Hepatic Disorders

Liver

A chemical factory that manufactures, stores, alters, and excretes a large number of substances involved in metabolism.

- Blood purification

- Glucose Metabolism

- Protein Metabolism

- Fat Metabolism

- Vitamin and Iron Storage

- Bile Formation

- Bilirubin Excretion

- Drug Metabolism

Functions of the Liver

Cirrhosis

A chronic disease characterized by the replacement of normal liver tissue with diffuse fibrosis that disrupts the structure and function of the liver.

Alcoholic Cirrhosis

The scar tissue characteristically surrounds the portal areas. This is most frequently caused by chronic alcoholism and is the most common type of cirrhosis.

Post Necrotic Cirrhosis

This is a late result of a previous bout of acute viral hepatitis.

Biliary Cirrhosis

Scarring occurs in the liver around the bile ducts. Results from chronic cholangitis (bile duct obstruction)

Jaundice

Caused by overproduction of bilirubin which was caused by dead red blood cells.

• Monitor Neurological Status

• Monitor daily weight, abdominal girth, and signs of edema.

• Implement fluid and sodium restrictions if needed.

• Prevent Bleeding → Monitor vital signs, assess for GI bleeding, and implement bleeding precautions.

• Support Liver Function

• Monitor Renal Function

• Educate & Provide Emotional support

Nursing interventions for hepatic disorders

Hepatitis

Inflammation of the liver

Viral Hepatitis

A systemic, viral infection in which necrosis and inflammation of liver cells produce a characteristic cluster of clinical, biochemical, and cellular changes. Five definitive types that cause liver disease have been identified: hepatitis A, B, C, D, and E.

Hepatitis A

• Agent: Enterovirus

• MOT: fecal-oral route (contaminated food or water)

• Cannot be transmitted through Blood Transfusions

Hepatitis B

• Agent: Hepatitis B virus

• MOT: Blood, saliva, semen, vaginal secretions

• Sexual contact

• Needles

• Vertical transmission (Childbirth)

• Exposure to infected blood (blood transfusion) or body fluids

Hepatitis C

• Agent: Hepatitis C Virus

• MOT: Direct blood contact and sexual contact

• Medications: Ribavirin and Interferon

Hepatitis D

• Agent: Hepatitis D virus that requires Hepatitis B for replication.

• MOT: Blood transfusion and body fluids.

• Also high dose of interferon alpha

Hepatitis E

• Agent: Hepatitis E virus.

• MOT: Fecal-oral route, often through contaminated water.

• Difference to hepatitis A, abrupt and severe outcomes

Hepatitis G and GBV-C

• Two related viruses that may cause hepatitis.

• MOT: Blood and body fluids, though their clinical significance is less clear than other hepatitis viruses.

Non-viral hepatitis

A type of liver inflammation not caused by a viral infection. It can result from factors such as alcohol use, certain medications, or autoimmune diseases.

Hepatotoxins

Causative agent of nonviral hepatitis

Toxic Hepatitis

Hepatitis caused by exposure to non-medicinal toxic agents other than ethyl alcohol, including, but not limited to, carbon tetrachloride, chloroform, tetrachloroethane, trichloroethylene, phosphorus, TNT, chloronapthalenes, methylenedianilines, ethylene dibromide, and organic solvents.

Drug-induced hepatitis

Involves inflammation of the liver, caused by medication. It is caused when you have a harmful or toxic amount of some medicines, vitamins, herbal remedies, or food supplements.

Medications that can lead to Hepatitis

isoniazid, halothane, acetaminophen, methyldopa, certain antibiotics, antimetabolites, anesthetic agents., antidepressants, psychotropic medications, anticonvulsants, antituberculosis agents

Cholecystitis

Inflammation of gallbladder

Cholelithiasis

Presence of stones in gallbladder

Hepatologist

A doctor who specializes in diagnosing and treating liver disease. They can also treat conditions affecting the gallbladder, pancreas, and biliary tree.