Nurse

Patients with hepatic issues, including cirrhosis, may require extensive care:
- Further care in a rehabilitation facility.
- Involvement of dietitians to ensure proper nutrition.
- Neurology involvement for related complications.

Metastasis: Cancer cells spreading from other primary sites (e.g., lungs) to the liver.
Hepatitis B and C: These viral infections are major risk factors for liver cancer.
- Transmission: Primarily through blood contact (e.g., sharps injuries, intravenous drug use, sexual contact).
  - Healthcare Providers: Needle sticks are a significant source of exposure, often due to improper sharps disposal or rushing procedures.
Age: Increased age correlates with a higher risk of various cancers, including liver cancer.
Toxin Exposure:
- Smoking
- Alcohol Consumption
Obesity: Poor self-care and obesity contribute to increased cancer risk.
Cirrhosis: The presence of scar tissue and cellular changes in a cirrhotic liver can lead to the development of malignant cells.

The liver's extensive portal system and rich vascularity facilitate the easy spread of malignant cells to other body parts.
Nearby Structures: Cancer can spread to the gallbladder, pancreas, and lungs.
Distant Sites: Spread to the breast and stomach is also possible.
Heart Cancer: Cancer in the heart is rare due to the unique nature of cardiac cells and constant movement.

Laboratory Tests:
- Liver Function Tests (LFTs)
- Complete Blood Count (CBC)
Imaging:
- Ultrasound
- CT Scan
- PET Scan: Utilizes a radioisotope that illuminates areas with cancer cells, making them visible as glowing regions on the scan.
Biopsy: Liver biopsy is a definitive diagnostic tool.
- Nursing Interventions for Liver Biopsy:
  - Post-procedure, position the patient on their right side for 2 hours to apply pressure and reduce bleeding risk.
  - Place a towel or pillow under the patient's right side.
  - Monitor vital signs every 15 minutes to detect any signs of bleeding, especially given the fragile nature of a diseased liver.

Hepatomegaly: Enlargement of the liver as it attempts to compensate for damage and regenerate around scar tissue.
Weight Loss: Caused by malnutrition (impaired toxin processing, leading to loss of appetite) and the systemic effects of cancer, especially if it has metastasized to areas like the stomach.
Peripheral Edema: Due to portal hypertension, which causes fluid to shift from the intravascular space into the tissues, similar to right-sided heart failure.
Dehydration: A consequence of fluid shifting out of the intravascular space.
- Nursing Intervention: Administer intravenous (IV) fluids, especially if the patient is NPO or at risk for gastrointestinal (GI) bleeding, to replace fluids and electrolytes.
Ascites: Accumulation of fluid in the abdominal cavity.
- Nursing Interventions: Daily girth measurements, regular assessment of the abdomen (peristaltic waves might be visible).
Pain: Typically located in the right upper quadrant and/or epigastric region.
- Initially mild, but progresses as the disease advances.
- Pain Management Consideration: Liver's role in drug metabolism requires careful selection of medications to avoid further burdening the organ.
Jaundice: Observable mainly in the sclera (eyes) and oral mucosa, as well as the skin.
Nausea and Vomiting
Enlarged Jugular Veins: Due to increased pressure.

Palliative Care: Focused on symptom management and improving quality of life.
Surgery:
- Excision of the tumor.
- Resection of a liver lobe. Note: If the liver is severely damaged by cirrhosis, it may not be able to regenerate the resected lobe effectively.
Chemotherapy:
- Side effects can include weight loss, nausea, vomiting.
- Monitoring White Blood Cell (WBC) count is crucial, as chemotherapy often lowers it (
  \text{Normal WBC range: } 5 \text{ to } 10 \times 10^3), impairing the immune system.

An encapsulated infection (abscess) on the liver.
Significantly impairs liver functioning.
Rapid Systemic Spread: Due to the liver's portal vasculature, an open abscess can quickly lead to systemic infection and septic shock.

Infection: Bacteria tend to localize where the body's defenses are weakest, such as in a compromised or non-functioning liver.
Low Immune System: Immunosuppression (e.g., from chemotherapy) increases susceptibility to abscess formation and bacterial overrun.
Perforation: Contents from a perforated organ (e.g., ruptured colon spilling fecal contents and E. Coli into the abdominal cavity) can migrate to and infect the liver.
- Signs of Intestinal Perforation: Abdominal distention, diaphoresis, rigid abdomen.

Flu-like Symptoms: Chills, fever.
Pain: Abdominal pain, tenderness, and discomfort.
Hepatic Enlargement: Hepatomegaly.
Anemia
Flake-colored Stools and Dark Urine: Indicate issues with bile flow (gallbladder/bile duct obstruction due to abscess or related bacteria).
Diaphragm Irritation: Pressure on the diaphragm can cause chronic hiccups.
Weight Loss and Malaise: Cachexia (more than 10\% body weight loss, muscle wasting).
Onset: Symptoms can vary, with some developing slowly. Undiagnosed liver abscesses have a 100\% mortality rate.

Antibiotic Therapy:
- Typically administered for 4 to 6 weeks.
- Patient Education: Emphasize completing the entire antibiotic course (to prevent resistant bacteria) and increasing fluid intake (to flush out bacteria).
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