Hepatic edema, also known as hepatogenic edema, develops mainly in association with hypoproteinemia, portal hypertension, lymphatic fluid leakage, secondary aldosteronism, and hyperabsorption of sodium by the renal tubules. Its characteristic clinical manifestation is mainly marked ascites, which can be manifested as obvious abdominal distension symptoms. On examination there can be a marked abdominal distention with positive ascites signs, and in severe cases patients may also present with umbilical hernia, difficulty in breathing and walking. In addition, there may be other areas of sunken edema, most commonly ankle edema, which can gradually spread upward. However, unlike nephrogenic edema, the head, face and upper extremities do not usually show symptoms of edema. Because hepatic edema is caused by chronic liver disease or cirrhosis, patients may also experience fatigue, anorexia, loss of appetite, nausea, vomiting, splenomegaly, hepatomegaly, chronic liver disease facies, liver palms, spider nevi, and even abdominal wall varices.