Liver Disorders

Liver Disorders Overview

  • Importance of liver health for overall body function.
  • Key functions of the liver: detoxification, production of proteins and clotting factors, and storage of vitamins, fats, and sugars.

Hepatitis

  • Definition: Inflammation of liver cells leading to
    • Limited detoxification ability
    • Impaired protein production and storage
    • Reduced waste removal
  • Causes: Viral infections, toxins, drugs, or autoimmune diseases
  • Types: Acute and chronic
  • Consequence: May lead to necrosis and permanent liver damage.

Clinical Manifestations of Hepatitis

  • Common flu-like symptoms:
    • Fatigue, muscle and joint pain, fever
  • Digestive symptoms:
    • Abdominal pain, nausea, vomiting, loss of appetite
  • Skin symptoms:
    • Pruritis, jaundice (yellowing of skin), dark urine, clay-colored stools

Viral Hepatitis Overview

  • Hepatitis A:
    • Route: Oral-fecal
    • Incubation: up to 60 days
    • Vaccine available; can be mild or asymptomatic
  • Hepatitis B:
    • Route: Blood and body fluids
    • Incubation: Up to 60 days
    • Vaccine required; acute managed with supportive care, chronic may require antivirals
  • Hepatitis C:
    • Route: Blood and body fluids
    • No vaccine; often chronic leading to severe complications
  • Hepatitis D: Uncommon, requires co-infection with Hepatitis B
  • Hepatitis E: Similar to Hepatitis A, primarily oral-fecal transmission.

Non-Viral Hepatitis

  • Causes: Toxins, medications
  • Diagnosis: Based on history and elevated liver enzymes
  • Treatment: Removing the offending agent, recovery is typically quick.

Cirrhosis

  • Definition: Chronic liver inflammation causing irreversible scarring and liver tissue destruction.
  • Consequences:
    • Altered blood flow leading to portal hypertension
    • Varices formation, ascites, hepatic encephalopathy, coagulopathies
  • Manifestations:
    • Fatigue, abdominal pain, jaundice, cognitive changes
    • Symptoms such as asterixis, palmar erythema, and vulnerabilities to bleeding (petechiae, bruising).
  • Risk Factors: Chronic hepatitis, alcoholism, biliary disorders, certain medications.

Diagnosing Cirrhosis

  • Blood tests show: elevated liver enzymes, bilirubin, decreased protein/albumin
  • Imaging: Ultrasound, CT, MRI
  • Definitive: Liver biopsy

Managing Cirrhosis

  • No cure; liver transplant is the only curative option.
  • Supportive care to manage complications, including
    • Diuretics, beta-blockers, lactulose
    • Surgical procedures for ascites and varices.

Ascites

  • Definition: Fluid build-up in the abdominal cavity due to liver damage.
  • Symptoms: Increased abdominal girth, pain, discomfort, shortness of breath.
  • Management: Daily girth measurements, fluid restrictions, diuretics

Paracentesis

  • A procedure to relieve ascites.
  • Requires informed consent and monitoring post-procedure for complications.

Esophageal Varices

  • Caused by portal hypertension, leading to dilated veins that can bleed easily.
  • Symptoms of bleeding include hematemesis and melena.
  • Treatment methods include
    • Sengstaken-Blakemore tube for compression, sclerotherapy, banding, and fluid replacement.

Hepatic Encephalopathy

  • Occurs due to toxin accumulation; symptoms include confusion, sleep disturbances, and asterixis.
  • Represents serious neurological impairment needing management.

Nonalcoholic Fatty Liver Disease (NAFLD)

  • Excess fat stored in liver; often asymptomatic
  • Associated with obesity and diabetes.
  • Management focuses on lifestyle changes (diet, exercise).

Liver Cancer

  • Can originate in the liver or metastasize from other areas.
  • Often diagnosed late leading to a poor prognosis.
  • Treatment may include surgery, chemotherapy, and palliative care.

Liver Biopsy Nursing Considerations

  • Risk of hemorrhage; frequent monitoring required post-procedure.
  • Patients must lie flat post-biopsy to reduce risks.

Each section provides critical insights into the anatomy, functions, and clinical considerations related to liver disorders.