Liver Diseases
Joan M. Pino-Talbot RN MSN APN CS
Rutgers University Fall 2005
Anatomy of the pancreas:
The pancreas is an elongated, tapered organ located across the back of the abdomen, behind the stomach. The right side of the organ (called the head) is the widest part of the organ and lies in the curve of the duodenum (the first section of the small intestine). The tapered left side extends slightly upward (called the body of the pancreas) and ends near the spleen (called the tail).
The pancreas is made up of two types of tissue:
exocrine tissue The exocrine tissue secretes digestive enzymes. These enzymes are secreted into a network of ducts that join the main pancreatic duct, which runs the length of the pancreas. endocrine tissue The endocrine tissue, which consists of the islets of Langerhans, secretes hormones into the bloodstream.
FUNCTION OF THE LIVER
The liver regulates most chemical levels in the blood and excretes a product called bile, which helps carry away waste products from the liver. All the blood leaving the stomach and intestines passes through the liver. The liver processes this blood and breaks down the nutrients and drugs into forms that are easier to use for the rest of the body. More than 500 vital functions have been identified with the liver. Some of the more well-known functions include the following:
Glucose metabolism
Ammonia conversion
Protein metabolism Fat metabolism Vitamin and iron storage
Drug metabolism
Bile formation
Bilirubin excretion Hepatic Dysfunction Cirrhosis Jaundice Esophageal varices Substance abuse Hepatitis A Hepatitis B Hepatitis C Hepatitis D Hepatitis E
jaundice
Jaundice
Jaundice is a yellowish discoloration of the skin and of the whites of the eyes caused by abnormally high levels of the pigment bilirubin in the bloodstream.
liver enlargement, portal hypertension
An enlarged liver (hepatomegaly) usually indicates liver disease. An enlarged liver (hepatomegaly) usually indicates liver disease. However, many people with liver disease have a normal-sized or even a shrunken liver. An enlarged liver usually causes no symptoms. However, if the enlargement is extreme, it may cause abdominal discomfort or a feeling of fullness. If the enlargement occurs quickly, the liver may be tender to the touch. When performing a physical examination, a doctor can usually estimate the size of the liver by feeling whether it extends below the level of the ribs.
Portal Hypertension Portal hypertension is abnormally high blood pressure in branches of the portal vein, the large vein that brings blood from the intestines to the liver. Varicose veins in the esophagus (esophageal varices) and in the upper part of the stomach bleed easily and sometimes massively. Varicose veins in the rectum may also bleed, though this is much less common.
The portal vein receives blood drained from the entire intestine and from the spleen, pancreas, and gallbladder. After entering the liver, the vein divides into right and left branches and then into tiny channels that run through the liver. When blood leaves the liver, it drains back into the general circulation through the hepatic vein
Symptoms
Protein-containing fluid (ascitic fluid) may leak from the surface of the liver and intestines and expand (distend) the abdominal cavity, a condition called ascites. Portal hypertension often enlarges the spleen (which drains its blood supply into the portal vessels via the splenic vein).
Varicose veins in the esophagus (esophageal varices) and in the upper part of the stomach bleed easily and sometimes massively. Varicose veins in the rectum may also bleed, though this is much less common.
Two factors can increase blood pressure in the portal blood vessels: increased volume of blood flowing through the vessels and increased resistance to the blood flow through the liver. In Western countries, the most common cause of portal hypertension is increased resistance to blood flow caused by cirrhosis (most often due to excessive alcohol intake).
Varicose veins in the esophagus
Diagnosis
An ultrasound scan may be used to examine the blood flow in the portal blood vessels and to detect the presence of fluid in the abdomen. A computed tomography (CT) scan can also be used to look for and examine any collateral vessels. In rare cases, a needle can be inserted through the abdominal wall and into the liver or spleen to directly measure pressure in the portal system (manometry)
Treatment
To reduce the risk of bleeding from esophageal varices, a doctor may try to reduce the pressure in the portal vein. One way is to give propranolol INDERAL Bleeding from esophageal varices is a medical emergency . Drugs such as vasopressin PITRESSIN or octreotide SANDOSTATIN may be given intravenously to constrict the bleeding veins, and blood transfusions are given to replace lost blood.
An endoscopic examination is usually done to confirm that the bleeding is from varices. The veins can then be blocked off with rubber bands or with injections of a chemical given through the endoscope. If the bleeding continues or recurs repeatedly, a surgical procedure may be done to create a bypass (called a shunt) between the portal venous system and the general (systemic) venous system.
Cirrhosis
Cirrhosis is the seventh leading cause of death in the United States, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Because of chronic damage to the liver, scar tissue slowly replaces normal functioning liver tissue, progressively diminishing blood flow through the liver.
