Portal Hypertension

COMPILED BY: MR. ASHISH ROY

1. PORTAL HYPERTENSION COMPILED BY : MR. ASHISH H. ROY (Nursing Tutor)

2. INTRODUCTION THE HEPATIC PORTAL CIRCULATION CARRIES BLOOD FROM GI TRACT ( FROM THE DISTAL OESOPHAGUS TO ANORECTAL JUNCTION )TO THE LIVER. PORTAL VENOUS BLOOD DRAIN INTO LIVER VENOUS SINUSOIDS AND HENCE INTO THE HEPATIC VEINS. Portal hypertension is an increase in the blood pressure within a system of veins called the portal venous system. 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.

3. ANATOMY PORTAL VEIN

4. DEFINITION OF PORTAL HYPERTENSION PORTAL HYPERTENSION IS THE HIGH BLOOD PRESSURE IN HEPATIC PORTAL SYSTEMS WHICH ARE PORTAL VEIN AND ITS BRANCHES, WHICH DRAIN FROM MOST OF THE INTESTINES TO THE LIVER . IT IS DEFINED AS HEPATIC VENOUS PRESSURE EQUAL TO OR GREATER THAN 6mmhg. cirrhosis is the most common cause of portal Hypertension.

5. ETIOLOGICAL FACTORS / CAUSES PRE- HEPATIC PHASE : congential portal artesia portal vein thrombosis (neonatal spesis ) phlebitis of portal vein (abdominal infection) HEPATIC PHASE Cirrhosis (alcoholic most frequently) Chronic hepatitis, Biliary cirrhosis POST HEPATIC Budd- chiari syndrome ( hepatic venous thrombosis ) triscuspid valve incompetence Right H.F From Constrictive pericarditis.

6. CLINICAL FEATURES/ SIGNS AND SYMPTOMS ASCITES ADBOMINAL PAIN OR TENDERNESS SPLEENOMEGALY WITH LEAD TO THROMBOCYTOPENIA HEMATEMESIS DUE TO SWOLLEN VEINS OF OESPHAGUS (ESOPHAGEAL VARIES) SWOLLEN VEINS ON ANTERIOR ABDOMINAL WALL GASTROINTESTINAL BLEEDING

7. DIAGNOSTIC EVALUATIONS ENDOSCOPY X –RAY CT SCAN MRI LIVER BIOPSY HVPG (HEPATIC VENOUS GRADIENT) : IT IS A CLINICAL MEASUREMENT OF PRESSURE GRADIENT BETWEEN PORTAL VEIN AND INFERIOR VENA CAVA. AN hvpg of greater than 5mmHg define portal vein hypertension.

8. MEDICAL MANAGEMENT Beta blockers eg ., Propranolol Vasodialators e.g , nitroglycerin Diuretics Lactulose for hepatic encephalopathy

9. SURGICAL MANAGEMENT PARACENTESIS IF ASCITES OCCURS SCLEROTHERAPY : it is a technique of injecting sclerosing drugs into the vertices causing narrowing of swollen veins thus preventing blooding and reducing swelling. This procedure is done by endoscopy. TIPS ( Transjuglar Intrahepatic portosytemic shunt) it is done to decrease pressure within portal system. It is shunt (tube) which carries blood from the intestine and intra abdominal organs to the liver and hepatic vein which carries blood from liver back to the vena cava of the heart.

10. TIPS

11. NURSING DIAGNOSIS RISK FOR INFECTION RELATED TO SHUNTING PROCEDURE Assess the symptomns of infections. Administer Antibiotics as Precribed . Administer Corticosteroids as prescribed. Encourage patient and provide perineal care. Monitor signs like fever and Note skin color temperature dry skin flushed and early signs of septicaemia Inspect incision and dressing for dressing and erythema. Instruct the patient the good handwashing and aseptic wound care to reduce risk of spread of infection. FLUID VOLUME EXCESS RELATED TO PRE- HEPATIC CAUSE Monitor vital signs of the paient to detect Hypertension, tachycardia. A dminister blood components and IV fluids as prescribed. monitor Intake / output continuously to check fluid volume status. Insert nasogastric tube if needed and assess the tube drainage for sings visible and occult blood. Monitor laboratories values, i.e , Hb , Hcl , Electrolytes , Prothrombin levels etc. Assess skin and mucous membrane, e.g , decrease skin turgor and capillary refill.

12. Nursing Management RISK FOR HEMORRHAGE RELATED TO SWOLLEN VEINS OF PORTAL SYSTEM. instruct the patient to avoid or limit activities if signs of bleeding show,. enourage patient to intake foods with high vitamin c contents. nurses should encourage patient to take proper rest and need to ambulation instruct the patient to elevate legs to mobilize edema and ascites. INEFFECTIVE BREATHING PATTERN RELATED TO INCREASE ABDOMINAL GIRTH. Asses respiratory rate and depth ascultate breaking sounds frequently provide fowler position or low fowler’s position to fscilitates lung expansion instruct patient in coughing and deep breathing to improve respiratory function.

13. FAQ Diuretics for Hypertension Diuretics, also known as water pills, belong to a class of medications that remove excess salt and water from the body. They are often used to treat hypertension, or high blood pressure. High blood pressure can be a contributing factor in the development of various forms of heart disease. When chosen as a treatment for hypertension, diuretics have proven to be effective in preventing heart attack and stroke in many individuals. Certain foods and herbs also possess diuretic effects, helping you to urinate more often to excrete excess fluids and sodium. Pharmaceutical Diuretics Prescription diuretic medications are grouped into three main types. Thiazide Thiazide diuretics help treat hypertension by causing the blood vessels to widen and the body to remove any extra fluid. Examples of thiazides include metolazone ( Zaroxolyn ), indapamide ( Lozol ), and hydrochlorothiazide ( Microzide ). Loop Diuretics Loop diuretics remove excess fluid by causing the kidneys to produce more urine. These include furosemide (Lasix), ethacrynic acid ( Edecrin ), and torsemide ( Demadex ). Potassium-Sparing Potassium-sparing diuretics encourage the body to get rid of fluids and sodium. However, they do this without causing a loss of potassium, which is a vital nutrient. Examples of potassium-sparing diuretics include triamterene ( Dyrenium ), eplerenone ( Inspra ), and spironolactone ( Aldactone ). Each of the three types of diuretic medication increases the amount of sodium you excrete through urination, but they affect different areas of your kidneys. Your kidneys are the filters through which toxins and excess fluids are flushed from your body. When you take a diuretic medication, the drug signals to your kidneys that you need to get rid of more sodium. Water binds to the sodium and is then removed during urination, leaving you with a lower blood volume. The reduction in blood volume slows the rate at which blood flows through your blood vessels, helping to decrease your blood pressure.

14. FOR PORTAL HYPERTENSION Thiazide and loop diuretics may also cause you to lose potassium in addition to water and sodium. Potassium is an important mineral that maintains healthy fluid levels and regulates heart and muscle function. Your doctor may advise you to take a potassium supplement or to eat foods rich in the nutrient to combat low potassium levels. Potassium-rich foods include : bananas avocados raisins beans dark leafy greens, such as kale and spinach squash mushrooms potatoes yogurt fish Potassium-sparing diuretics don’t pose as much as a threat to your potassium levels. However, they aren’t as effective in treating hypertension as the other types of diuretic medications, so they are often prescribed along with other drugs. Thiazide diuretics are the primary treatment method for people who have hypertension-related heart disease. However, your doctor will tailor your drug regimen to your specific health concerns. Your specific medication may contain more than one type of diuretic agent in a single pill or dose.

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