Increased Risk of Clots and Bleeding – Complications of Liver Cirrhosis (Nursing)

00:01 Hi! Welcome to our video series on the liver and chronic disease.

00:05 Now this one is a bit of a mind bender because look at the title increased risk of clots and bleeding? Isn't it usually one or the other? Well, you're right in most cases, but the liver is an amazing organ, which also means it has some amazing problems.

00:23 So let's start with just a very simple straightforward question, is the risk greater for bleeding or clotting for a patient that has cirrhosis that seems simple enough right? It's either one or the other but actually it's complicated.

00:39 Patients with cirrhosis or liver disease are at risk for bleeding and clotting.

00:46 Now I've got some fancy terminology for you up there on the screen spontaneous bleeding or thrombotic events, but that just means they're at a risk for both.

00:55 Patients with liver disease can have a higher risk of bleeding and a higher risk for developing clots.

01:03 So patients with cirrhosis can experience changes to both pro- and anti-coagulant factors.

01:09 Just another way of saying that they might be extra good at making clots or extra good at not making clots Pro and anti-coagulant factors.

01:21 Now take a look at the picture I have for you there.

01:23 You should recognize that you've got the liver.

01:25 The stomach, you've got the spleen over there, but look at those vessels.

01:30 That's not good.

01:31 And that's not normal.

01:33 Look how they're kind of squiggly their torturous and their engorged.

01:37 This is where varices become a problem.

01:40 So take a patient who has cirrhosis.

01:42 They've got a liver that the blood supply is coming back up from the gut through that portal vein and it...

01:49 all of a sudden it's just having a really hard time getting that blood from the portal vein through the liver because remember that cirrhotic tissue is all gnarly when it repairs itself.

02:02 So things start backing up.

02:05 Look at that picture, that's why you've got those tortuous of bloated looking veins the ones around the stomach are called gastric varices.

02:15 The ones around the esophagus are called esophageal varices.

02:19 Now these vessels are tortured, twisted and they're pretty fragile.

02:24 So there is an increased risk to burst.

02:28 That's bad news because that's a pretty powerful blood supply.

02:32 When someone with esophageal varices when those bursts they can bleed out or lose tremendously large life-threatening volumes of blood that fast.

02:44 So you take a patient with liver disease if they're at risk for being what? Procoagulant they bleed easily and we put that blood under high pressure and these gastric varices with these esophageal varices you can imagine it's a disaster.

03:02 If one of those fragile friable vessels bursts.

03:07 It's not enough that they're bleeders, they can also develop clots or thrombus.

03:12 Now, the most common place is also in the portal vein.

03:15 So think about that.

03:17 Wait a minute I thought you said it backs up? Exactly.

03:20 Because that pressure is now so intense and it's having a hard time pushing blood through that liver.

03:25 It's going to hang out there for a while.

03:27 It's not going to keep moving as much as it should.

03:30 Blood that hangs out starts to clot and that's why a thrombus could start to develop in that portal vein.

03:37 Now the patient could also develop a DVT like in their calf, or another area of their body, but that portal vein, it's so pivotal that you understand that portal vein is bringing back a huge blood supply from the intestines to the liver.

03:52 When the liver is damaged the pressure inside that portal vein is building building building building building because it's so hard to try and force that I'd through the liver.

04:01 Develop torturous veins you can develop clots and that's why it is so problematic for patients with advanced liver disease.