LIVER
LARGEST GLAND IN THE BODY, 3-4 LBS. CARBOHYDRATES ARE ALSO PRODUCED IN THE LIVER.
THE LIVER PLAYS AN IMPORTANT ROLE IN DETOXIFYING THE BODY BY CONVERTING WHICH BYPRODUCT OF METABOLISM?
AMONIA
WHAT VITAMIN ARE STORED IN THE LIVER?
B12, FOLIC ACID, IRON, VITAMIN A, D AND VITAMIN K
GALLBLADDER
IS A PEAR-SHAPED ORGAN UNDER THE LIVER THAT STORES BILE. IT RELEASES BILE THROUGH A TUBE CALLED THE COMMON BILE DUCT
BILE
FLUID MADE BY THE LIVER TO DIGEST FAT
LIVER FUNCTION TESTS
HELP DETECT LIVER DAMAGE. THESE BLOOD TESTS MEASURE THE LEVELS OF CERTAIN PROTEINS AND ENZIMES IN YOUR BLOOD.
LIVER ENZYME TESTS
ALAINE TRANSAMINASE(ALT)
ASPARTATE TRANSAMINASE(AST)
BOTH ARE INCREASED IN HEPATITIS OR CIRRHOSIS:
ALT
AST
HIGH LEVELS OF ALP AND GGT CAN BE SIGN OF:
LIVER BILE DUCT DAMAGE
TWO MAIN PROTEINS FOUND IN THE BLOOD:
GLOBULIN, AND ALBUMIN
LOW ALBUMIN LEVELS CAN BE A SIGN OF:
LIVER DAMAGE
INCREASED LEVEL IN DEHYDRATION AND DIARRHEA
ALBUMIN
AMMONIA
BY- PRODUCT OF PROTEIN CATABOLISM. METABOLIZED BY THE LIVER AND EXCRETED BY THE KIDNEYS AS UREA
ELEVATED LEVELS MAY LEAD TO ENCEPHALOPATHY
NORMAL VALUE 10-80 mcg / dL
CIRRHOSIS
CHRONIC DEGENERATIVE DISEASE OF THE LIVER.
SCAR TISSUE RESTRICTS THE FLOW OF BLOOD TO THE LIVER
TYPES OF CIRRHOSIS:
LAENNEC'S
POSTNECROTIC
PRIMARY BILIARY
SECONDARY BILIARY
CIRRHOSIS LATER CLINICAL MANIFESTATIONS:
JAUNDICE, CHANGES IN MENTAL RESPONSIVENESS AND MEMORY
SPIDER ANGIOMAS IN FACE, NECK, SHOULDERS
ANEMIA, ASCITES, EDEMA, HEPATOMEGALY SPLENOMEGALY.
COMPLICATIONS OF CIRRHOSIS
PORTAL HYPERTENSION, ASCITES, ESOPHAGEAL VARICES, HEPATIC ENCEPHALOPATHY
PORTAL HYPERTENSION
PERSISTENT INCREASE PRESSURE WITHIN THE PORTAL VEIN THAT DEVELOPS AS A RESULT OF OBSTRUCTION TO FLOW
ASCITES
ACCUMULATION OF FLUID AND ALBUMIN IN THE PERITONEAL CAVITY. DAMAGED LIVER CAN'T METABOLIZE PROTEIN SO PROTEIN INTAKE MAY RESULT IN ELEVATED AMMONIA LEVELS,
IF PATIENT IS PRESCRIBED SIMVASTATIN (ZOCOR) TO LOWER CHOLESTEROL:
GIVE MED. AT BEDTIME OR WITH EVENING MEAL
CLINICAL MANIFESTATIONS/ASSESSMENT OF CIRRHOSIS:
LIVER IS FIRM AND EASY TO PALPATE
SPIDER TELANGIECTASIS
ANEMIA
BLEEDING TENDENCIES
EPISTAXIS
PETECHIA
JAUNDICE
PURPURA
HEMATURIA
BLEEDING GUMS
DISORIENTATION
SPIDER TELANGIECTASIS
SMALL DILATED VESSELS
BLEEDING TENDENCIES
BRUISING AND FREQUENT NOSEBLEEDS
PETECHIA
PURPLISH OR REDDISH SPOT DUE TO IMPAIRED COAGULATION FROM LIVER
NURSING INTERVENTIONS FOR CIRRHOSIS
ANTIEMETICS. BENADRYL AND DRAMAMINE
CONTRAINDICATED: VISTARIL, COMPAZINE, AND ATARAX
PT'S WITH CIRRHOSIS:
ADMINISTER FUROSEMIDE TO REDUCE ACCUMULATION IN THE ABDOMEN
IMPLEMENT A LOW-SODIUM DIET TO CONTROL FLUID ACCUMULATION
MEASURE ABDOMINAL GIRTH TO DETERMINE FLUID ACCUMULATION
CAUSE OF CIRRHOSIS:
ELIMINATE IT; ALCOHOL
HEPATOTOXINS
ENVIROMENTAL EXPOSURE TO HARMFUL CHEMICALS
DIET FOR CIRRHOSIS
WELL BALANCED
HIGH IN CALORIES
MODERATE IN PROTEIN
LOW IN FAT
LOW IN SODIUM REDUCES EDEMA
LOW PROTEIN(BREAKS DOWN TO AMONNIA)
SUPPLEMENTAL VITAMINS AND FOLIC ACID
TREATMENT OF COMPLICATIONS OF CIRRHOSIS
ASCITES
BEDREST
STRICT I&O
RESTRICT FLUIDS AND SODIUM
DIURETICS, ALDACTONE, LASIX, HCTZ
VITAMINS K, C, AND FOLIC ACID SUPPLEMENTS
LEVEEN PERITONEAL, JUGULAR SHUNT
PARACENTESIS
ABDOMINAL PARACENTESIS
REMOVAL OF ASCITIC FLUID
ASEPTIC TECHNIQUE
EMPTY BLADDER BEFORE PROCEDURE
PATIENT SITS UPRIGHT
HEPATIC ENCEPHALOPATHY
DECREASE PROTEIN IN DIET, (AS LIVER CAN ONLY METABOLIZE A SMALL AMOUNT OF PROTEIN AT A TIME). ENCEPHALOPATHY PROGRESSS TO COMA DUE TO HIGH LEVELS OF AMMONIA