1750: Hepatic disorders

š80% of circulation comes from portal vein (brings in nutrients)

š20% of circulation comes from hepatic artery

šCapable of regeneration

šSteroid, CHO, protein & fat metabolism.

šDetoxification

šBile production and excretion

šStorage

šPhagocyte system

šConverts ammonia to urea 

šMetabolize & eliminate bilirubin

šSerum protein studies -albumin

šDirect & indirect serum bilirubin, urine bilirubin & urobilinogen

šCBC with platelets

šCoagulation studies

šProthrombin

malnutrition RT alcoholism

šAcute or chronic cirrhosis of liver

šHepatitis

šViral

šAnoxia

šMetabolic disorders

šNutritional deficiencies

šJaundice (yellow discoloration of the skin d/t build up of bilirubin)

šPortal HTN (increased pressure in the capillaries) results in ascites, and varices

šHepatic encephalopathy (build up of toxins in the brain d/t dysfunction of the liver to clear toxins leading to toxic circulation) or coma

šNutritional deficiencies (malnourished d/t liver's impairment of processing nutrients)

šYellow- or green-tinged sclera and skin caused by increased serum bilirubin levels

šHemolytic, *hepatocellular, *obstructive

šHereditary hyperbilirubinemia

Hepatocellular and obstructive jaundice are most associated with liver d

šMild or severely ill

šLack of appetite, N/V, weight loss

šMalaise, fatigue, weakness

šHeadache, chills, fever, infection

šDark, orange-brown urine, clay-colored stools

šDyspepsia and intolerance of fats, impaired digestion

šPruritus

šObstructed blood flow through the liver results in increased pressure throughout the portal venous system

Cirrhosis slows the normal blood flow through the liver, thus increasing pressure in the vein that brings blood from the intestines and spleen to the liver.

šAffects veins in esophagus causing esophageal varices (enlarged veins), rectum and abdomen

šCauses fluids to be pushed out of capillaries leading to third spacing (ascites)

šPortal HTN resulting in increased capillary pressure and obstruction of venous blood flow

šVasodilatation of the major abdominal organs

šChanges in the ability to metabolize aldosterone, increasing fluid retention

šDecreased synthesis of albumin, decreasing serum osmotic pressure

šMovement of albumin into the peritoneal cavity

šLow-sodium diet

šDiuretics

šBed rest

šParacentesis

šAdministration of salt-poor albumin

• šTransjugular intrahepatic portosystemic
• shunt (TIPS)

Spironolatone (Aldactone)

šOccurs in about 1/3 of patients with cirrhosis and varices

šFirst bleeding episode has a mortality rate of 30% - 50%

šManifestations: hematemesis, melena, general deterioration, and shock

šPts w/ cirrhosis should undergo screening endoscopy q2 years

šTreat for shock; administer oxygen

šIV fluids, electrolytes, volume expanders, blood and blood products

• šVasopressin, somatostatin, octreotide to
• decease bleeding

šNitroglycerin in combination with vasopressin to reduce coronary vasoconstriction

šPropranolol and nadolol to decrease portal pressure; used in combination with other treatment

• šViral hepatitis: a systemic viral infection that causes necrosis and inflammation of
• liver cells with characteristic sx and cellular and biochemical changes.

šA and E: fecal–oral route; contaminated food (E is not chronic)

šB and C: bloodborne

šD: only people with hepatitis B are at risk

šHepatitis G and GB virus-C

šSpread by poor hand hygiene; fecal–oral

šIncubation: 15 to 50 days

šIllness may last 4 to 8 weeks

šMortality rate is 0.5% for those younger than age 40 years and 1% to 2% for those >40 yo

• šManifestations: mild flu-like sx, low-grade fever, anorexia, later jaundice and dark
• urine, indigestion and epigastric distress, enlargement of liver and spleen

šGood handwashing, clean water, & proper sewage disposal

šVaccine available.

šImmunoglobulinn for contacts to provide passive immunity

šBed rest during acute stage

šNutritional support

Bloodborne (like Hep C)

šinterferon & antiviral agents: lamivudine (Epivir), adefovir (Hepsera)

Vaccine available

Precautions: standard & infection control measures

Bloodborne

šAntiviral medications: interferon, ribavirin (Rebetol)

Caused by Portal HTN.

Blood is shunted into splenic vein.

Increased removal & destruction of RBCs & WBCs, & platelets.

• šMay lead to anemia, leukopenia, &
• thrombocytopenia