hepatic

Hepatic Anatomy and Physiology

  • Organs Related to the Liver:

    • Liver
    • Esophagus
    • Gall bladder
    • Portal vein
    • Hepatic artery
    • Intestines
    • Ribs
    • Spleen
    • Stomach

  • Institutional Reference:

    • National Cancer Institute

Functions of the Liver

  • Metabolism:

    • Alcohol and Drug Metabolism
    • Glucose and Fat Metabolism

  • Storage:

    • Vitamins (A, D, E, K)
    • Iron Storage

  • Excretion:

    • Bilirubin
    • Ammonia

  • Secretion:

    • Bile Formation/Secretion

  • Protein and Clotting Factors Production:

    • Albumin (maintains fluid balance)
    • Thrombin
    • Fibrinogen

  • Toxic Substances:

    • Byproducts of RBC Breakdown
    • Byproducts of protein breakdown, which influence RBC production

Hepatitis Overview

  • Types Covered:
    • Hepatitis A
    • Hepatitis B
    • Hepatitis C
    • Important for understanding the most common causes and implications such as liver cirrhosis.

Hepatitis A, B, and C

  • Hepatitis A:

    • Spread: Fecal-Oral route
    • Vaccine Availability:
    • Recommended for all children at age one
    • International travelers

  • Hepatitis B:

    • Spread: Blood and Body Fluids
    • Vaccine Availability:
    • Given to all infants
    • High-risk individuals (e.g., healthcare workers, individuals with high-risk sexual behaviors)

  • Hepatitis C:

    • Spread: Blood and Body Fluids
    • Vaccine Availability:
    • No vaccine available; carriers can still transmit even if asymptomatic.

Symptoms of Hepatitis

  • The 3 Phases of Hepatitis:
    1. Prodromal:
    • Flu-like symptoms
    • Aversions to food
    • Right upper quadrant (RUQ) pain
    1. Icteric:
    • Onset of jaundice
    • Most contagious stage
    • Hepatomegaly
    1. Convalescent:
    • Recovery phase after acute illness
    • Jaundice resolves
    • Improvement in patient’s condition

Understanding Jaundice

  • Definition: Yellowing of body tissues due to issues with bilirubin metabolism or normal bile flow.

  • Causes:

    • Excessive RBC breakdown leading to elevated bilirubin levels in blood.

  • Symptoms Associated with Jaundice:

    • Discolored skin
    • Dark yellow/amber urine (tea color)
    • Sometimes accompanied by pruritus (itching)

Nursing Care for Hepatitis

  • Nutritional Management:

    • Small, frequent meals
    • Increase vitamins
    • Avoid alcohol

  • Activity Management:

    • Encourage rest during early stages, considering activity intolerance.

Teaching Prevention for Hepatitis

  • Preventive Measures:
    • Vaccination for Hepatitis A and B
    • Safe sexual practices
    • Needle exchange programs
    • Handwashing and hygiene practices
    • Proper food handling techniques

Hospital Precautions for Hepatitis Patients

  • Precautions in Hospital Setting:
    • Contact precautions
    • Droplet precautions
    • Standard/Universal precautions

Liver Cirrhosis

  • Definition: Chronic, irreversible, progressive liver disease.

  • Typical Demographics:

    • Often seen in males aged 35-65.

  • Risk Factors:

    • Excessive alcohol intake
    • Drug use
    • Chronic hepatitis B and C
    • Right-sided heart failure
    • Long-term bile obstruction leading to hepatomegaly.

Pathophysiology of Cirrhosis

  • Sequence of Events::
    • Injury to liver → Liver attempts to repair → Development of scar tissue → Liver enlargement → Irregular shape leading to impeded blood flow → Poor liver function.

Case Study of “Jim”

  • Patient Background:

    • 55-year-old man with diabetes and coronary artery disease
    • History of IV drug abuse and heavy alcohol use.
    • Diagnosed with Hepatitis C approximately 10 years ago.

  • Current Condition:

    • Increased fatigue, nausea/vomiting, and a weight loss of 7 pounds in a week and a half.
    • Observations: Yellowish skin, multiple areas of ecchymosis on upper extremities.

Complications of Cirrhosis

1. Portal Hypertension

  • Definition: Increased portal vein pressure leading to complications.

  • Possible Outcomes:

    • Esophageal varices
    • Splenomegaly (enlargement of spleen)

2. Ascites

  • Definition: Fluid accumulation seen with portal hypertension.
    • Causes proteins and water to shift out of blood vessels into abdominal cavity due to low albumin levels.

3. Jaundice

  • Resulting from the liver’s decreased ability to excrete bilirubin
  • Accumulation can lead to pruritus (itching).

4. Hepatic Encephalopathy

  • Cause: Elevated ammonia levels due to liver's failure to detoxify.
  • Early Symptoms:
  • Late Symptoms:
    • Asterixis (flapping tremors)
    • Constructional Apraxia (inability to construct simple figures)
    • Fetor hepaticus (musty, fecal breath)

Monitoring and Diagnostic Tests for Liver Disease/Cirrhosis

  • Blood Tests to Monitor:

    • Liver enzymes (ALT, AST)
    • Prothrombin time
    • RBCs, WBCs, and platelets
    • Albumin levels
    • Bilirubin concentrations
    • Ammonia levels

  • Other Diagnostic Tools:

    • CT Scan or liver biopsy.

Liver Biopsy Procedure

  • Pre-Procedure Requirements:

    • Consent and baseline assessments
    • Labs (coagulation studies)
    • NPO status and IV access

  • During the Procedure:

    • Expose the right side of the abdomen; patient must exhale and hold breath while the needle is inserted.

  • Post-Procedure Monitoring:

    • Positioning and monitoring vital signs; be vigilant against internal bleeding risks.
    • Provide instructions for activity restriction afterward.

Paracentesis

  • Indication: Needle insertion into abdomen to relieve excess fluid, alleviating pressure on the lungs.

  • Nursing Care:

    • Consent and baseline assessment
    • Monitor drainage and vital signs throughout the procedure.

Nursing Interventions/Priorities for Cirrhosis

  1. Breathing Management:

    • Implement pulmonary hygiene strategies and interventions as necessary.

  2. Monitoring Fluid Volume:

    • Daily intake and output (I & O)
    • Monitor abdominal girth and weight.

  3. Neurological Status Monitoring:

    • Watch for elevated ammonia levels and its effects.
    • Provide a low-protein diet if severe symptoms manifest.

  4. Bleeding Precautions:

    • Monitor lab values and prevent esophageal varices through appropriate precautions.

  5. Nutritional Monitoring:

    • High calorie, high carbohydrate diet; concerns over malnutrition and protein restriction as necessary.

  6. Infection Risk and Skin Integrity:

    • Address risk factors for infection and skin issues.

Liver Cancer and Liver Transplants

  • Liver Cancer Epidemiology:

    • Most common cause of death in patients with cirrhosis; rates are higher in men.
    • Increasing prevalence due to Hepatitis C diagnoses.

  • Treatment Approaches:

    • Treatment varies based on cancer stage; can involve palliative care for advanced stages.

  • Liver Transplants:

    • Generally not recommended for patients with liver cancer due to prognosis concerns; ethical considerations regarding alcohol and drug use related to candidate selection.