Liver and Pancreatic Problems
HEPATIC FUNCTION
CATEGORY DESCRIPTION
Carbohydrate Metabolism Glycogenesis( Conversion of glucose to glycogen)
Glycogenolysis ( Breakdown of glycogen to glucose)
Glucogeneogenesis ( formation of glucose)
Protein Metabolism Synthesis of nonessential amino acids and plasma proteins
Urea formation from NH3
Lipid, Lipoprotein Synthesis of lipoproteins
metabolism Breakdown of triglycerides
Ketone formation
Synthesis of fatty acids
Cholesterol synthesis and breakdown
Bile acid synthesis, Bile formation and excretion
Excretion
Storage Glucose storage
Storage of A, D, E, K, B1, B2, B12, Folic acids,Fatty Acids,
some minerals
Detoxification, Excretion Drugs, Procoagulants,Clotting factors
Pathogen Removal Macrophagic clearance of microorganisms
Steroid catabolism Conjugation , excretion of adrenal and gonad steroids
Cirrhosis of the Liver
Chronic progressive disease
Extensive degeneration and destruction of
liver parenchyma
Regenerative process is disorganized,
resulting in fibrosis
Impeded vascular flow
Insidious, prolonged course
Etiology of Cirrhosis
Alcoholic-Most common
Fat accumulation in liver cells
Unstopped, leads to scarring throughout liver
Postnecrotic-
From viral, toxic or autoimmune hepatitis
Wide bands of scarring
Biliary-
From obstruction within biliary system
Fibrosis
Cardiac-From Right sided heart failure
Pathophysiology of Cirrhosis
Cell necrosis
Destroyed liver cells replaced by scar tissue
Irregular, disorganized regeneration
Poor cellular nutrition
Hypoxia caused by inadequate circulation
Decreased functioning of liver
Clinical Manifestations
Early
GI disturbances: N and V, anorexia,
Flatulence, change in bowel habits
Pain
Lassitude
Organomegaly
Clinical Manifestations
Later
Jaundice
Skin lesions: spider hemangiomas, palmar
erythema, pruritis
Hematological problems
Endocrine disturbances
Peripheral neuropathy
Jaundice
Hemolytic-in breakdown of RBC’s which
produces in unconjugated bilirubin
Blood Tx Reactions, Sickle Cell and/or
Hemolytic Anemia
Hepatocellular-altered bilirubin uptake by
liver
Hepatitis, cirrhosis, liver Ca
Obstructive-obstructed flow of bile
Liver Ca, hepatitis, cirrhosis
Complications of Cirrhosis
Portal Hypertension and Esophageal
Varices
Structural changes venous changes
obstruction of blood flow Portal
Hypertension Collateral Circulation
Development (especially in lower esophagus)
New vessels are fragile, non-elastic bleed
easily
Complications of Cirrhosis
Bleeding Esophageal Varicose-most
frequent lifethreatening complication
Mortality rate-30-60%
Can be slow bleed
Sudden, rapid bleed much more common
Medical Emergency
Complications of Cirrhosis
Ascites and Peripheral Edema
Results from decreased osmotic pressure from
impaired synthesis of albumin and increased
pressures from Portal Hypertension
Peripheral: Ankle, Sacral
Ascites-edema in abdominal, peritoneal cavity
• Abdominal distension
• Weight gain
Complications of Cirrhosis
Hepatic Encephalopathy-coma
In end stages of liver disease
Ammonia enters circulation because liver has
lost ability to metabolize-not fully understood
Gradual or sudden inset
LOC, asterixis (hand flapping)
Odor-fetor hepaticus
• Musty, ammonia like smell
Complications of Cirrhosis
Hepatorenal syndrome
Renal function deterioration accompanies liver
failure
No structural change in kidneys
Not fully understood
Treatment-Strict Fluid, Na
restrictions,Diuretics,
Treatments often not successful
Therapeutic Management of
Cirrhosis/ Liver Failure
Rest-
Decrease metabolic demands
Allow liver cell recovery
May require complete bed rest
Issues of total Bed Rest
Therapeutic Management
Ascites Management
Fluid, Na restrictions
Diuretics
Salt poor albumins
Strict I/O, Weights
Paracentesis-remove fluid
Peritoneovenous shunt-surgical procedure
which shunts ascites fluid into circulatory
system
TIPS Procedure: Radiological Procedure
Therapeutic Management
Esophageal varices
Once presence of varices has been detected-
PREVENTION of bleeding
• no ASA, no ETOH, no irritating foods
Bleeding-
• Meds-Vassopressin
• Balloon Tamponade
• Sclerotherapy, Ligation, Shunting
Supportive therapy
• Blood, FFP, Fluid Replacement
• Vit K
Therapeutic Management
Hepatic encephalopathy
Goal is to reduce ammonia levels
Protein Restrictions
Neomycin, Lactulose
• Given PO, per NG or Per Rectum in suppository or
enema form
• Diarrhea is desired outcome--is how ammonia is
excreted from body
Levadopa use
Controlling GI bleeding- old blood in tract
Therapeutic Management
Liver Transplantation
Lifestyle considerations
Compliance considerations
Nursing Management of
Cirrhosis/ Liver Failure
Alt. Nutrition: less than body requirements
Many restrictions, diminished appetite
Impaired Skin Integrity
Ineffective Breathing Pattern
Risk for Injury
Activity Intolerance
Body Image Disturbance
Risk for Infection
Nursing Management: PCs
PC: Hepatic encephalopathy
PC: Hepatic Insufficiency/Failure
PC: Hyperbiliruinemia
PC: Hemorrhage
• Where???
PC: Hepatorenal syndrome