Why does a starving person get ascites

Portal and hepatic veins were unremarkable. Thus, a diagnosis of acute liver injury associated with anorexia nervosa was considered the most plausible diagnosis. A careful and progressive refeeding was performed, but liver transaminases remained abnormal. Thus, 10 days after hospital admission, a liver biopsy was performed by the transjugular route. At histology, architecture of the liver was normal without fibrosis.

Portal tracts and biliary and vascular structures were normal. Cytoplasm of hepatocytes was clarified and some acidophil bodies were found predominant in the centrilobular region. In addition, ceroid pigments at the apical pole of the hepatocytes were observed Figure 1. An electron microscopy study was also performed in a fragment of liver biopsy, which showed features that strongly suggested a phenomenon of autophagocytosis: the density of glycogen particles in the hepatocytes was very low, consistent with cytoplasm clarification on PAS staining at the optical microscopy.

In addition, the number of both mitochondria and rough endoplasmic reticulum appeared to be reduced. This observation contrasts with an increased number of Golgi bodies and smooth endoplasmic reticulum as well as primary and secondary lysosomes containing digested material Figure 1. Eight weeks after admission, with progressive refeeding the test returned back to normal Figure 2.

This case of anorexia nervosa illustrates the consequences of severe malnutrition on the liver, with marked elevation of liver enzymes, profound glycogen depletion, and histological evidence of autophagocytosis. A median peak value of ALT of 56 times normal has been reported in a recent case series. This biological alteration has been found to inversely correlate with the body mass index, suggesting that severe starvation is involved in the pathogenic mechanism of anorexia nervosa associated liver injury.

Surprisingly, these biological signs of acute liver injury contrast with the absence of liver cell necrosis, which we would expect with such an elevation in liver enzymes [ 9 ]. Accordingly, Rautou et al. Similar changes were observed in our patient.

Overall, these histological findings are consistent with severe glycogen depletion as the primary cause of liver injury. A more detailed examination of liver tissue using electron microscopy brings additional information on the consequences of severe starvation.

In addition to low density of glycogen particles, we observed a decreased number of mitochondria and endoplasmic reticulum together with an increase in autophagosomes, similar to the findings of a recent study [ 10 ]. These alterations illustrate the consequences of autophagy, which is a physiological mechanism that the cell activates during episodes of stress including severe starvation. During this process, cytoplasmic components are degradated and appear as autophagosomes at electron microscopy studies, as in the present case.

Therefore, it is tempting to speculate that the elevated transaminases originate from the altered mitochondria. It can be associated with acute liver injury that is slowly reversible with careful enteral nutrition.

Sophie Restellini and Laurent Spahr were involved in acquisition of data and drafting and writing the paper. Laura Rubbia-Brandt was involved in the pathological analyses. Proteins in the body are responsible for the balance of osmotic pressure in the body, besides their structural roles. Proteins are generally macromolecules, which means that they are sizably large and not easy to transport through cells permeable membranes.

The proteins can pass through the membranes only through special mechanistic procedures in the membranes and are otherwise found in the blood serum or lymph. The presence of proteins in the lymphatic system of the body leads to a higher osmotic pressure in the lymphatic fluid, as compared to the water in the gut.

This hypertonicity causes fluid to flow from the gut into the lymph fluid and eventually into the blood stream. The regulation of water maintains a healthy distribution of water throughout the body. If this regulation is compromised due to protein deficiency, the buildup of fluid leads to distention of abdomen as well as fluid retention or edema.

Effective treatment can usually reverse many of the signs and symptoms of kwashiorkor. It is important to reintroduce foods slowly and carefully to avoid refeeding syndrome. A look at anasarca, a condition that causes a general swelling of the body.

Included is detail on how it is diagnosed and the outlook for the…. Edema, or water retention, occurs when fluid builds up in the tissues of the body. Learn about edema here. A calorie is an amount of energy that a particular food provides.

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Marasmus, or 'wasting,' is a form of severe malnutrition that results from a lack of protein and calories. It can happen in places where people do not….

Why does malnutrition cause stomach bloating? Medically reviewed by Natalie Butler, R. Causes Symptoms Diagnosis vs. What causes kwashiorkor? Share on Pinterest It is important for a person with kwashiorkor to reintroduce food carefully. Major causes are diabetes and high blood pressure The pancreas is a leaf-shaped organ about 5 inches about 13 centimeters long. It is surrounded by the lower edge of the stomach and the first It usually affects the lungs.

Tuberculosis is spread mainly when people breathe air Ascites tends to occur in long-standing chronic rather than in short-lived acute liver disorders.

It most commonly results from. Portal hypertension Portal Hypertension Portal hypertension is abnormally high blood pressure in the portal vein the large vein that brings blood from the intestine to the liver and its branches. Portal hypertension usually results from cirrhosis Cirrhosis of the Liver Cirrhosis is the widespread distortion of the liver's internal structure that occurs when a large amount of normal liver tissue is permanently replaced with nonfunctioning scar tissue.

People with fatty liver may feel tired or have mild abdominal discomfort but otherwise have no symptoms Ascites may occur in other liver disorders, such as severe alcoholic hepatitis without cirrhosis, chronic hepatitis, and obstruction of the hepatic vein Budd-Chiari syndrome Budd-Chiari Syndrome Budd-Chiari syndrome is caused by blood clots that completely or partially block blood flow from the liver.

The blockage may occur anywhere from the small and large veins that carry blood from In people with a liver disorder, ascitic fluid leaks from the surface of the liver and intestine and accumulates within the abdomen. A combination of factors is responsible. They include the following:. Also, albumin usually leaks from blood vessels into the abdomen. Normally, albumin, the main protein in blood, helps keep fluid from leaking out of blood vessels.

When albumin leaks out of blood vessels, fluid also leaks out. Small amounts of fluid within the abdomen usually cause no symptoms. Moderate amounts may increase the person's waist size and cause weight gain.