3.  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

4.  Impaired protein metabolism with decreased production of albumin and clotting factors  What signs & symptoms would you expect?

5.  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)

6.  Enlarged tender liver  Jaundice  Portal hypertension  Esophageal varices  Portal systemic encephalopathy ( hepatic encephalopathy)  Asterixis  Hepatorenal syndrome

7.  Stage I- Prodromal  Stage II- Impending  Stage III- Stuporous  Stage IV- Comatose

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

9.  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

10.  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

12.  Most common cause cirrhosis  Other causes:  Biliary cirrhosis  Hepatitis B or C

13.  End stage of liver disease: progressive, irreversible  Most common cause of liver disease  Alcoholic cirrhosis most common type of cirrhosis in North America and many parts of Europe and South America

16.  Functional liver tissue is gradually destroyed  Blood can no longer flow freely due to fibrous connective tissue formation  Restricted blood flow causes portal hypertension

17.  Populations at risk:  Excessive alcohol consumption  Women develop cirrhosis at overall lower levels of alcohol use  IV drug use

19.  Diuretics  Nitrate and ammonia reducing drugs  Beta blockers  Iron, Vitamin K  Antacids

20.  Restricted Sodium and Fluid intake  Vitamin Mineral supplements  Caloric intake  Liver transplant  Paracentesis  Gastric lavage  Balloon tamponade  TIPS

21.  Considering the clinical manifestation of liver disease you tell me!

22.  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.

23.  Interventions include:  Identifying the source of bleeding and initiating measures to halt it ▪ Massive esophageal bleeding ▪ Esophageal varices

24.  Interventions include:  Role of ammonia  Reduction of ammonia levels  Nutrition therapy using simple and brief guidelines  Drug therapy: ▪ Lactulose ▪ Neomycin sulfate ▪ Metronidazole

25. 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?

26.  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.

27.  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

28.  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.

30.  What are we doing?

31.  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.

32.  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

33.  Acute, chronic graft rejection  Infection  Hemorrhage  Hepatic artery thrombosis  Fluid and electrolyte imbalances  Pulmonary atelectasis  Acute renal failure  Psychological maladjustment