Liver Functions and Disorders: Hepatitis & Cirrhosis

The liver stores glycogen, metabolizes drugs and fats, detoxifies ammonia, and produces bile, clotting factors, and albumin.

Albumin transports drugs, attracts water, and binds calcium for bone strength.

Bile collects bilirubin and cholesterol and excretes them through the gastrointestinal system.

Clotting factors regulate PT, PTT, and INR.

The liver converts ammonia (a byproduct of protein breakdown) into urea, which the kidneys excrete.

The liver converts old red blood cells to bilirubin and excretes it via stool.

Inflammation of the liver, which can be viral, idiopathic, drug-induced, autoimmune, or alcohol-related.

Hepatitis severity ranges from mild, which impairs hepatocyte function, to moderate, possibly obstructing blood and bile flow, to severe, causing cirrhosis, liver cancer, or liver failure.

Hepatitis viruses enter the body through the hepatic portal venous system, reaching the liver, where they bind to receptors on hepatocytes and enter through endocytosis.

Unprotected sex, contact with blood, substance use disorder, birth, tattoos, hemodialysis, and unscreened blood are some of the risk factors for chronic hepatitis.

Hepatitis C treatment options include peginterferon alfa 2-a and ribavirin combination therapy.

Hepatitis B treatment includes hepatitis B immunoglobulin therapy, given within 24 hours after exposure.

Hepatitis B and C can exist in a carrier state where the infected person is asymptomatic and may be unaware they have the virus, even if they have a chronic low-grade infection.

Universal precautions are crucial in healthcare settings to prevent the spread of hepatitis B and C due to the potential for asymptomatic carriers.

Hepatitis B is significantly more infectious than Hepatitis C and HIV.

Hepatitis B can be transmitted from a birthing parent to the baby, with a high risk of the baby developing chronic Hepatitis B.

Hepatitis C is now curable with Direct Acting Antivirals (DAAs). Treatment is typically 8-12 weeks and patients report minimal side effects.

A significant challenge in treating Hepatitis C is that 44% of people with the virus are unaware they have it.

A rare but life-threatening complication of Hepatitis, where severe liver failure occurs rapidly over hours to days.

Symptoms include malaise, flu-like symptoms, nausea, vomiting, diarrhea, low appetite, joint pain, low-grade fever, clay stools, dark urine, jaundice, RUQ tenderness, hepatomegaly.

Indicates an active Hepatitis A infection.

Indicates recovery from or immunity to Hepatitis B.

A small piece of liver tissue is removed and examined to assess the extent of liver damage.

Hepatitis B can be spread through contact with infected blood or bodily fluids, such as sharing needles for drug use, having unprotected sex with an infected person, or using a razor used by someone with hepatitis B.

Cirrhosis occurs when healthy liver tissue is replaced by scar tissue, often caused by chronic hepatitis B or C infections.

Portal hypertension is increased pressure in the portal vein, caused by scar tissue in the liver that restricts blood flow. This can lead to fluid buildup in the abdomen and other complications.

Esophageal varices are enlarged, thinned veins in the esophagus caused by portal hypertension. They can rupture, leading to bleeding and potentially fatal complications.

Ascites is fluid buildup in the peritoneal cavity due to portal hypertension and low albumin levels.

Hepatic encephalopathy is brain dysfunction caused by the buildup of ammonia in the bloodstream when the liver cannot detoxify it.

Hepatitis B is preventable by vaccination. Vaccination is highly effective in protecting against infection.

Ammonia accumulates in the blood because the liver can't detoxify it.

Involuntary jerking movements of the hands, a sign of liver failure.

The liver breaks down estrogen, so when it's impaired, estrogen levels increase.

Progressive kidney failure that occurs alongside liver failure.

Tremors, itchy skin, jaundice, confusion, ascites, edema, enlarged breasts in men, and more.

Low protein, low fat, high carbohydrate, and high calorie, with vitamin and mineral supplements.

High AST, ALT, bilirubin; Low albumin, calcium, and platelets; High PT/PTT/INR.

Shunting surgery, TIPS procedure, endoscopic variceal ligation.

A shunt is a medical procedure used to reroute blood flow around the liver to reduce pressure and potentially prevent bleeding from varices. It allows some blood to bypass the liver and reduce the pressure in the portal vein.

A liver transplant is a complex procedure with strict guidelines. Candidates must be medically stable with no severe cardiac or respiratory issues, metastatic cancers, or uncontrolled substance use.

