Damage to Hepatocytes – Causes of Ascites (Nursing)

00:01 Let's look at the third cause of ascites.

00:03 We're talking about damage to the liver itself damage to hepatocytes.

00:09 We're going to dig into the damage to the hepatocyte but before we do, I just want to remind you do a quick review of what hepatocyte is.

00:17 I know it's nerdy but I think this stuff is so cool.

00:21 So let's start with a graphic of the whole liver.

00:24 Got it.

00:25 All right. Now I'm going to focus on the liver lobule, see it there.

00:29 Okay, so look at the difference.

00:31 We're blowing up making it bigger so it's easier for you to see, got the liver, the liver lobules, now a single lobule that's the hepatocyte.

00:42 So you see we've got the venous supply, that's blue.

00:45 You've got the arterial supply, that's red.

00:48 But what is that green? We've got these Triads that go all the way around the hepatocyte.

00:53 Well that's involved in bile.

00:56 But in cirrhosis, these hepatocyte see these amazing cells these worker bees are damaged.

01:04 Now when they're damaged, they can't synthesize proteins.

01:08 Okay we already know that's a problem, right? If I have less protein, I have less oncotic pressure, and that is why you have the plasma leaking out of the vascular spaces because you have less oncotic pressure.

01:23 Why do I have less oncotic pressure? Because in cirrhosis I have damage to the hepatocytes.

01:30 Liver, lobules, single lobules, hepatocyte.

01:33 There you go.

01:35 If I have cirrhosis, I have damage to these very special cells.

01:40 Now that's part of it.

01:42 Let me go into some other challenges.

01:44 We know that because they can't make protein that's part of the reason why we have ascites.

01:49 But also damage to hepatocytes have this altered metabolism.

01:54 So they cause an increase in some substances.

01:58 Now I'd like you to write these down the first one is, Renin.

02:02 The second one is aldosterone.

02:05 And the third one is ADH.

02:09 So you've written those three down, renin, aldosterone and ADH.

02:17 Don't say aldosterone like that in public.

02:19 I just do it because it makes me laugh and it helps you remember but don't call a doctor about the aldosterone or they're really going to question your practice, okay.

02:29 So we're talking about the third cause of ascites, and these are three substances that are increased when the hepatocyte so are damaged and has to do with altered metabolism.

02:43 So what happens when the body has extra renin? Hey, we're at risk for elevated blood pressure.

02:50 Remember renin is the first substance in the RAAS.

02:56 Now what happens at the end of the RAAS? You end up with Angiotensin II.

03:04 That is a bad mama jama.

03:06 Okay Angiotensin II causes potent constriction.

03:11 Everything clamps down because renin is required when the body senses.

03:18 My blood pressure is too low.

03:19 One of the ways the body tries to compensate is to increase the amount of renin.

03:24 So renin kicks off the RAAS, you end up with Angiotensin II, and...

03:32 potent vasoconstriction.

03:35 It also stimulates the excretion of what? Right, aldosterone.

03:42 Well, what does aldosterone tell my body to do? Tells my kidneys, Hey guys, hang on to sodium because it wants to increase the volume.

03:51 Remember when the kidneys reabsorb or hang onto sodium what follows? Right, water.

03:59 Okay so I have extra renin an extra aldosterone, my blood pressure is going to go up.

04:06 I'm going to have increased volume. Why? Because I have that potent vasoconstriction and I also have that volume retention.

04:17 Okay, so I've got those two things I'm battling with.

04:21 Damaged hepatocytes cause an increase in renin and aldosterone and what was the third one? Right.

04:29 Anti-diuretic hormone.

04:33 So if I have extra ADH, that's a hormone that is against diuresing.

04:39 What is that going to do to my fluid volume balance? Well, if I'm getting the message, I've got extra chemical messengers, these hormones that are telling me, hey, hey, hang on to fluid.

04:51 We're against to decreasing or peeing it out.

04:54 Look at all the ways this can wreak havoc.