Hepatic

Group 3: Liver

Topic

Topic Content

(6 students)

Joann Chaimuang

Haylee Heitzmann

Emma Plasencia

Isabella Rodriguez 

Liver Functions

Hepatic Dysfunctions

Viral Hepatitis

Cirrhosis

Liver functions

• What are the major functions of the liver, and how does its unique ability to regenerate play a role in its function?  

The major functions of the liver are glucose metabolism, vitamin and iron storage, bile formation, bilirubin excretion, and drug metabolism. The ability to regenerate its damaged cells can help to make sure that all the functions that the liver has can be carried out if a part of it gets damaged. Although with chronic damage this isn’t able to happen as well. 

• Explain the role of the liver in glucose metabolism, protein metabolism, and fat metabolism.

With glucose metabolism it can break down excess glucose into glycogen so that it can be stored in the liver for times when the blood sugar is low. It can also turn glycogen into glucose so that we can raise our blood glucose levels. During protein metabolism it can synthesize proteins in our plasma so that it can be used in our body. Clotting factor synthesis requires vitamin K for this to happen. Fat metabolism is breaking fatty acids down into ketones so that they can be used as a source of energy.  

• Describe the circulation of blood into and out of the liver, including the sources of blood supply and its significance for liver function. 

The circulation of blood in the liver is called hepatic-portal circulation. The blood comes in through the portal vein and hepatic artery and leaves through the hepatic vein. It has two entrances and one exit so that the blood going back to the heart has the right balance of nutrients. 

• How does the liver contribute to digestion and absorption of fats in the gastrointestinal tract, and what role does bile play in this process?

The liver contributes to digestion because it can get the nutrients that the small intestine absorbs. It helps with the absorption of fats since it can take them and break them down into an energy source. Bile is important in the process because it can be used to help breakdown fats. 

• What are the two main sources of blood supply to the liver, and what is the significance of their different compositions (nutrient-rich versus oxygen-rich)?

The two main sources of blood supply are the hepatic artery and the portal vein. The portal vein would be nutrient rich and the hepatic artery would be oxygen rich. The different composition makes sure that the liver is getting both oxygen and nutrients that it needs. 

• Describe the circulatory pathway within the liver, from the sinusoids to the hepatic vein, and explain how it contributes to liver function.

The path within the liver is blood flowing from the portal vein and hepatic artery into the liver, into the sinusoids, where it goes to the hepatocytes, then gets drained into the central veins of the liver, where they get converged into the hepatic vein. This contributes to liver function because it can allow for nutrients that need to get absorbed and then all the nutrients that need to be sent out can also flow. 

Hepatic Dysfunctions

Jaundice

• What is jaundice, and how does it manifest in the body, both in terms of the coloration of tissues and the bilirubin level in the blood?

Jaundice is buildup of bilirubin and it causes body tissues (sclerae/skin) to turn yellow/greenish, and bilirubin level in blood is elevated. 

• At what serum bilirubin level does jaundice become clinically evident, and why is the sclera often the most noticeable site for jaundice?

Bilirubin level in blood exceeds 2.5mg/dl. 

The sclera is the most noticeable site for jaundice because of its high affinity for bilirubin.

Ascites

• Define ascites and explain its underlying causes. 

  • Increased accumulation of peritoneal fluid in the abdomen caused by a variety of disorders associated by the liver.

  • Underlying causes

    •  portal hypertension: 

      • a result of increased capillary pressure and obstruction of venous blood flow through damaged liver

      • Causes an increase in pressure gradient pressure between the portal vein and the hepatic veins causing fluid to accumulate in the peritoneal cavity

    •  decreased synthesis of albumin

      •  Hypoalbuminemia: decreased plasma oncotic pressure, which facilitates accumulation in the abdominal cavity. 

• What are some common symptoms associated with ascites, and why are they significant indicators in clinical assessment? 

  • abdominal girth, weight gain, swelling of the lower extremities (pedal edema), dyspnea may be presented as a result of pleural effusion, satiety anorexia, and general weakness. Abdominal hernias which are due to an increased in intra-abdominal pressure, this may be visible as well as visible collateral veins and striae (stretch marks) 

• Why is diagnostic paracentesis routinely performed on patients with ascites, and what specific complication is it used to detect? 

