Portal HTN W/ Upper GI Bleed Case Study Flashcards
List the etiologies associated with upper GI bleeding
PUD
Gastritis
Esophageal varices
Mallory-Weiss tear
Stress ulcers
NSAIDS
ETOH
Steroids
Describe the patho involved in development of portal HTN and esophageal varices in alcoholic liver disease
As hepatocytes are damaged with liver disease, fibrosis occurs that results in stiff tissue and increased pressure against the flow of blood
The GI blood returning to the liver creates alternate routes of circulation, diverting around the roadblock
Common areas of diverted circulation are the esophageal, gastric, and rectal areas.
As these are venous vessels, they are less able to withstand high pressures and develop varicosities
Over time, these vessels may rupture and bleed as a result of wretching
What is the purpose of sclerotherapy?
To scar/harden the varices by injecting a solution directly into the varices that will cause necrosis and scarring to halt/prevent bleeding
What nursing interventions are important in caring for a pt undergoing sclerotherapy?
Provide info about the procedure
Positioning the pt
Administering sedation
Monitoring VS for significant change and reporting
Watching for post procedure complications
What post procedure complications should a nurse be watching for in a pt who had sclerotherapy?
Dysphagia
Aspiration
Esophageal perforation
Sub sternal pain
Mucosal ulcerations
Strictures
What is a Minnesota tube used for?
It is an internal pressure dressing to stop bleeding
Complications of a Minnesota tube?
Aspiration
Airway obstruction
Esophageal rupture
Why is chest pain a common complication of vasopressin
Vasopressin causes vasoconstriction of the blood vessels, shunting blood away from the varicies
It also causes vasoconstriction of coronary arteries, which can cause ischemic chest pain
What other complications are associated with vasopressin infusion?
MI
HTN
Poor peripheral circulation
Dysrhythmias
Abdominal cramping
Describe the mechanisms currently thought to cause the development of ascites
Inadequate albumin levels to hold the fluid in the vascular space as a result of the liver’s inability to synthesize protein
This allows fluid to leak into the peritoneal cavity, creating ascites
This problem is complicated by increasing levels of aldosterone and ADH as the liver can no longer detoxify these hormones, resulting in excessive retention of Na and water
What are the complications associated with ascites?
Increased portal pressure
Decreased circulating blood volume as a result of 3rd spacing
Pleural effusion
Ineffective breathing patterns as the ascetic fluid pushes upward on the diaphragm
Venous return is impeded as a result of pressure on the IVC from the ascetic fluid
What interventions are used to control or resolve ascitic fluid accumulation?
Na restriction
Potassium sparing diuretics
LeVeen or Denver shunt
Paracentesis
What is the action of neomycin?
It kills intestinal flora that would normally break down protein, which decreases the amount of ammonia produced
What is the action of lactulose?
Creates an acidic environment in the intestine that attracts ammonia from the blood into the large intestine
It also contains a laxative that then rids the body of the ammonia
What is the benefit of a total portal systemic shunt procedure?
It diverts blood away from varices
It bypasses the liver circulation and decreases portal pressures
