Nurs 3366 - Disorders of the Liver

What is Hepatitis?

inflammation of the liver

• viral hepatitis: 3 most common strains: A(HAV) , B (HBV), C (HCV)

What is HAV?

S&S have fairly acute onset (fever, malaise, jaundice); course usually mild with full recovery

• often transmitted enterally; ex-- tainted food such as oysters

vaccine and immunoglobulin shot available for Hep A

What is HBV & HCV?

transmitted parenterally (from “outside” the gut) via IV drug abuse, receiving blood, needlestick of infected patient & sexually

• insidious onset with devastating destruction of liver cells; can exist without S&S for many years while being passed on to others unknowingly

vaccine & immunoglobulin available for HBV, but NOT for HCV

What is Cirrhosis?

end-stage, IRREVERSIBLE disease of liver

• begins with some inflammatory initiation, which eventually leads to most of normal architecture of entire liver being destroyed

• most common cause is excessive ETOH (alcohol) intake; alcohol’s toxic metabolites gradually destroy hepatocytes & they are replaced by fibrotic tissue & fat cells

What are the nutritional problems due to Cirrhosis?

• impaired production of bile salts→unable to absorb fat & fat- soluble vitamins—will have many vitamin deficiencies, weight loss

• impaired fat & cholesterol metabolism, will have impaired synthesis of lipoproteins & altered cholesterol levels

• impaired glycogenesis (create stored glucose) or gluconeogenesis, may easily become hypoglycemic

What are the protein depletion problems due to Cirrhosis?

• decreased levels of plasma proteins - ascites - movement of water from blood to abdominal tissue space

• decreased levels of clotting factors - leads to easy bleeding

What are the problems with metabolism caused by Cirrhosis?

decreased ability to break down ammonia into urea, resulting in increased blood ammonia levels

• leads to hepatic encephalopathy

• flapping tremor of hands called asterixis (AKA “liver flap”)

sex hormones can’t be broken down, so men get gynecomastia (breast growth in men), & women get hirsutism (abnormal hair growth)

glucocorticoids can’t be broken down→ hypercortisolism→ Cushing’s syndrome

aldosterone can’t be broken down→hyperaldosteronemia →salt & fluid retention→ ascites and generalized edema

What occurs with the Kupffer cells in Cirrhosis?

no longer function properly to filter out bacteria, plus leukopenia from splenomegaly = increased risk of infection

What are the problems related to Portal hypertension?

• ascites

• splenomegaly: shunting of blood into splenic vein enlarges spleen syndrome develops called hypersplenism— stasis of blood in spleen

• varices—hemorrhoidal, esophageal - enlarged, thin-walled veins that can rupture

How do you diagnose Cirrhosis?

lab tests specific for liver:

• elevated indirect serum bilirubin; sometimes also low direct bilirubin

• elevated serum liver enzymes

What is the treatment of Cirrhosis?

reestablish appropriate fluid balance

• give diuretics to mobilize fluid from tissue to blood to urine

• sometimes give IV albumin to increase protein in blood so water won’t be going out from blood to tissues

control ammonia – low protein diet & certain drugs can be given