portal HTN + ACS

Question 1

What is portal hypertension?

Answer 1

Increased blood pressure in the portal venous system, which carries blood from the GI organs to the liver.

Question 2

What is the main cause of portal hypertension?

Answer 2

Liver cirrhosis.

Question 3

Explain the pathophysiology of portal hypertension.

Answer 3

Liver damage → ↑ resistance to portal blood flow → blood backs up into surrounding veins → causes varices, ascites, splenomegaly, and other complications.

Question 4

What are the clinical manifestations of portal hypertension?

Answer 4

Hematemesis, melena, abdominal distention (ascites), encephalopathy, enlarged spleen (low platelets/WBCs), and visible abdominal veins (“roadmap” appearance).

Question 5

Why does encephalopathy occur in portal hypertension?

Answer 5

The liver isn’t filtering out ammonia, leading to buildup and brain dysfunction.

Question 6

What causes splenomegaly in portal hypertension?

Answer 6

Backed-up blood flow leads to spleen enlargement, causing low platelets and WBCs.

Question 7

What visible sign can appear on the abdomen with portal hypertension?

Answer 7

Visible abdominal veins (like a roadmap).

Question 8

What are signs of advanced liver failure in portal hypertension?

Answer 8

Jaundice, confusion, ascites, coagulopathy, and weakness.

Question 9

What is the treatment for portal hypertension?

Answer 9

Same as for esophageal varices — control bleeding, reduce portal pressure (Octreotide, beta-blockers), endoscopic therapy, or TIPS procedure.

Question 10

What is abdominal compartment syndrome (ACS)?

Answer 10

A life-threatening condition where pressure inside the abdomen becomes dangerously high, leading to organ dysfunction.

Question 11

What causes abdominal compartment syndrome?

Answer 11

Bleeding or trauma in abdomen, abdominal surgery, severe ascites, pancreatitis, burn injuries, or tight abdominal closure post-surgery.

Question 12

How does ACS differ from pregnancy-related abdominal pressure?

Answer 12

In pregnancy, the body adapts with hormones to allow organ shifting; in ACS, the body is not prepared, causing organ compression and failure.

Question 13

What are the physiological effects of increased abdominal pressure?

Answer 13

↓ lung expansion → respiratory failure; ↓ venous return → ↓ cardiac output; ↑ ICP → confusion; ↓ renal perfusion → oliguria/anuria; GI ischemia → bowel necrosis.

Question 14

What are the key clinical manifestations of ACS?

Answer 14

Tense, distended abdomen; ↓ urine output; hypotension; tachycardia; restlessness/confusion; pain out of proportion to findings.

Question 15

How is ACS diagnosed?

Answer 15

Bladder pressure monitoring — intra-abdominal pressure (IAP) > 20 mmHg plus organ dysfunction (e.g., decreased urine output).

Question 16

What are early interventions for ACS?

Answer 16

Elevate HOB, manage fluids carefully, and gastric decompression.

Question 17

What is the definitive treatment for severe ACS?

Answer 17

Emergency decompressive laparotomy.

Question 18

What supportive treatments may be needed for ACS?

Answer 18

Ventilation, IV fluids, vasopressors, dialysis (if needed).

Question 19

What are key nursing implications in ACS?

Answer 19

Monitor urine output, watch for sudden abdominal distention or tightness, assess ventilator resistance, prepare for bladder pressure monitoring, and notify provider immediately.

Question 20

What is important to avoid during fluid resuscitation in ACS?

Answer 20

Avoid excessive fluids, as they can worsen abdominal pressure.

Question 21

What is bladder pressure monitoring used for?

Answer 21

To indirectly measure intra-abdominal pressure and diagnose abdominal compartment syndrome.

Question 22

Why is bladder pressure used to estimate abdominal pressure?

Answer 22

The bladder acts as a passive balloon, so increases in abdominal pressure are transmitted to the bladder.

Question 23

How often is bladder pressure measured?

Answer 23

Every 4–6 hours.

Question 24

What equipment is needed for bladder pressure monitoring?

Answer 24

Foley catheter, sterile saline (25 mL), pressure transducer, and drainage clamp.

Question 25

How is bladder pressure monitoring performed?

Answer 25

Insert Foley → clamp drainage → instill 25 mL saline → attach transducer → zero at heart level → read pressure at end of expiration.

Question 26

What is the gold standard for diagnosing ACS?

Answer 26

Bladder pressure monitoring.