Metabolizes proteins, carbohydrates and fats.

Metabolism of steroid hormones and most drugs.

Synthesizes essential blood proteins, including albumin and clotting factors

Detoxifies alcohol and other substances

Produces bile Minerals and fat

soluble vitamins are stored in the liver

Impaired protein metabolism with decreased production of albumin and clotting factors

What signs & symptoms would you expect?

Edema-why? Ascites-why? Risk for bleeding Alteration in blood glucose levels Reduced bile production impairs

absorption of lipids and fat-soluble vitamins

Femininazation in men, irregular menses in women ( due to impaired metabolism of steroid hormones)

Enlarged tender liver JaundicePortal hypertensionEsophageal varicesPortal systemic encephalopathy

( hepatic encephalopathy)AsterixisHepatorenal syndrome

Stage I- ProdromalStage II- ImpendingStage III- StuporousStage IV- Comatose

In early stages, signs of liver disease include: Fatigue Significant change in weight GI symptoms Abdominal pain and liver tenderness Pruritus

In late stages, the signs vary: Jaundice and icterus Dry skin Rashes Petechiae, or ecchymosis (lesions) Warm, bright red palms of the hands Spider angiomas Peripheral dependent edema of the

extremities and sacrum

Assess nasogastric drainage, vomitus, and stool for presence of blood

Fetor hepaticus ( musty breath odor)

Amenorrhea Gynecomastia, testicular atrophy,

impotence Bruising, petechiae, enlarged spleen Neurologic changes

Most common cause cirrhosisOther causes:Biliary cirrhosisHepatitis B or C

End stage of liver disease: progressive, irreversible

Most common cause of liver diseaseAlcoholic cirrhosis most common

type of cirrhosis in North America and many parts of Europe and South America

Functional liver tissue is gradually destroyed

Blood can no longer flow freely due to fibrous connective tissue formation

Restricted blood flow causes portal hypertension

Populations at risk:Excessive alcohol consumptionWomen develop cirrhosis at overall

lower levels of alcohol use IV drug use

DiureticsNitrate and ammonia reducing drugsBeta blockers Iron, Vitamin KAntacids

Restricted Sodium and Fluid intakeVitamin Mineral supplementsCaloric intakeLiver transplantParacentesisGastric lavageBalloon tamponadeTIPS

Considering the clinical manifestation of liver disease you tell me!

Nutrition therapy consists of low sodium diet, limited fluid intake, vitamin supplements.

Drug therapy includes a diuretic, electrolyte replacement.

Paracentesis is the insertion of a trocar catheter into the abdomen to remove and drain ascitic fluid from the peritoneal cavity.

Observe for possibility of impending shock.

Interventions include: Identifying the source of bleeding and

initiating measures to halt it▪ Massive esophageal bleeding▪ Esophageal varices

Interventions include: Role of ammonia Reduction of ammonia levels Nutrition therapy using simple and brief

guidelines Drug therapy:▪ Lactulose▪ Neomycin sulfate▪ Metronidazole

Mr. Morris was brought to the Emergency Room by ambulance this morning after he began to vomit profuse amounts of red blood at home. Immediate treatment includes a type and crossmatch for a unit of blood. The history elicited from Mrs. Morris reveals that her husband is a 52-year-old repairman with an eighteen year history of alcoholism. She insists, however that he has not drunk alcohol since joining Alcoholics Anonymous a year ago. Upon further questioning, Mrs. Morris says that for the past few months her husband had had a very poor appetite, and has complained of fatigue, indigestion and forgetfulness. Mr. Morris is thin and jaundiced with a noticeably protruding abdomen. You have been informed that Mr. Morris will be sent to your unit where you have been assigned as his primary care nurse.

a) What medications might you expect to administer to Mr. Morris?b) What are your top 3 priority interventions for Mr. Morris?c) What teaching would you like to provide to Mr. Morris?

Incubation period for hepatitis A is 15 to 50 days.

Disease is usually not life threatening.

Disease may be more severe in individuals older than 40 years.

Many people who have hepatitis A do not know it; symptoms are similar to a GI illness.

Spread is via unprotected sexual intercourse with an infected partner, sharing needles, accidental needle sticks, blood transfusions, hemodialysis, maternal-fetal route.

Symptoms occur in 25 to 180 days after exposure; symptoms include anorexia, nausea and vomiting, fever, fatigue, right upper quadrant pain, dark urine, light stool, joint pain, and jaundice

Hepatitis carriers can infect others, even if they are without symptoms

Spread is by sharing needles, blood, blood products, or organ transplants (before 1992), needle stick injury, tattoos, intranasal cocaine use.

Incubation period is 21 to 140 days. Most individuals are asymptomatic;

damage occurs over decades. Hepatitis C is the leading indication for

liver transplantation in the United States.

What are we doing?

The liver is one of the most common organs to be injured in patients with abdominal trauma.

Clinical manifestations include abdominal tenderness, distention, guarding, rigidity.

Treatment involves surgery, multiple blood products.

Used in the treatment of end-stage liver disease, primary malignant neoplasm of the liver

Donor livers obtained primarily from trauma victims who have not had liver damage

Donor liver transported to the surgery center in a cooled saline solution that preserves the organ for up to 8 hours

Acute, chronic graft rejection InfectionHemorrhageHepatic artery thrombosisFluid and electrolyte imbalancesPulmonary atelectasisAcute renal failurePsychological maladjustment