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    B.SC Nursing Medical Surgical Nursing - I Unit: Iv - Nursing Management of Patients With Disorders of Digestive System Portal Hypertension

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    Poova Ragavan
    This document discusses portal hypertension, which occurs when there is elevated blood pressure in the portal vein system that transports blood to the liver. It defines portal hypertension and describes its causes such as liver damage blocking blood flow. Signs include ascites, enlarged spleen, and varicose veins. Treatment involves medications, dietary changes, procedures like TIPS and sclerotherapy to reduce pressure and prevent bleeding complications. Nursing care focuses on monitoring for infections and fluid imbalances and assisting with paracentesis to drain fluid buildup.

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    B.SC Nursing Medical Surgical Nursing - I Unit: Iv - Nursing Management of Patients With Disorders of Digestive System Portal Hypertension

    Uploaded by

    Poova Ragavan
    230 views32 pages
    This document discusses portal hypertension, which occurs when there is elevated blood pressure in the portal vein system that transports blood to the liver. It defines portal hypertension and describes its causes such as liver damage blocking blood flow. Signs include ascites, enlarged spleen, and varicose veins. Treatment involves medications, dietary changes, procedures like TIPS and sclerotherapy to reduce pressure and prevent bleeding complications. Nursing care focuses on monitoring for infections and fluid imbalances and assisting with paracentesis to drain fluid buildup.

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    Portal Hypertension

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    This document discusses portal hypertension, which occurs when there is elevated blood pressure in the portal vein system that transports blood to the liver. It defines portal hypertension and describes its causes such as liver damage blocking blood flow. Signs include ascites, enlarged spleen, and varicose veins. Treatment involves medications, dietary changes, procedures like TIPS and sclerotherapy to reduce pressure and prevent bleeding complications. Nursing care focuses on monitoring for infections and fluid imbalances and assisting with paracentesis to drain fluid buildup.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    230 views32 pages

    B.SC Nursing Medical Surgical Nursing - I Unit: Iv - Nursing Management of Patients With Disorders of Digestive System Portal Hypertension

    Uploaded by

    Poova Ragavan
    This document discusses portal hypertension, which occurs when there is elevated blood pressure in the portal vein system that transports blood to the liver. It defines portal hypertension and describes its causes such as liver damage blocking blood flow. Signs include ascites, enlarged spleen, and varicose veins. Treatment involves medications, dietary changes, procedures like TIPS and sclerotherapy to reduce pressure and prevent bleeding complications. Nursing care focuses on monitoring for infections and fluid imbalances and assisting with paracentesis to drain fluid buildup.

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    B.

    Sc NURSING
    MEDICAL SURGICAL NURSING – I
    UNIT: IV -NURSING MANAGEMENT OF
    PATIENTS WITH DISORDERS OF
    DIGESTIVE SYSTEM
    PORTAL HYPERTENSION

    MR.V.POOVARAGAVAN.RN
    PROFESSOR
    OBJECTIVES

    At the end of the class the students are able to


    - Define portal hypertension

    - Describe the risk factor, etiology of portal


    hypertension
    - Explain the pathophysiology and clinical
    manifestation of portal hypertension
    OBJECTIVES

    At the end of the class the students are able to


    - Discuss the diagnostic evaluation and
    complication of portal hypertension
    - enumerate medical, surgical and nursing
    management of patient with portal hypertension
    INTRODUCTION

    Portal Veins coming from the stomach,


    intestine, spleen , and  pancreas  merge into the
    portal vein, which then branches into smaller
    vessels and travels through the  liver. If the
    vessels in the  liver are blocked due to liver
    damage, blood cannot flow properly through the
    liver.
    ANATOMY AND PHYSIOLOGY

    Portal veins coming from the stomach,


    intestine, spleen , and  pancreas  merge into the
    portal vein, which then branches into smaller
    vessels and travels through the  liver. If the
    vessels in the  liver are blocked due to liver
    damage, blood cannot flow properly through the
    liver.
    ANATOMY AND PHYSIOLOGY

    As a result, high pressure in the portal


    system develops. This increased pressure in the
    portal vein may lead to the development of large,
    swollen veins (varices) within the esophagus
    stomach, rectum, or umbilical area (belly button).
    Varices can rupture and bleed, resulting in
    potentially life-threatening complications.
    DEFINITION
    Portal hypertension is elevated pressure in the portal
    vein associated with increased resistance to blood
    flow through the portal venous system.

    Portal hypertension is defined as the elevation of the


    hepatic venous pressure gradient to > 5 mmhg.

