAC OUTPUT

PERIPHERAL VASODILATION

NON-OSMOTIC VASOPRESSIN RELEASE

V2 RECEPTOR ANTAGONIST

VASOPRESSIN V2 RECEPTOR

AQUAPORIN-2

INCREASED WATER PERMEABILITY OF COLLECTING DUCT

WATER RETENTION