Definition
- Portal hypertension is elevated pressure in the portal vein associated with increased resistance to blood flow through the portal venous system.
Risk Factors
- Cirrhosis
- Mechanical obstruction (e.g. thrombosis, tumor)
Pathophysiology
Obstruction of portal venous flow through the liver leads to:
- Formation of esophageal, gastric, and hemorrhoidal varicosities due to increased venous pressure
- Accumulation of fluid in the abdominal cavity (i.e. ascites)
The spleen and other organs that empty into the portal system also undergo the effects of congestion.
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Assessment/Clinical Manifestations/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.
Medical Management
Shunts to relieve pressure in the portal vein created by cirrhosis.
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.
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.
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).
Nursing Diagnosis
- Risk for infection
- Activity
- 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.
Promote measures to prevent or reduce edema.
- Encourage the client to elevate the lower extremities and wear support hose to prevent lower-extremity edema.
- 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.