  • Diagnostic paracentesis is routinely performed on patients with ascites to detect the presence of spontaneous bacterial peritonitis (SBP, a bacterial infection of fluid in the abdomen). This is used to detect the complication of cirrhosis which has a high mortality rate. 

• What is the primary dietary modification recommended for managing ascites, and why is it essential for treatment? 

  • Dietary restrictions of salt intake is the mainstay of treatment of ascites  to achieve a negative sodium balance to reduce fluid retention. 

  • Should consume 2,000 mg or less of sodium 

  • Patients should be educated and have guidance on what a sodium- restricted diet looks like, patients shouldn’t eat processed, canned, and frozen foods unless indicated that there is low sodium

  • This is essential because water follows sodium plays a big role in fluid retention; so by limiting it, it can decrease fluid buildup

• Explain the role of diuretics in reducing ascites.

  • Diuretics alongside with sodium restrictions decrease ascites by 90%

  • When combining spironolactone (Aldactone), an aldosterone-blocking agent, and furosemide (Lasix), a loop diuretic agent, is the most effective regimen to control ascites and pedal edema.

• What are the possible complications associated with diuretic therapy for ascites, and how can they be managed or prevented during treatment?

  • Possible complications of diuretic therapy are dehydration, volume depletion, and electrolyte abnormalities, such as hypokalemia or hyperkalemia, hyponatremia, kidney impairment, and hepatic encephalopathy. A common side effect of Spironolactone would be Gynecomastia (enlargement of breast tissues in males)

How does decreased synthesis of albumin in liver disease relate to the development of ascites? What role does hypoalbuminemia play in this condition?

• The decreased synthesis of albumin in liver disease relates to the development of ascites because it contributes to the movement of fluid from the vascular system into the peritoneal space. Due to liver disease there will be albumin-rich fluid, 15 L or more, may accumulate in the peritoneal cavity as ascites

• Hypoalbuminemia exacerbates the imbalance between the forces that regulate fluid movement between vascular and interstitial spaces:

  • Reduced oncotic pressure 

  • Increased hydrostatic pressure

Portal Hypertension

• What are the major complications of portal hypertension, and why are they significant for individuals with liver disease?

Major Complications of portal hypertension are ascites and esophageal varices. They are significant for individuals with liver disease because with ascites, fluid accumulation can move into the lungs and cause fluid in lungs.. With esophageal varices, it is significant because this can cause hemorrhoids which can be life threatening if they burst.

• What are the primary causes of portal hypertension, and how does it affect blood flow in the liver?

Primary causes of portal hypertension is liver disease, like cirrhosis, which causes hardening of the liver making it difficult to metabolize substances which then results in a buildup and increased pressure. Blood is unable to flow through in this case. 

Esophageal Varices: 

• What are esophageal varices? 

Esophageal Varices are bubbles that line the esophagus and can inflate/burst causing bleeding. They are a consequence of portal hypertension. 

• Why are gastroesophageal varices so dangerous in patients with liver disease, and how often do they result in death?

They are so dangerous in patients with liver disease because they are large veins in the esophagus that can rupture/burst more easily if there is increased blood pressure in the portal vein. 

• How do esophageal varices form in the lower esophagus or stomach?

They form in the lower esophagus or stomach when blood flow to the liver is blocked, causing blood to become backed up into the veins of the esophagus or stomach, which is known as portal hypertension. 

• What are the common signs and symptoms of a patient with bleeding esophageal varices, and why is alcohol abuse often associated with this condition?

The common signs and symptoms of a patient with bleeding esophageal varices are vomiting blood, lightheadedness due to the blood loss, and sometimes loss of consciousness. Alcohol is often associated with this condition because chronic alcohol abuse can lead to cirrhosis of the liver, which results in a raised pressure in the portal vein, backing up the esophagus and other blood vessels. This increases the likelihood of developing esophageal varices. 

• Why is early endoscopic evaluation important for patients with esophageal varices, and how does the size of varices impact the choice of treatment?

Early endoscopic evaluation is important for patients with esophageal varices because it allows us to be able to identify the cause and site of bleeding. The size of the varices impacts the choice of treatment because depending on the size of them, it can determine if the healthcare specialist wants to proceed with surgery to remove them or not, and if they need specific medications to treat the varices and reduce their risk of bleeding. 

Hepatitis Vs Cirrhosis

Hepatitis:

• What are the different types of viral hepatitis, and how do they affect the liver? 

