Ch. 31 - Liver Disorders

Pathophysiology Exam 3

What are the major functions of the liver?

Metabolism of carbohydrates, proteins, and fats

Bile production

Detoxification

Storage of vitamins and glycogen

Synthesis of albumin and clotting factors

What is bile?

A digestive fluid produced by the liver that helps digest and absorb fats

What is bilirubin?

A yellow pigment produced from the breakdown of red blood cells that is processed and excreted by the liver

Why is albumin important?

It maintains plasma oncotic pressure and helps keep fluid inside blood vessels

Why are clotting factors produced by the liver important?

They are necessary for normal blood coagulation

What causes jaundice?

Elevated bilirubin levels due to impaired liver function or bile flow

What is jaundice?

Yellow discoloration of the skin, sclera, and mucous membranes

Why does liver disease cause dark urine?

Excess bilirubin is excreted in the urine

Why do patients with liver disease develop clay-colored stools?

Lack of bilirubin reaching the intestines prevents normal brown stool color

Why does liver disease cause pruritus (itching)?

Bile salts accumulate in the skin

What causes ascites?

Portal hypertension and decreased albumin production lead to fluid accumulation in the abdomen

Why does liver dysfunction cause edema?

Low albumin decreases oncotic pressure, allowing fluid to leak into tissues

Why do patients with liver disease bruise easily?

The liver cannot produce enough clotting factors

What is hepatomegaly?

Enlargement of the liver

What are spider angiomas?

Small, sider-like dilated blood vessels seen on the skin due to liver disease

What is hepatic encephalopathy?

Brain dysfunction caused by the buildup of ammonia and other toxins that the damaged liver cannot remove

What are common signs of hepatic encephalopathy?

Confusion

Altered mental status

personality changes

Asterixis (flapping tremor)

Eventually coma

What is asterixis?

A flapping tremor of the hands caused by hepatic encephalopathy

What causes hepatitis A?

Infection with the hepatitis A virus (HAV)

How is hepatitis A transmitted?

Fecal-oral transmission through contaminated food, water, or close personal contact

Is hepatitis A acute or chronic?

Acute only; it does not cause chronic liver disease

What are common risk factors for hepatitis A?

Poor sanitation

Contaminated food or water

Travel to endemic areas

Close contact with an infected person

What is the pathophysiology of hepatitis A?

The virus infects liver cells, causing inflammation and temporary liver dysfunction

What are the early symptoms of hepatitis A?

Fatigue

Fever

Malaise

Nausea

Vomiting

Loss of appetite

What are the later symptoms of hepatitis A?

Jaundice

Dark urine

Pale stools

Right upper quadrant pain

Pruritus

How is hepatitis A diagnosed?

Positive IgM anti-HAV antibodies in the blood

What is the treatment for hepatitis A?

Supportive care, including rest, hydration, and good nutrition

How can hepatitis A be prevented?

Vaccination

Proper hand hygiene

Safe food and water practices

What is cirrhosis?

Progressive replacement of normal liver tissue with fibrous scar tissue

What are common causes of cirrhosis?

Chronic alcohol use

Chronic hepatitis B or C

Nonalcoholic fatty liver disease (NAFLD)
Autoimmune liver disease

What is the pathophysiology of cirrhosis?

Chronic liver injury causes inflammation, fibrosis, and regeneration of abnormal liver nodules, leading to impaired liver function

What happens to blood flow through the liver in cirrhosis?

Scar tissue obstructs blood flow, increasing portal vein pressure

What is portal hypertension?

Increased pressure in the portal venous system due to resistance to blood flow through the liver

What complications result from portal hypertension?

Ascites

Esophageal varices

Splenomegaly

Hemorrhoids

What are esophageal varicose?

Dilated veins in the esophagus caused by portal hypertension

Why are esophageal varices dangerous?

They can rupture and cause massive, life-threatening bleeding

What causes ascites in cirrhosis?

Portal hypertension combined with decreased albumin production

Why does cirrhosis cause hypoalbuminemia?

The damaged liver cannot synthesize enough albumin

Why does cirrhosis increase bleeding risk?

Reduced production of clotting factors impairs coagulation

Why does ammonia increase in cirrhosis?

The damaged liver cannot effectively convert ammonia into urea

What complication results from elevated ammonia levels?

Hepatic encephalopathy

What is liver failure?

Severe loss of liver function resulting in the inability to perform essential metabolic, synthetic, and detoxification functions

What are major manifestations of liver failure?

Jaundice

Ascites

Edema

Coagulopathy

Hepatic encephalopathy

Hypoglycemia

Portal hypertension

Why can hypoglycemia occur in liver failure?

The liver cannot store or release glycogen effectively

What laboratory findings are common in liver failure?

Elevated AST, ALT, bilirubin, PT/INR, and ammonia; decreased albumin

Which liver enzymes indicate hepatocyte injury?

AST (aspartate aminotransferase) and ALT (alanine aminotransferase)

Which laboratory value is elevated when bile cannot be properly excreted?

Bilirubin

Which laboratory value reflects impaired clotting factor production?

Prolonged PT/INR

Which laboratory value decreases because the liver cannot synthesize proteins?

Albumin

What is the definitive treatment for end-stage liver failure?

Liver transplant

A patient has jaundice, dark urine, pale stools, and itching. What body substance is accumulating?

Bilirubin and bile salts

A patient with cirrhosis develops confusion and a flapping tremor. What complication has occurred?

Hepatic encephalopathy

Which toxin is primarily responsible for hepatic encephalopathy?

Ammonia

A patient with cirrhosis suddenly vomits large amounts of blood. What is the most likely cause?

Ruptured esophageal varices

Why does portal hypertension develop in cirrhosis?

Scar tissue increases resistance to blood flow through the liver

Why does liver disease cause edema and ascites?

Decreased albumin production and portal hypertension

Which hepatitis virus is transmitted by the fecal-oral route?

Hepatitis A

Does hepatitis A cause chronic liver disease?

No, it only causes acute infection

Which laboratory values are most elevated with hepatocyte injury?

AST and ALT

What is the definitive treatment for end-stage cirrhosis and liver failure?

Liver transplant