Care of a Patient with Liver Dysfunction Summary Notes

Concepts

• Priority Concepts:

  • Cellular Regulation: Pertains to the processes that govern cell growth, differentiation, and reproduction.
  • Infection: Understanding the role of pathogens in liver dysfunction.

• Interrelated Concepts:

  • Inflammation: The body's response to liver damage, which can lead to further complications.
  • Nutrition: The impact of dietary choices on liver health and recovery.

Pathophysiology: Liver

• Location: The liver is a large, essential organ located in the right upper quadrant (RUQ) of the abdomen.
• Blood Supply: Receives blood from two sources:
  • Hepatic Artery: Supplies oxygen-rich blood.
  • Portal Vein: Supplies nutrient-rich blood from the gastrointestinal tract.
• Functions:
  • Metabolism: Central to glucose, protein, and fat metabolism.
  • Detoxification: Converts harmful substances into harmless ones for excretion.
  • Digestion: Produces bile for emulsifying fats and aiding digestion.

Functions of the Liver

• Glucose Metabolism: Regulates blood sugar levels; stores glucose as glycogen and converts it back to glucose when necessary.
• Ammonia Conversion: Transforms toxic ammonia (from protein breakdown) into urea for kidney excretion.
• Protein Metabolism: Synthesizes essential plasma proteins (e.g., albumin, clotting factors).
• Fat Metabolism: Breaks down fatty acids; produces cholesterol and lipoproteins.
• Vitamin and Iron Storage: Stores fat-soluble vitamins (A, D, K, B12) and iron, releasing them as needed.
• Bile Formation: Produces bile for fat digestion and absorption.
• Bilirubin Excretion: Processes bilirubin for bile excretion, preventing jaundice.
• Drug Metabolism: Detoxifies medications and toxic substances, making them water-soluble for removal.

Health Promotion

• Preventing Liver Disease:
  • Vaccination: Important for hepatitis types prevention.
  • Safe Lifestyle Choices: Avoiding alcohol, drug use, and high-risk behaviors.
  • Healthy Diet: Maintaining a balanced diet and proper weight.
  • Medication Awareness: Understanding drug effects and avoiding hepatotoxic substances.
  • Regular Screenings: Monitoring liver health proactively.
  • Promoting Health Equity: Ensuring access to liver healthcare for all populations.

Comparison of Hepatitis Types

Etiology of Liver Dysfunction

• Causes:
  • Liver damage can arise from various factors such as:
  • Viral Infections: Hepatitis viruses
  • Autoimmune Disorders: Conditions that attack liver tissue.
  • Toxins: Exposure to harmful substances and drugs.
• Progression: Can lead to serious conditions like cirrhosis, liver failure, or hepatocellular carcinoma (HCC).

Cirrhosis of the Liver

• Definition: Chronic liver damage leads to fibrosis and impaired function.
  • Stages:
  • Compensated: The liver still functions adequately despite damage.
  • Decompensated: Severe dysfunction leads to complications.
• Common Causes:
  • Hepatitis C: Leading cause of cirrhosis and liver cancer in the U.S.
  • Autoimmune Hepatitis: Chronic inflammation causes liver damage.
  • NAFLD/NASH: Nonalcoholic fatty liver disease, linked to obesity and diabetes.
  • Alcohol Use: Chronic excessive drinking

Assessment Cues: Cirrhosis

• History: Age, employment, needlestick injuries, social history.
• Physical Symptoms:
  • Neurologic: Asterixis (flapping tremors), hepatic encephalopathy.
  • Integumentary: Jaundice, spider angioma, palmar erythema.
  • Gastrointestinal: Anorexia, nausea, changes in bowel habits, dull abdominal pain.
  • Hematologic: Anemia, thrombocytopenia, splenomegaly.
• Metabolic: Hypokalemia, hyponatremia, hypoalbuminemia.

Diagnostic Testing: Labs

Treatment Strategies for Cirrhosis

• Fluid Management:
  • Ascites Management: Sodium restriction, diuretics, paracentesis.
• Preventing Esophageal Varices:
  • Screen with endoscopy, beta-blockers, avoid NSAIDs.
• Bleeding Management:
  • Stabilization, IV therapy, blood products, endoscopy for banding.
• Supportive Measures:
  • Fresh frozen plasma, packed RBCs, liver-healthy diet, antibiotics as necessary.

Hepatic Encephalopathy

• Definition: A condition caused by ammonia buildup leading to confusion and altered mental status.
  • Management: Lactulose to trap ammonia, rifaximin (antibiotic), dietary protein management.

Evaluation Outcomes for Liver Dysfunction

• Patients should achieve:
  • Decrease or resolution of ascites.
  • Electrolytes within normal limits.
  • No incidence of hemorrhage; or prompt management if occurs.
  • Prevention or proper management of hepatic encephalopathy.
  • Successful abstinence from alcohol/drugs if related to the disease etiology.

Care Coordination and Management

• Implement care strategies to ensure proper monitoring, patient education, and resource allocation for ongoing liver health support.