Different types of viral hepatitis are Hepatitis A, B, C, D, and E. 

These infections of the liver can cause necrosis (tissue death) and inflammation of the liver cells. 

• What are the possible outcomes of a viral hepatitis infection, and how do they differ from one another?

Possible outcomes of a viral hepatitis infection are hardening of the liver, or liver cancer. 

Hepatitis A: leads to liver failure, occurs through oral-fecal route, able to recover

Hepatitis B: transmitted through blood, can lead to liver failure or progress to chronic infection which later leads to development of cirrhosis, end-stage liver disease, or cancer of the liver. 

Hepatitis C: leading cause of liver disease and primary indicator for liver transplant. 

Hepatitis D: leads to liver failure/death, only individuals with Hep B are at risk 

Hepatitis E: transmitted by oral-fecal route usually due to contaminated waters. Responsible for most cases of hepatitis in India. 

• What are some common clinical symptoms and laboratory findings associated with viral hepatitis?

Early Hepatitis is usually asymptomatic. Acute symptoms associated with viral hepatitis are fever, nausea/vomiting, fevers, jaundice. 

Laboratory findings include elevated ALT, AST, WBC levels. Elevated bilirubin indicates jaundice is also associated with viral hepatitis. Positive Viral Serology specific for certain hepatitis can also indicate presence of the viral infection. 

Cirrhosis

• What are the common causes of chronic liver disease, and how do they contribute to liver damage?

The common causes are chronic alcohol use, late acute viral hepatitis, chronic biliary obstruction abdominal infection, and fatty liver. They contribute to  cirrhosis by damaging the liver and when it is repairing dense connective tissue or scar tissue is formed. 

• Describe the pathophysiology of cirrhosis and how it is related to the replacement of normal liver tissue by fibrotic tissue.

The liver gets damaged by toxins, viral infections, or where the body attacks the liver. This is related because since the liver can regenerate damaged cells that will happen, but with extensive damage scar tissue of dense connective tissue will form hardening the liver. This then causes the liver to not receive blood flow as well as it used to. 

• How does cirrhosis of the liver relate to the development of various complications and its impact on overall health?

It leads to various complications like portal hypertension, ascites, and esophageal varices because of it being obstructed because of how covered in scar tissue it is, which backs up the veins, which causes a fluid overload. Jaundice can happen because the hepatocytes get damaged allowing for bilirubin to back up, which causes us to turn yellow. Ammonia can also build up causing hepatic encephalopathy, which causes mental status changes. Nutritional deficiencies can happen because vitamins can’t be stored and some nutrients need vitamins to be metabolized. 

• Why is cirrhosis considered a significant health concern, and what are its implications for mortality and morbidity in the United States?

It is considered a significant health concern because it is late stage liver failure and the only treatment would be a liver transplant. This can affect mortality since there isn’t really a treatment to reverse it. It can affect morbidity because it affects a large portion of our population.

Hepatic Dysfunction

Definition | Causes

Clinical Manifestations | Assessment | Complications

Medical & Nursing Management

Example:

Jaundice

• Hepatocellular jaundice

• Obstructive

• Hemolytic jaundice

• Hereditary jaundice

Caused by impairment of liver metabolizing and secreting 

bilirubin

• caused by viral hepatitis, hepatotoxins, metabolic disorders, ischemia, autoimmune, pregnancy

• due to obstruction of the bile ducts

• Caused by  increased bilirubin due to hemolysis, heme disorders

• Due to inherited disorders of bilirubin

Serum level greater than 3mg/dL

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Portal Hypertension

Ascites

Esophageal Varices

Hepatic Encephalopathy 

Vitamin Deficiency

Viral Hepatitis

BRIEF Pathophysiology

Mode of transmission

Clinical Manifestation | Assessment

Risk Factors

Prevention

Medical & Nursing Management

Hepatitis A

Hepatitis B

Hepatitis C

Hepatitis D

Hepatitis E

Non-viral Hepatitis

BRIEF Pathophysiology

Clinical Manifestation | Assessment

Risk Factors

Prevention

Medical & Nursing Management

Alcoholic Liver Disease

Cirrhosis

BRIEF Pathophysiology

Clinical Manifestation | Assessment

Risk Factors

Prevention

Medical & Nursing Management

Alcoholic Liver Disease