Nursing Assessment and Management of Hepatic Disorders

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.