1. Interventions for Clients with Liver Cancer

3. Cancer of the Liver One of the most common tumors in the world Most common complaint: abdominal discomfort Treatment includes: –Chemotherapy –Surgery

9. 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

10. Complications Acute, chronic graft rejection Infection Hemorrhage Hepatic artery thrombosis Fluid and electrolyte imbalances Pulmonary atelectasis Acute renal failure Psychological maladjustment

11. 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.

14. Complications Portal hypertension Ascites Bleeding esophageal varices Coagulation defects Jaundice Portal-systemic encephalopathy with hepatic coma Hepatorenal syndrome Spontaneous bacterial peritonitis

18. Physical diagnosis of liver diseases

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

20. 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

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

22. 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)

23. 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

24. Management of Hemorrhage Blood transfusions Endoscopic procedures Transjugular intrahepatic portal- systemic shunt Surgical management

25. 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

26. Hepatitis Widespread viral inflammation of liver cells Hepatitis A Hepatitis B Hepatitis C Hepatitis D Hepatitis E Hepatitis F and G are uncommon

27. 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)

28. 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.

30. 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)

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

36. 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.

39. Hepatitis D Transmitted primarily by parenteral routes Incubation period 14 to 56 days

40. 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

41. Clinical Manifestations Abdominal pain Changes in skin or eye color Arthralgia (joint pain) Myalgia (muscle pain) Diarrhea/constipation Fever Lethargy Malaise Nausea/vomiting Pruritus

42. 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.

43. 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

44. 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.