Hepatic Dysfunction Overview

Functions of the Liver

• The liver performs several vital functions:
  • Glucose Metabolism:
  • Converts glucose from meals into glycogen for storage.
  • In times of need, glycogen is converted back to glucose (glycogenolysis) or synthesized from amino acids (gluconeogenesis).
  • Ammonia Conversion:
  • Converts ammonia (toxic by-product) into urea for excretion.
  • Protein Metabolism:
  • Synthesizes almost all plasma proteins.
  • Fat Metabolism:
  • Breaks down fatty acids to produce energy and ketone bodies; helps in cholesterol and complex lipid synthesis.
  • Vitamin and Iron Storage:
  • Stores vitamins A, B, E, D, and iron.
  • Bile Formation:
  • Bile aids in fat digestion and is continuously produced, stored in the gallbladder.
  • Bilirubin Excretion:
  • Processes bilirubin, a waste product from the breakdown of red blood cells, and excretes it in bile.
  • Drug Metabolism:
  • Metabolizes and detoxifies drugs; important for bioavailability of medications.

Liver Disorders

• Liver disorders can arise from various causes, including viruses, toxins, obesity, and metabolic conditions.
• Notable diseases include cirrhosis and hepatitis.

Symptoms of Liver Dysfunction

• Common signs and symptoms include:
  • Jaundice: Yellowing of skin and eyes due to high bilirubin levels.
  • Fatigue & Weakness: General lack of energy.
  • Malaise & Pruritus: Discomfort and itching often due to bile salt retention.
  • Abdominal Pain & Distension: Pain in the upper right quadrant due to liver enlargement or ascites.
  • Altered Mental Status: Changes due to hepatic encephalopathy.
  • Easy Bruising & Bleeding: Due to reduced clotting factors production.
  • Fluid Retention: Seen as edema and ascites due to hypoalbuminemia.

Assessment of Liver Health

• Health history should focus on:
  • Exposure to Hepatotoxic Substances: Medications, alcohol use, travel history.
  • Physical Signs: Jaundice, muscle atrophy, spider angiomas, palmar erythema.
• Labs & Diagnostics:
  • Liver Function Tests: ALT, AST, and GGT levels indicate liver cell damage.
  • Imaging: Ultrasound, CT, MRI help visualize liver structure.
  • Liver Biopsy: Determines extent of liver disease.

Complications of Liver Disease

• Ascites: Fluid accumulation due to portal hypertension.
• Esophageal Varices: Enlarged veins in the esophagus prone to rupture and bleed.
• Hepatic Encephalopathy: Neurocognitive impairment caused by the accumulation of toxins like ammonia.
• Portal Hypertension: Increased blood pressure in the portal venous system, leading to complications.

Treatment Options

• Medical Management:
  • Dietary modifications and pharmacologic therapy for ascites and hepatic conditions.
  • Diuretics to manage fluid retention.
  • Lactulose for hepatic encephalopathy to reduce blood ammonia levels.
• Surgical Interventions:
  • TIPS for ascites or variceal bleeding management.
  • Liver transplantation is considered for irreparable liver failure.
  • Endoscopic procedures like sclerotherapy or banding for varices.

Nursing Care Considerations

• Monitor I&O, daily weight, and abdominal girth for signs of ascites progression.
• Educate patients on diet, medication adherence, and avoiding liver toxins like alcohol.
• Provide psychological support to patients and families on the implications of liver disease and treatments.

Hepatitis Overview

• Types of Viral Hepatitis: A, B, C, D, E—each with different transmission routes and implications.
  • Hepatitis A: Fecal-oral; often self-limiting.
  • Hepatitis B: Blood and sexual contact; can lead to chronic issues.
  • Hepatitis C: Primarily blood-borne; high risk of chronic liver disease.
  • Hepatitis D: Requires hepatitis B to cause infection.
  • Hepatitis E: Fecal-oral; similar to hepatitis A.
• Preventive Measures: Vaccination, safe practices, and public health campaigns.

Cirrhosis & Liver Transplantation

• Cirrhosis Definition: Replacement of liver tissue with fibrous scar tissue, disrupting function.
• Management: Nutritional support, regular monitoring, medications for symptom management and hormone imbalances.
• Liver Transplantation: Considered for ESLD; involves comprehensive assessment for candidacy and post-operative care to prevent complications.

Conclusion

• Understanding liver functions, disorders, and management strategies is essential for providing effective nursing care in hepatic dysfunction cases.