Portal Hypertension – Causes of Ascites (Nursing)

00:01 Now the second cause of ascites is portal hypertension.

00:05 We touched on this a little bit earlier, but let's take a look at it again.

00:09 There's a liver for you.

00:11 So take a look at that liver.

00:13 We know we have the arterial blood supply that's red.

00:16 Put your finger on that portal vein.

00:18 Remember that portal vein is connected to...

00:21 your gut, right.

00:23 So when I eat food, it goes in my mouth down into my stomach into the duodenum, hooks up with bile, moves through my intestines and then my intestines send that blood back up to the liver to be processed in the liver.

00:38 How do they do it? Through that system that leads to the portal vein.

00:42 Okay.

00:43 Now I need a liver that flows well, if a liver has been damaged, there's extra hypertension in that system because it's..

00:53 Having a ramp up to move the blood through.

00:57 With portal hypertension fluids and proteins end up shifting from the blood vessels into the lymph space.

01:05 Okay.

01:06 Now we've got issues.

01:07 We need those to be separate they work together and dumped in at particular points, but because of portal hypertension, fluids and proteins will shift from the blood vessels into that lymphatic space.

01:21 Now, the lymph space is overloaded and it can't carry off the extra protein and fluid and it leaks into the peritoneum.

01:30 Okay remember we talked about the balance in a lymph system if it's overloaded or if it's not functioning we end up with fluid accumulating, or like edema.

01:41 Portal hypertension is one of the things that happens in cirrhosis because that liver is all gnarly and so that blood trying to push through that liver.

01:52 The pressure has to really be ramped up.

01:55 So because of that portal hypertension because the liver is damaged I end up portal hypertension then fluids and protein end up shifting from the blood vessels into the lymph space, the lymph space becomes overloaded, it can't remove that extra fluid because of the extra protein and fluid that's there it's going to leak into the peritoneum.

02:17 Okay, the protein in the peritoneum will draw even more fluid into the cavity.

02:23 Okay so this might be a good time for you to grab a pencil and let's walk through this want you to write some of these things out with me.

02:30 Okay, so we know we have portal hypertension because the liver has become cirrhotic, so the pressure in the portal vein has to become higher in order to keep moving fluid through the liver, good.

02:45 So portal hypertension leads to fluids and protein shifting from the blood vessels into the lymph’s space.

02:54 Now because of this shift, the lymph space is overloaded.

02:59 When it becomes overloaded, it can't carry off that extra protein in fluid.

03:04 And so it's just try and shove it wherever it can into the peritoneum.

03:09 Now protein that's now there because portal hypertension, fluids and protein shifted into the lymph space lymph space couldn't get rid of it.

03:19 So now we've got extra protein sliding all over the place and the protein in the peritoneum will draw even more fluid into the cavity.

03:29 Help me understand why protein in the peritoneum is going to draw more fluid into the cavity.

03:37 Good deal.

03:39 Protein attracts sodium and wherever sodium goes, water follows.

03:45 You got it.

03:46 Okay now here's a fairly complete list of the causes of portal hypertension.

03:52 I'm not asking you to memorize this.

03:55 I just want you to be aware that, look at the three categories.

03:58 It can be within the liver.

04:01 It can be after the liver or it can be before the liver.

04:05 So intrahepatic means I have got a problem right inside the liver tissue, just like when we talk about pre renal, intra renal and post renal.

04:13 It's the same thing.

04:14 It's just a system to organize the types of causes.

04:18 So it can be intrahepatic within the liver, after the liver post hepatic and pre hepatic.

04:25 Now, we're not going to spend a lot of time breaking these down here.

04:28 I just wanted you to be aware that there are multiple causes of portal hypertension.