← Chapter 12
Medical-Surgical Nursing · Chapter 12

Portal Pressure: Mechanism to Manifestation

Every complication of cirrhosis traces back to one of two failures — the liver cannot synthesise, or blood cannot get through it. Switch each step of the mechanism on and off and watch exactly which signs appear and disappear, so you reason the findings out instead of memorising a list. Then take the priority boards, where a bleeding varix and a confused patient both come down to what you do in the first sixty seconds.
Portal circulation diagram Blood flows from the gut and spleen into the portal vein and through the liver to the systemic circulation. When the liver is fibrotic, pressure backs up into the spleen, into collateral veins that become varices, into the peritoneum as ascites, and past the liver to the brain carrying ammonia. GUT AND SPLEEN protein, ammonia, platelets PORTAL VEIN LIVER SYSTEMIC CIRCULATION SPLEEN CONGESTS platelets sequestered COLLATERAL VEINS varices, caput, haemorrhoids PERITONEUM ascites BRAIN shunted ammonia
Switch each step of the mechanism