    Clinically significant portal hypertension is present


    when gradient exceeds 10 mmHg. Risk of variceal
    bleeding increases beyond a gradient of 12 mmHg.
    CLASSIFICATION AND CAUSES

    Prehepatic

    Portal vein thrombosis

    Splenic vein thrombosis

    Massive spleenomegaly
    CLASSIFICATION AND CAUSES

    Hepatic

    1. Presinusoidal: schistosomiasis

    congenital hepatic fibrosis

    2. Sinusoidal: cirrhosis of liver alcoholic

    hepatitis

    3. Postsinusoidal: hepatic sinusoidal

    obstruction (veno-occlusive syndrome)


    CLASSIFICATION AND CAUSES

    Post hepatic

    -Budd-Chiari Syndrome

    -Inferior vena cava obstruction

    -cardiac causes:

    Restrictive cardiomyopathy

    Constrictive pericarditis

    Severe congestive cardiac failure


    PATHOPHYSIOLOGY

    Due to causes

    Obstruction of portal venous flow

    Portal vascular resistance is increased in liver cell injury

    Stellate cell activation into myofibroblast & smooth muscle protein

    alpha-actin Endothelin Contraction of activated cells

    Abnormal blood flow pattern causing increased resistance

    fibrogenesis Increased resistance leads to portal hypertension


    SIGNS AND SYMPTOMS
    • Ascites

    • Shifting dullness or fluid wave on abdominal


    percussion
    • Dilated abdominal vessels radiating from the
    umbilicus (e.g. caput medussae)
    • Enlarged, palpable spleen

    • Bruits detected over the upper abdominal area


    because of esophageal and gastric varicosities.
    DIAGNOSTIC EVALUATION

     HISTORY COLLECTION

     PHYSICAL EXAMINATION

     BLOOD TESTS.

     CHEST X RAY

     ANGIOGRAM

     ULTRASOUND

     ENDOSCOPY
    MEDICAL MANAGEMENT

    • Beta-blockers and nitroglycerin may be
    appropriate to decrease pressure within the
    portal system.
    • Lactulose may be prescribed as a treatment for
    hepatic encephalopathy.
    • propranolol and isosorbide, may help lower the
    pressure in the portal vein
    NON MEDICAL MANAGEMENT

    Dietary restrictions include limiting salt to


    prevent further ascites fluid accumulation.
    Protein may also be restricted, since increased
    protein load can overwhelm the liver's ability to
    synthesize it and may lead to hepatic
    encephalopathy.
    NON MEDICAL MANAGEMENT

    Distal splenorenal shunt (DSRS) was

    designed to reroute blood only from the veins

    coming from the esophagus and stomach while

    preserving the blood flow through the portal vein.

    The splenic vein was joined to the left

    kidney vein thereby selectively decompressing

    the esophageal and gastric varices.


    DISTAL SPLENORENAL SHUNT (DSRS)
    MEDICAL MANAGEMENT

    Sclerotherapy is the techniques of

    injecting sclerosing drugs into the varices,

    causing a narrowing of the swollen veins thus

    preventing bleeding and reducing swelling. This

    procedure is done endoscopically.


    SURGICAL MANAGEMENT
    Transjugular intrahepatic portosystemic shunt
    (TIPS), a catheter is introduced by a radiologist into
    the jugular vein and advanced to the hepatic vein.

    The catheter is threaded into a large branch of the


    portal vein, and a stent is placed connecting the portal
    vein (bringing blood to the liver from the digestive
    tract) with the hepatic vein (returning blood from the
    liver to the heart).
    TRANSJUGULAR INTRAHEPATIC
    PORTOSYSTEMIC SHUNT (TIPS)
    NURSING DIAGNOSIS

    • Risk for infection

    • Activity intolerance

    • Risk for imbalanced fluid volume


    NURSING MANAGEMENT
    • Administer medications, which may include diuretics.

    • Assist the health care provider with paracentesis,


    which removes the fluid (e.g. ascites) from the
    peritoneal cavity; the volume usually is limited to 2 to
    3L of fluid, but it may be more. Observe the client
    closely for signs and symptoms of vascular collapse.

    • Measure and record abdominal girth and body


    weight daily, assess for abdominal fluid wave.
    NURSING MANAGEMENT

    • Promote measures to prevent or reduce edema.

    • Encourage the client to elevate the lower

    extremities and wear support hose to prevent

    lower-extremity edema.
    NURSING MANAGEMENT

    • Administer salt-poor albumin, which temporarily

    elevates the serum albumin level. This increases

    serum osmotic pressure, helping to reduce edema

    by causing ascetic fluid to be drawn back into the

    bloodstream and eliminated by the kidneys.


    BIBLIOGRAPHY

     Brunner and suddarth’s (2004) “Text book of


    medical surgical nursing”, 10th edition, published by
    Lippincott Williams and Wilkins page no. 2079-2087.
     Lewis (2002), “Medical surgical nursing”, 6th edition,
    published by Mosby page no 1635-1651.
     Black .J.M. & Hawks .J.H, (2004), “Medical Surgical
    Nursing” 7th edition, New Delhi: Elsevier publication,

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