Liver Disease

CARE OF PATIENTS WITH LIVER PROBLEMS

LIVER FUNCTION

  • Bile Ducts

  • Right Lobe of Liver

  • Left Lobe of Liver

  • Stomach: Functions include:   - Removes potentially toxic byproducts of certain medications.   - Prevents shortages of nutrients by storing vitamins, minerals, and sugar.   - Metabolizes, or breaks down, nutrients from food to produce energy, as needed.   - Produces most proteins needed by the body.   - Helps the body fight infection by removing bacteria from the blood.   - Produces most substances that regulate blood clotting.   - Produces bile, a compound needed to digest fat and absorb vitamins A, D, E, and K.

ALTERATION IN LIVER FUNCTION

  • Impaired functions due to liver problems can include:   - Amino Acids: Impaired protein metabolism.   - Carbohydrates: Disrupted glucose metabolism.   - Lipids: Impaired absorption of fat-soluble vitamins (A, D, E, K).   - Impaired metabolization of cholesterol and toxins.   - Impaired clotting factors, including fibrinogen, prothrombin, and factors V, VII, IX, XI, XII.   - Impaired hormone production, including insulin-like growth factor, angiotensinogen, thrombopoetin, and hepcidin.

CLINICAL MANIFESTATIONS

  • Liver disease may initially be asymptomatic, becoming evident only when the patient decompensates.

  • Common signs and symptoms (s/s) include:   - Anorexia   - Weight loss   - Weakness   - Fatigue   - Potentially osteoporosis related to Vitamin D malabsorption.

  • Additional symptoms:   - Jaundice (yellowing of the eyes or skin)   - Gastrointestinal bleeding   - Dull aching pain in the right upper quadrant of the abdomen   - Pruritus (itchiness)   - Coagulopathy   - Increasing abdominal girth   - Mental status changes   - Disrupted bowel function, leading to diarrhea or constipation.

CIRRHOSIS

  • Definition: Irreversible scarring of the liver caused by chronic reaction to hepatic inflammation and necrosis.

  • Common Causes:   - Chronic alcoholism   - Chronic viral hepatitis   - Nonalcoholic steatohepatitis (NASH)   - Bile duct disease   - Genetic diseases

  • Impact: Scarring leads to cessation of liver function.

  • According to XpertDox (2009), over 400,000 people are affected in the US.

  • Prevalence: Alcohol consumption is estimated to cause 20%-50% of cases. It is the 9th leading cause of death in the US.

  • Common symptoms:   - Tiredness   - Loss of appetite   - Weight loss   - Vomiting

  • Diagnosis methods:   - Blood tests   - Abdominal ultrasound   - Abdominal CT and MRI scans.

  • Treatment options:   - Diet and medications   - Liver transplantation.

  • Complications:   - Unstoppable bleeding   - Kidney failure   - Liver cancer.

PORTAL HYPERTENSION

  • Effects of Portal Hypertension:   - Esophageal varices (enlarged veins in the esophagus that can bleed)     - Symptoms include hematemesis (vomiting blood), gastropathy, melena (dark tarry stools), splenomegaly, and dilated abdominal veins (caput medusae).     - Rectal varices (hemorrhoids) may also occur.

  • Effects of Liver Cell Failure:   - Coma   - Fetor hepaticus (breath smelling like a freshly opened corpse)   - Spider nevi (small, dilated blood vessels)   - Gynecomastia (development of breast tissue in men)   - Jaundice   - Ascites (fluid accumulation in the abdominal cavity)   - Loss of sexual hair   - Testicular atrophy   - Liver