A nurse is caring for a patient with ascites related to liver cirrhosis. The patient has hypoalbuminemia and increasing abdominal distention. Which pathophysiological process should the nurse identify as the primary cause of the ascites in this patient?

Choice A rationale Ascites in liver cirrhosis is primarily caused by increased portal hypertension, which elevates hydrostatic pressure in the splanchnic circulation. This high pressure, combined with reduced plasma oncotic pressure due to hypoalbuminemia (normal range approximately 3.5 to 5.5 g/dL), drives fluid (transudate) out of the permeable liver and intestinal vessels into the peritoneal cavity. Choice B rationale While the hepatic lymphatic system contributes to ascites by producing and leaking excess lymph, the primary driver is the sustained increase in portal vein pressure and the underlying fluid imbalance due to poor albumin synthesis, not a simple physical obstruction of the overall lymphatic system. Choice C rationale Excess protein intake is not a cause of ascites in cirrhosis; rather, the low serum albumin (hypoalbuminemia) due to impaired liver synthesis is a major contributing factor. Low plasma oncotic pressure fails to retain fluid within the capillaries, allowing it to leak into the peritoneum. Choice D rationale Acute peritoneal infection, such as spontaneous bacterial peritonitis (SBP), can worsen existing ascites or lead to fluid buildup (exudate) through inflammation, but it is typically a complication of established ascites, not the primary cause of ascites development in chronic liver cirrhosis. .