CH 31, Liver Disorders

Where is the liver located?

RUQ

Portal Vein

blood vessel that carries blood from the GI tract to the liver

what happens to the blood from the portal vein during liver damage?

It can cause pressure in the portal circulation, resulting in portal hypertension, which will lead to pooling and ascites

Responsibilities of the liver

• bile salt secretion (for fat digestion)

• detoxes waste

• converts excess glucose to glucogen for storage,

• converts heme to hemoglobin

• converts ammonia to urea

• regulates poisonous substances 

• converts bilirubin to bile 

• Major producer of cholesterol

• Synthesizes and breakdowns protein 

• Produces most of body’s albumin

First pass effect

metabolic process where the liver alters/inactivates substances that are absorbed from the GI tract before they enter systemic circulation

where should the nurse look for jaundice in a black person?

the eyes and the mouth

Cirrhosis

bleeding/scarring of tissue caused by chronic liver damage; the liver stops filtering correctly, so all chemicals and enzymes start to build up

Complications of cirrhosis

• med toxicity due to inability to filter

• Anemia can occur because liver is supposed to make heme

• ascites and lower extremity edema from portal vein HTN

what causes cirrhosis?

alcohol and hepatitis

Manifestations of alcoholic liver disease

• RUQ pain and tenderness

• Nausea

• Malaise

• Low grade fever

• Darkened urine 

• Hepatomegaly

Hepatitis

a systemic infection affecting the liver that’s preventable by vaccine; it spreads through water or contact with someone infected

cause of toxic hepatitis

acetaminophen

General manifestations of hepatitis

• Fever

• abdominal pain

• fatigue

• nausea & vomiting

• malaise

• myalgia

• anorexia

• smokers lose taste for tobacco

• dark urine

• pruritus

• hepatomegaly

• jaundice

• itchy skin

• arthralgias

How is Hep A transmitted?

fecal-oral route from contaminated food/water or person to person; it’s able to live on surfaces at room temp

How is Hep A killed?

by thoroughly cooking food

Manifestations of Hep A

usually mild with no complications

• flu like symptoms

  • body aches

  • fever

  • chills

  • n&v

  • diarrhea

How is Hep B spread

by blood, body fluids, & sex

How is Hep B diagnosed?

by looking for HBsAG antibody in blood; this is only in the blood if the person has had the virus, not the vaccine

How is Hep B treated?

no cure, so prevention is the key (safe sex and vaccination), but can be treated with interferon alfa and drugs that inhibit viral polymerase will knock it out

Risk Factors for Hep B

• Non hispanic black ethnicity

• Cocaine use

• Many sex partners

• Unprotected sex

• Wear gloves and gown

How is Hep C transmitted?

via blood

What is Hep C?

a chronic virus that’s becoming curable, and targets hepatocytes and B lymphocytes; it can live dormant in ppl for years with no symptoms

incubation period for Hep C

2 weeks- 8 months; person can be asymptomatic and spread it without knowing

How is Hep C diagnosed?

HCV RNA can be detected weeks to months before antibody formation

what kinds of precautions should be used with Hep patients?

standard

• gloves

• gown

• mask

• goggle

what kind of diet should a hep patient be on?

High carb because liver can’t process carbs properly but they’re necessary (healthy carbs are easier to digest)