Liver Functions and Pathophysiology

Liver Functions

• Protein metabolism
• Ammonia conversion
• Hormone and Albumin production
• Clotting factor production
• Vitamin K and iron storage
• Glucose and fat metabolism
• Bile production, bilirubin excretion
• Drug metabolism
• Blood filtration.

Pathophysiology of Liver Disease

• Impaired protein metabolism
• Decreased ammonia conversion
• Reduced albumin and clotting factor production.
• Disrupted glucose and fat metabolism
• Reduced bile production and biliary excretion.
• Impaired steroid hormone metabolism

Risk Factors & Causes

• Alcohol-related liver damage
• Biliary obstruction (blocked bile ducts)
• Nonalcoholic fatty liver disease (obesity and high-fat diet)
• Hepatitis B and C infections
• Toxic medication effects
• Autoimmune conditions

Prevention Strategies

• Hepatitis B vaccination
• Safe medication use
• Routine healthcare exams
• Avoid excessive alcohol use and drug injection/needle sharing
• Reduce exposure to environmental toxins
• Maintain a healthy diet and manage weight

Clinical Manifestations

• Early-stage liver disease (compensated) is often asymptomatic but can present with fatigue, malaise, loss of appetite, and weight loss
• Advanced-stage liver disease (uncompensated) includes edema, ascites, increased bleeding/bruising, esophageal varices, gastrointestinal symptoms (gastritis, diarrhea, anorexia), jaundice, malnutrition, muscle wasting, neurological symptoms (asterixis, ataxia, encephalopathy), and splenomegaly

Collaborative Care

• Holistic approach addresses physiological, psychosocial, and spiritual well-being.
• Interventions :counseling, behavioral therapy, job coaching, and nutritional support.

Lab & Diagnostic Tests

• Liver function tests (AST, ALT)
• Complete blood count (CBC)
• Coagulation studies (PT, platelets)
• Serum markers (electrolytes, bilirubin, albumin, ammonia, glucose, cholesterol)
• Imaging (abdominal ultrasound, CT, MRI)
• Procedures (esophagoscopy for varices, liver biopsy)

Pharmacologic Therapies

• Diuretics like Spironolactone (Aldactone) and Furosemide (Lasix)
• Lactulose (Enulose) reduces ammonia levels.
• Beta-blockers (Nadolol/Corgard, Propranolol/Inderal) manage portal hypertension.
• Supplements include ferrous sulfate, folic acid, B-complex vitamins, B12, thiamin, Vitamins A, D, E, K

Nutritional Therapies

• Low sodium diet (<2g/day)
• Fluid restriction (1,000-1,500 ml/day)
• Adequate calories and protein (adjusted for encephalopathy)
• Moderate carbohydrate intake (50-70% of daily calories)
• Parenteral Nutrition (TPN) and vitamin/mineral supplementation may be needed

Surgical & Procedural Treatments

• Liver transplant
• Paracentesis (fluid removal for ascites)
• Balloon tamponade (for variceal bleeding)
• TIPS (transjugular intrahepatic portosystemic shunt) procedure

Lifespan Considerations

• Liver disease is a top 10 cause of death per CDC
• Biliary Atresia (infants & children): congenital bile duct obstruction leading to liver failure, symptoms appear at 2-3 weeks: jaundice, abdominal distension, hepatomegaly, clay-colored stools, tea-colored urine treated with surgical intervention or liver transplant.
• Cirrhosis (all ages): chronic progressive liver scarring leading to failure treated with symptom control or possible liver transplant.

Nursing Process

• Assessment includes health history (weight loss, abdominal pain, bleeding tendencies, jaundice alcohol/drug use, medication history) and physical examination (vital signs, mental status, abdominal girth edema, bruising, jaundice, hepatosplenomegaly).
• Nursing diagnoses include excess fluid volume, disturbed thought process, ineffective protection, impaired skin integrity, imbalanced nutrition, and risk for injury.
• Expected outcomes: health maintenance, complication prevention, weight/nutritional improvement, cessation of alcohol/drug use, skin integrity/bleeding risk reduction, and injury prevention
• Interventions: daily weights, abdominal girth measurement, low-sodium/protein-modified diet, neurological status monitoring (encephalopathy signs), prescribed medications, skin breakdown and injury prevention, and bleeding complications monitoring

Specific Liver Disease Complications

• Jaundice (Bilirubin >2.0 mg/dL) presents with yellowing skin/sclera, dark urine, light-colored stool, and itching
• Management: Short nails, warm baths, non-alcoholic/fragrance-free soaps/lotions
• Portal Hypertension: silent but progressive, leading to ascites, varices, hemorrhoids, treated with beta-blockers or TIPS.
• Splenomegaly:increased RBC, WBC, platelet destruction anemia, leukopenia, thrombocytopenia, monitor fatigue, infection and bleeding through labs
• Ascites: excess fluid in peritoneal cavity Increased abdominal girth, rapid weight gain, SOB Managed through low sodium diet, bed rest, diuretics (Spironolactone), respiratory status & labs
• Hepatic Encephalopathy: increased ammonia levels affect mental function mood/cognitive changes, asterixis, fetor hepaticus treated with lactulose, enteral/parenteral nutrition.
• Hepatorenal Syndrome: liver failure causes kidney dysfunction treated with albumin infusion, kidney perfusion support.