Nursing Assessment and Management of Hepatic Disorders

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Questions and Answers

What is the primary reason why liver disorders are common?

Exposure to toxic substances

Viral infections

Tumors

All of the above (correct)

Which of the following is a function of the liver in the regulation of metabolism?

Production of hormones

Synthesis of proteins

Transformation of nutrients (correct)

Storage of glucose

What is the approximate weight of the liver?

1200-1500 g (correct)

1000-1200 g

800-1000 g

1500-1800 g

What is the primary role of bile in the GI tract?

Digestion and absorption of fats Signup and view all the answers

Where is the liver located in the body?

Behind the ribs in the upper right portion of the abdominal cavity Signup and view all the answers

How many lobes is the liver divided into?

4 Signup and view all the answers

What is the primary function of the gallbladder in relation to bile?

To store bile until it is needed for digestion Signup and view all the answers

Which of the following is a manifestation of hepatic dysfunction?

Chronic liver disease Signup and view all the answers

What is the most common cause of parenchymal damage leading to hepatocellular dysfunction?

Malnutrition related to alcoholism Signup and view all the answers

What is the role of the liver in ammonia conversion?

To convert ammonia into urea Signup and view all the answers

Which of the following is NOT a function of the liver?

Muscle contraction Signup and view all the answers

What is the ratio of chronic liver disease rates in men compared to women?

2:1 Signup and view all the answers

What is the primary mechanism by which fluid accumulates in the peritoneal cavity in patients with liver damage?

Sodium and water retention, increased intravascular fluid volume, and decreased synthesis of albumin Signup and view all the answers

What is a common complication of ascites in patients with cirrhosis?

Umbilical hernia Signup and view all the answers

What is the primary cause of portal hypertension in liver disease?

Obstruction of blood flow through the damaged liver Signup and view all the answers

What is the primary method used to assess the presence and extent of ascites?

Percussion of the abdomen Signup and view all the answers

Which of the following is a suspected causative factor in the development of ascites?

Vasodilation in the splanchnic circulation Signup and view all the answers

What is a common presenting symptom of ascites?

Increased abdominal girth Signup and view all the answers

What is the result of the liver's failure to metabolize aldosterone?

Increased sodium and water retention by the kidney Signup and view all the answers

What is a common finding on physical examination of patients with ascites?

Distended veins over the abdominal wall Signup and view all the answers

What are the two major consequences of portal hypertension?

Ascites and varices Signup and view all the answers

What is a potential complication of ascites:

Fluid and electrolyte imbalances Signup and view all the answers

What is the consequence of the inability of damaged liver cells to metabolize certain vitamins?

Nutritional deficiencies Signup and view all the answers

What is the term for the increased pressure throughout the portal venous system?

Portal hypertension Signup and view all the answers

Study Notes

Introduction to Hepatic Disorders

Liver function is complex, and liver dysfunction affects all body systems.
Liver disorders are common and may result from a virus, exposure to toxic substances, or tumors.

Anatomic and Physiologic Overview of the Liver

The liver is a large, highly vascular organ located behind the ribs in the upper right portion of the abdominal cavity.
It weighs between 1200 and 1500 g and is divided into four lobes.
The liver is a chemical factory that manufactures, stores, alters, and excretes a large number of substances involved in metabolism.
The liver receives nutrient-rich blood directly from the gastrointestinal (GI) tract and then either stores or transforms these nutrients into chemicals used elsewhere in the body for metabolic needs.
The liver is especially important in the regulation of glucose and protein metabolism.
The liver manufactures and secretes bile, which has a major role in the digestion and absorption of fats in the GI tract.
The liver removes waste products from the bloodstream and secretes them into the bile.

Functions of the Liver

Glucose metabolism
Ammonia conversion into urea
Protein metabolism
Fat metabolism
Vitamin and iron storage
Bile formation
Bilirubin excretion
Drug metabolism

Manifestations of Hepatic Dysfunction

Hepatic dysfunction results from damage to the liver's parenchymal cells, directly from primary liver diseases, or indirectly from obstruction of bile flow or derangements of hepatic circulation.
Liver dysfunction may be acute or chronic, with chronic liver disease being more common.
The rate of chronic liver disease is twice as high in men as in women, and more common in Asian and African countries than in Europe and the United States.

Ascites

Ascites is the accumulation of fluid in the peritoneal cavity, which can occur due to liver damage, cancer, kidney disease, or heart failure.
Sodium and water retention, increased intravascular fluid volume, increased lymphatic flow, and decreased synthesis of albumin by the damaged liver contribute to the movement of fluid from the vascular system into the peritoneal space.
Large amounts of albumin-rich fluid, 15 L or more, may accumulate in the peritoneal cavity as ascites.

Clinical Manifestations of Ascites

Increased abdominal girth and rapid weight gain are common presenting symptoms of ascites.
Patients may experience shortness of breath and discomfort from the enlarged abdomen, with striae and distended veins visible over the abdominal wall.
Umbilical hernias also occur frequently in those patients with cirrhosis.

Assessment and Diagnostic Findings

The presence and extent of ascites are assessed by percussion of the abdomen.
When fluid has accumulated in the peritoneal cavity, the flanks bulge when the patient assumes a supine position.
The presence of fluid can be confirmed by percussing for shifting dullness or by detecting a fluid wave.

Portal Hypertension

Portal hypertension is the increased pressure throughout the portal venous system that results from obstruction of blood flow through the damaged liver.
Commonly associated with hepatic cirrhosis, it can also occur with non-cirrhotic liver disease.
The two major consequences of portal hypertension are ascites and varices.

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Description

This quiz assesses the nurse's understanding of liver function and dysfunction, as well as their clinical assessment and management skills in caring for patients with liver disorders. It covers the common causes of liver disorders, including viral infections, toxic substances, and tumors.