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Cirrhosis and portal hypertension, complicated by inappropriate levels of nitric oxide, results in pooling of blood in splanchnic gut circulation This in turn causes relative systemic hypoperfusion Leads to high output state increased cardiac output Release of antidiuretic hormone, renin, angiotensin, aldosterone lead to increased sodium water avidity leading to further overload of the splanchnic circulation Net effects include hyponatremia and systemic hypotension with hepatorenal syndrome as the end state when the kidney s strangle themselves off from their own blood supply Dr Matherly accutane effects

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