Portal Hypertension – Signs of Liver Cirrhosis (Nursing)

00:00 Okay now we talked about cirrhosis so we know it's going to look like I want to talk about something even more interesting about portal hypertension.

00:10 So it seems complicated at first but it really isn't we're going to walk you through it.

00:16 So first we're going to drop in the liver the star of the show.

00:20 Got it? All right good! Now we're going to bring in the stomach.

00:26 Okay, see how close they are, now, we're stretching them out a little bit because really inside your abdomen there pretty tight, but we're going to give you a little extra space in between them so you can see easily what these organs are.

00:39 Next to the stomach, or going to drop in the spleen.

00:43 I think it's one of the most underrated organs in our body and remember it's the largest one in the lymphatic system.

00:50 Now, we're going to put in our small intestines.

00:54 Cool! Lastly, I'm going to slide the pancreas right underneath the stomach and you'll see how it connects their to the small intestine and we're going to tuck the gall bladder right underneath the liver.

01:07 Now, here's where it gets really cool.

01:10 So we're going to put the inferior vena cava ehind the liver and show you how it connects to the heart of the liver.

01:19 Now this is a part that's super cool.

01:21 Now we're going to take the vessels from the intestines and join them to the portal vein.

01:27 We're going to take the vessel from the spleen and join it to the portal vein.

01:32 We're going to take the veins from the stomach and the esophagus and join them to the portal vein.

01:38 Now, you see how all these structures are bringing blood back to the liver because remember the liver has to blood supplies, the artery, which we don't have on there for you because we're just focusing on the portal veins, but the artery delivers blood about 25% but that portal vein system develops to 75% of the blood supply that goes up to the liver.

02:04 Now we've talked about cirrhosis.

02:06 We have a really good visual in your mind of what it looks like.

02:09 Remember that tissue is kind of narrowly and it's not easy to blood to flow through it.

02:15 So put your finger, right on the portal vein where it enters the liver, got it? Okay so hold your finger there.

02:23 I want you to trace the blood supplies to the organs, right? You've got to the spleen, to the stomach, to the esophagus, to the intestines.

02:33 There you go.

02:34 So you can see where they all flow.

02:36 Now picture in your mind pinching that vessel down making it really difficult for that blood to flow through there.

02:43 That's what it feels like to your portal vein because when that liver is stiff and fibrotic, it has a very difficult time trying to deliver that much blood into the liver.

02:56 So everything backs up, right? That's why your spleen gets big.

03:01 That's why you're, look around those vessels that the veins that are around your esophagus and your stomach, those become - really engorged and in large and very very fragile.

03:14 Puts our liver patients at extreme risk for bleeding.

03:18 What it's the other reason that puts them at risk for bleeding? Right, like the livers involved in making clotting factors.

03:23 So they don't clot well, and now they've got these vessels that are just overworked to the point that they're extremely fragile.

03:31 So that's the risk of portal hypertension.

03:35 That's how cirrhosis causes portal hypertension and now we're going to break it down a little more but I wanted you to have that framework before we walk through the rest of it.

03:45 So when we think about the effects of portal hypertension? Can you see why the patient develops esophageal varices? Right! You see without portal vein is if it's having a hard time getting lift delivering blood to the liver, you're going to end up with blood backing up and why you end up with those very fragile vessels around your esophagus.

04:07 I remember at the very beginning of my career when I had a patient whose esophageal varices burst, and it was nothing we could do to save them.

04:16 It is graphic and burnt my memory.

04:20 Now we've got some other symptoms are like hematemesis, that means when those varices start to leak into bleed they're going to drain on through the GI tract so they may throw up blood, they may notice you have tarry stools, they're pooping blood, they're not going to feel like eating they're just going to feel really really bad.

04:37 Now there's a term called Melena, and I want you to be familiar with that because that's a medical term.

04:42 But that means a really black tarry stool and it has a horrific odor.

04:50 This is what you see in patients who have a GI gastrointestinal bleed this what we're talking about.

04:56 If those vessels are bleeding and draining into that GI system, It's going to end up exiting the body as stool and when it's black and tarry and unbelievably stinky.

05:09 I know and we had a GI bleed on the unit, I would step off the elevator and say, well I know what diagnosis we have on the unit tonight, and it's so embarrassing for your they're awake and alert because it's really hard to get rid of that smell.

05:23 So work on having your professional face when you're working with your patients because it is embarrassing to those who are awake and alert.

05:31 So when we say Melena, that's a black tarry stool that's got old blood in it, it's got a really strong odor, and it is hard to flush when you dump that in the toilet because it's just really really sticky.

05:45 Now we've talked about what happens with esophageal varices and how blood ends up in the GI tract, now let's talk about splenomegaly.

05:53 Right, that's when that spleen gets really big.

05:56 Now why would the spleen get big? You are getting so good, because the liver is cirrhotic and we know that's back and blood up all the way through and it's definitely connected to the spleen.

06:07 And so that's why you end up with splenomegaly.

06:10 Now, why do we have ascites? We'll talk about that more in detail, but that's fluid volume shifting in the abdominal cavity.

06:18 Now, there's a personal one, rectal varices, right? Those are like hemorrhoids.

06:25 Same concept, it's all because of of portal hypertension, so see how understanding normal and how it all fits together, understanding how a healthy liver works, understanding the damage from a cirrhotic liver, all the blood supply, then it makes perfect sense why you're going to see these things in your patients.

06:44 So stop memorizing lists, understand why your patient knows he symptoms.

06:49 Stick with us! We'll help you learn it all we promise.