A detailed medical flowchart showing the pathophysiology of ascites. The chart should flow top to bottom with clear boxes and arrows. Start with "Liver Cirrhosis / Hepatic Dysfunction" at the top. Then branch into two parallel pathways: LEFT PATHWAY - Sinusoidal Hypertension: - Fibrosis → Increased sinusoidal resistance → Portal Hypertension - Capillarization of Space of Disse (loss of fenestrations) - ↑ Hepatic lymph production → Lymphatic overflow → Ascites RIGHT PATHWAY - Splanchnic Vasodilation (Peripheral Arterial Vasodilation Theory): - Portal Hypertension → Bacterial translocation + local mediators (NO, Prostacyclin, Glucagon) - Splanchnic Arterial Vasodilation - ↓ Effective Arterial Blood Volume (EABV) - Activation of baroreceptors - Three neurohumoral systems activated: RAAS (↑Renin→↑Angiotensin II→↑Aldosterone), SNS (↑Norepinephrine), ADH/AVP - Renal Na⁺ and H₂O Retention - ↑ Plasma Volume / Extracellular Fluid Expansion - Fluid transudation across splanchnic capillaries → ASCITES BOTTOM SECTION - Starling Forces box: - ↑ Portal hydrostatic pressure + ↓ Oncotic pressure (Hypoalbuminemia from liver failure) - Net fluid movement into peritoneal cavity → ASCITES Final box at bottom: "ASCITES = Pathological accumulation of fluid in peritoneal cavity" Include a small legend box: Three theories: 1. Underfill theory 2. Overflow theory 3. Peripheral Arterial Vasodilation theory (current accepted) Use a clean clinical white background, blue and teal color scheme for boxes, red arrows for key pathologic steps, professional medical textbook style