1. Interventions for Clients with Liver Problems

3. Cirrhosis
Cirrhosis is extensive scarring of the liver, usually caused by a chronic irreversible reaction to hepatic inflammation and necrosis.
Complications depend on the amount of damage sustained by the liver.
In compensated cirrhosis, liver has significant scarring but performs essential functions without causing significant symptoms.
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6. Complications Portal hypertension Ascites Bleeding esophageal varices
Coagulation defects
Jaundice
Portal-systemic encephalopathy with hepatic coma
Hepatorenal syndrome
Spontaneous bacterial peritonitis

10. Physical diagnosis of liver diseases

11. Clinical Manifestations
In early stages, signs of liver disease include:
Fatigue
Significant change in weight
Gastrointestinal symptoms
Abdominal pain and liver tenderness
Pruritus

12. Clinical Manifestations
In late stages, the signs vary:
Jaundice and icterus
Dry skin
Rashes
Petechiae, or ecchymoses (lesions)
Warm, bright red palms of the hands
Spider angiomas
Peripheral dependent edema of the extremities and sacrum

13. Abdominal Assessment Massive ascites Umbilicus protrusion
Caput medusae (dilated abdominal veins)
Hepatomegaly (liver enlargement)

14. Laboratory Assessment
Aminotransferase serum levels and lactate dehydrogenase may be elevated.
Alkaline phosphatase levels may increase.
Total serum bilirubin and urobilinogen levels may rise.
Total serum protein and albumin levels decrease.
(Continued)

15. Laboratory Assessment (Continued)
Prothrombin time prolonged; platelet count low
Decreased hemoglobin and hematocrit values and white blood cell count
Elevated ammonia levels
Serum creatinine level possibly elevated
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16. Management of Hemorrhage
Blood transfusions
Endoscopic procedures
Transjugular intrahepatic portal-systemic shunt
Surgical management

17. Potential for Portal-Systemic Encephalopathy
Interventions include:
Role of ammonia
Reduction of ammonia levels
Diet therapy using simple and brief guidelines
Drug therapy:
Lactulose
Neomycin sulfate
Metronidazole
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18. Hepatitis Widespread viral inflammation of liver cells Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis D
Hepatitis E
Hepatitis F and G are uncommon

19. Hepatitis A
Similar to that of a typical viral syndrome; often goes unrecognized
Spread via the fecal-oral route by oral ingestion of fecal contaminants
Contaminated water, shellfish from contaminated water, food contaminated by handlers infected with hepatitis A
Also spread by oral-anal sexual activity
(Continued)
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20. Hepatitis A (Continued)
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 of age.
Many people who have hepatitis A don’t know it; symptoms are similar to a gastrointestinal illness.

22. Hepatitis B
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.
(Continued)
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23. Hepatitis B (Continued)
Hepatitis carriers can infect others, even if they are without symptoms.

28. Hepatitis C
Spread is by sharing needles, blood, blood products, or organ transplants (prior to 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 U.S.
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31. Hepatitis D Transmitted primarily by parenteral routes
Incubation period 14 to 56 days
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32. Hepatitis E
Present in endemic areas where waterborne epidemics occur and in travelers to those areas
Transmitted via fecal-oral route
Resembles hepatitis A
Incubation period 15 to 64 days
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33. Clinical Manifestations
Abdominal pain
Changes in skin or eye color
Arthralgia (joint pain)
Myalgia (muscle pain)
Diarrhea/constipation
Fever
Lethargy
Malaise
Nausea/vomiting
Pruritus

34. Fatty Liver (Steatohepatitis)
Fatty liver is caused by the accumulation of fats in and around the hepatic cells.
Causes include:
Diabetes mellitus
Obesity
Elevated lipid profile
Many clients are asymptomatic.

35. Hepatic Abscess Liver invaded by bacteria or protozoa causing abscess
Pyrogenic liver abscess; amebic hepatic abscess
Treatment usually involves:
Drainage with ultrasound guidance
Antibiotic therapy
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36. Liver Trauma
The liver is the most common organ injured in clients with penetrating trauma of the abdomen, such as gunshot wounds and stab wounds.
Clinical manifestations include abdominal tenderness, distention, guarding, rigidity.
Treatment involves surgery, multiple blood products.

37. Cancer of the Liver One of the most common tumors in the world
Most common complaint: abdominal discomfort
Treatment includes:
Chemotherapy
Surgery
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43. Liver Transplantation
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
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44. Complications Acute, chronic graft rejection Infection Hemorrhage
Hepatic artery thrombosis
Fluid and electrolyte imbalances
Pulmonary atelectasis
Acute renal failure
Psychological maladjustment