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Livers main functions
- blood filter
- glucose....stored as glycogen
- vitamins ABDK
What happens when ammonia levels are too high?
What happens when V. D isnt around?
cant absorb calcium....hypocalcemia
LIver is important to make bile soooo....
we can emulcify fats.
so fat soluble things can be converted to water soluble products and then excreted in the urine
How does the liver detoxify the body?
- uses Kupffer cells (phagocytes) to remove bacteria
- breaks down drugs for excretion
- catabolizes hormones
What is so important about the liver catabolizing hormones?
If hormones dont get broken down they will continue to have their effect on the body.
males-have estrogen/progesterone.....doesnt get removed they will grow boobs (gynohermastia)
females-have testosterone and doesnt get removed they will have facial hair (hirtshuim)
How much liver do we need to have functioning to survive?
only 10%....and the liver regnerates itself. So stop drinking now!!
What is cirrhosis?
irreversible chronic inflammatory disease
characterized by massive degeneration and destruction of hepatocytes, resulting in a disorganized lobular pattern of regneration
caused by alcohol
liver cells become damaged and die. Fibrotic tissue replaces liver cells, causing the liver to shrink. Liver becomes unable to carry out its functions
begins with inflammation or obstruction, and intrahepatic bile duct destruction....chronic obstruction causes increased pressure in the bile ducts causing an accumulation of bile. Necrosis to edema to fibrosis....scar tissue causes destruction of liver
result is portal hypertension and liver failure
seen in persons with severe right sided heart failure causing high pressure in the IVC....heart cant pump blood in to circulation, causing the liver to become anoxic...resulting in necrosis and fibrosis
2 ways to get liver failure that is common.....
- Hepatitis from tattoos
- drug overdose....tylenol
Early symptoms of liver failure
- weight loss
- ascites.....causing abdominal discomfort/anorexia
- lack of energy
Cardiovascular symptoms of liver failure
- warm, flushed skin
- htn...but then decreases
- bounding pulses
- Portal hypertension
- activity intolerance
Why do you see dysrhythmias with liver failure?
changes in electrolytes....K
Respiratory problems seen with liver failure
- breathe rapidly and shallow
- Ineffective breathing pattern
How can ascites affect a persons breathing?
fluid puts pressure on the diaphragm and prevents the lungs from expanding normally
result is dyspnea and hyperventilation
Renal issues from liver failure?
causes decreased renal perfusion so have decreased UO
Neurologic symptoms from liver failure
- range from irritated and restless to coma
- most occur from accumulation of ammonia causing encephalopathy
Hematologic problems seen with liver failure?
deficient in clotting factors
so the person will bleed....which will increase ammonia....which will cause encephalopathy
Protein and the liver....
when a person starts to have liver issues they are encouraged to have a diet high in protein. But once encephalopathy occurs, then they can not eat protein anymore
Person with clotting problems will show this how?
- gingival bleeding
ADH and liver failure
- initially na and water retention occur in the intravascular spaces from decreased metabolism of ADH.
- As the liver becomes congested and portal pressure increases the fluid will seep into the peritoneal cavity (ascites) and plasma volume will decrease
- When plasma volume decreases the compensatory mech. of releasing ADH occurs causing more water and sodium retention, resulting in dilutional HYPONATREMIA
K, Ca and Mag with liver failure
Hypokalemia from diarrhea, aldosterone accum and diuretics
Hypocalcemia from decreased dietary intake and decreased absorption of V. D
Hypomagnesia from the livers inability to store magnesium
fecal breath odor from sever liver failure and accumulation of Methyl-mercaptan
Portal hypertension causes....
Infection and liver failure
because there is dysfunction in the filtering of Kupffer cells, which are phagocytes....they are more likely to get infections
Dermatologic symptoms of liver failure
- jaundice from accumulation of billi
- palmar erythema-red soles of feet
- spider angioma
Where will you see jaundice first?
submucosal area of the tongue
What predisposes a person with liver failure to emboli?
the liver will lose it's ability to remove activated clotting factors from the blood....=clots
How do you become malnourished with liver failure?
- liver cant metabolise and store:
- V. A, B12, D
S/S of encephalopathy
- slurred speech
- impaired decision making
How do you remove fluid in the abdomen (ascites)? But then what?
person will be able to breathe better and BP will decrease from decreased pressure in the abdomen...but they may tank, so give them albumin before to help them maintain BP
Supplemental vitamins to give person with liver failure
People with liver failure will have impaired skin integrity....how do I help with this
- turn frequently
- massage bony prominences
- keep skin clean and dry
Patients with ascites need to remove.....from their diet?
Antidote for acetaminophen OD?
Mucomyst...given over several days
7.5 grams of Tylenol is lethal