Paracentesis is the draining of fluid from the abdominal cavity (ascites) using a needle. Before the procedure, the bladder should be emptied to prevent accidental puncture. Vital signs should be monitored, especially blood pressure, which may decrease as fluid is drained.

Lactulose is a medication used to treat hepatic encephalopathy, a brain disorder related to liver dysfunction. It works by decreasing ammonia levels in the blood by promoting its excretion through stool. Careful monitoring for low potassium levels (hypokalemia) is necessary.

Individuals with cirrhosis should avoid taking acetaminophen (Tylenol) due to impaired liver function, which can lead to severe damage and liver failure.

Viral infections that cause inflammation of the liver, spread through the fecal-oral route. They are acute only and do not progress to chronic stages.

Ingestion of contaminated food and water, contact with infected stool, crowded conditions.

Vaccination for Hep A, Immunoglobulin within 2 weeks post-exposure for Hep A.

Jaundice, dark urine, clay-colored stools, abdominal pain, fatigue, loss of appetite.

Supportive care, rest, fluids, and avoiding alcohol.

Albumin is produced by the liver and plays a crucial role in transporting drugs and hormones throughout the body, attracting water to maintain blood volume, and binding calcium for strong bones.

Ammonia is a waste product of protein breakdown. The liver converts harmful ammonia into urea, which is safely excreted by the kidneys.

Red blood cell breakdown releases bilirubin. The liver converts old red blood cells into bilirubin and excretes it through the stool, giving it its characteristic brown color.

The hepatic portal vein transports nutrient-rich blood from the gastrointestinal system to the liver. This allows the liver to filter and process nutrients before they enter the general circulation.

Hepatitis is inflammation of the liver, causing varying degrees of damage. It has several causes, including viral infections, autoimmune diseases, and drug toxicity.

Hepatitis can be caused by different factors, including viral infections (A, B, C, D, E), autoimmune disorders, drug toxicity, and alcohol abuse.

Depending on the severity, hepatitis can progress from mild, causing impaired liver function, to moderate, obstructing blood and bile flow, to severe, leading to cirrhosis, cancer, and liver failure.

Hepatic encephalopathy is brain dysfunction caused by a buildup of ammonia in the bloodstream. The liver is normally responsible for detoxifying this waste product.

Common symptoms of hepatitis B include fatigue, loss of appetite, nausea, vomiting, abdominal pain, jaundice (yellowing of the skin and eyes), dark urine, and clay-colored stools.

Hepatitis C is now curable with Direct Acting Antivirals (DAAs). Treatment is typically 8-12 weeks and patients report minimal side effects.

A significant challenge in treating Hepatitis C is that 44% of people with the virus are unaware they have it.

Hepatitis D cannot occur without Hepatitis B! The best prevention is the Hepatitis B vaccine.

The best prevention is the Hepatitis B vaccine.

Viral infections that cause inflammation of the liver, spread through the fecal-oral route.

When the liver isn't working properly, it can't convert ammonia into urea, causing it to build up in the blood.

Involuntary flapping of the hands, a sign of liver failure indicating brain dysfunction due to ammonia buildup.

The liver breaks down estrogen. When it's damaged, estrogen levels rise, leading to symptoms like gynecomastia (breast enlargement in men), spider angiomas, and palmer erythema.

Progressive kidney failure that occurs alongside liver failure, often with a sudden decrease in urine output.

Symptoms of severe liver scarring include tremor, itchy skin, jaundice, confusion, ascites, edema, enlarged breasts in men, and more.

A low-protein, low-fat, high-carbohydrate, and high-calorie diet with vitamin and mineral supplements is recommended for cirrhosis.

Treatment options for cirrhosis include shunting surgery, TIPS procedure, and endoscopic variceal ligation.

A shunt creates a new channel to reroute blood flow around the liver. This bypasses the damaged liver and reduces pressure in the portal vein, potentially preventing bleeding from varices.

Patients with cirrhosis have a weakened liver that can't process medications like acetaminophen effectively. Taking it can lead to severe liver damage and failure.

Paracentesis involves draining fluid from the abdomen (ascites) using a needle. It's crucial to ensure an empty bladder before the procedure and monitor vital signs throughout.

Lactulose is a medication used to decrease ammonia levels in the blood. Ammonia buildup can lead to brain dysfunction in liver disease. Lactulose helps excrete ammonia through stool.

Nursing actions for ascites include monitoring daily weight, measuring abdominal girth, assessing respiratory status, and assisting the client with care as needed.