What causes cirrhosis?
The most common cause of cirrhosis is alcohol abuse. Other causes include the following: hepatitis and other viruses use of certain drugs chemical exposure bile duct obstruction autoimmune diseases obstruction of outflow of blood from the liver (i.e., BuddChiari syndrome) heart and blood vessel disturbances
Ascites
ascites accumulation of fluid in the abdominal cavity
ALCOHOL (ETOH)
Alcohol abuse is a leading cause of morbidity and mortality throughout the world. It is estimated that in the United States as many as 10 % of men and 3 % of women may suffer from persistent problems related to the use of alcohol.
Alcohol affects many organ systems of the body, but perhaps most notably affected are the central nervous system and the liver. Almost all ingested alcohol is metabolized in the liver and excessive alcohol use can lead to acute and chronic liver disease. Liver cirrhosis resulting from alcohol abuse is one of the ten leading causes of death in the United States.
REMEMBER,
LIVER DISEASE IS NOT THE ONLY LIFETHREATENING COMPLICATION OF ALCOHOL USE DISORDERS. ALL ALCOHOLICS MUST ABSTAIN FROM DRINKING AS NUMEROUS OTHER ALCOHOL-RELATED MEDICAL, SOCIAL AND PSYCHOLOGICAL PROBLEMS CAN LEAD TO MORBIDITY AND MORTALITY
Alcohol-Induced Liver Disease
Alcohol-induced liver disease, as the name implies, is caused by excessive consumption of alcohol and is a common, but preventable, disease. Did you know? Women are more prone to liver damage from drinking alcohol than men.
Three primary types of alcoholinduced liver disease:
Fatty Liver Alcoholic hepatitis Alcoholic cirrhosis
Fatty liver is excessive accumulation of fat inside the liver cells. Fatty liver is the most common alcoholinduced liver disorder. The liver is enlarged, causing upper abdominal discomfort on the right side.
Fatty Liver (Steatosis)
Alcohol abuse can lead to the accumulation of fat within hepatocytes, the predominant cell type in the liver. A similar condition can also be seen in some obese people who are not alcohol abusers.
Fatty liver is reversible if the patient stops drinking, however, fatty liver can lead to steatohepatitis. Steatohepatitis is fatty liver accompanied by inflammation and this condition can lead to scarring of the liver and cirrhosis.
Alcoholic hepatitis
Alcoholic hepatitis is an acute inflammation of the liver, accompanied by the destruction of individual liver cells and scarring. Symptoms may include fever, jaundice, an increased white blood cell count, an enlarged, tender liver, and spider-like veins in the skin.
Hepatitis
Alcohol can cause acute and chronic hepatitis. The patient who presents with alcoholic hepatitis is usually a chronic drinker with a recent episode of exceptionally heavy consumption.
Alcoholic hepatitis can range from a mild hepatitis, with abnormal laboratory tests being the only indication of disease, to severe liver dysfunction with complications such as jaundice (yellow skin caused by bilirubin retenti hepatic encephalopathy (neurological dysfunction caused by liver failure), ascites (fluid accumulation in the abdomen), bleeding esophageal varices (varicose veins in the esophagus), abnormal blood clotting and coma.
Alcoholic cirrhosis
Alcoholic cirrhosis is the destruction of normal liver tissue, leaving non-functioning scar tissue.
Symptoms may include those of alcoholic hepatitis in addition to portal hypertension, enlarged spleen, ascites, kidney failure, confusion, or liver cancer. In the United States, alcohol abuse is the leading cause of liver cirrhosis.
Symptoms of alcohol-induced
Symptoms of alcohol-induced liver disease depend on how much and how long a person has been drinking alcohol. The following are the most common symptoms of alcohol-induced liver disease.
enlarged liver fever jaundice - yellowing of the skin and eyes. increased white blood cell count spider-like veins in the skin portal hypertension enlarged spleen ascites - fluid build-up in the abdominal cavity. kidney failure confusion
Diagnostic procedures for alcohol-induced liver disease may include the following: laboratory tests liver function tests - a series of special blood tests that can determine if the liver is functioning properly. liver biopsy - a procedure in which tissue samples from the liver are removed (with a needle or during surgery) from the body for examination under a microscope.
Specific treatment for alcohol-induced liver disease is based on:
your age, overall health, and medical history extent of the disease your tolerance for specific medications, procedures, or therapies expectations for the course of the disease your opinion or preference The goal of treatment is to restore some or all normal functioning to the liver. Treatment usually begins with abstinence from alcohol. The liver has great restorative power and is often able to repair some of the damage caused by alcohol. In most cases, the only damage it cannot reverse is scarring from cirrhosis.
Treatment
The most important measure in the treatment of alcoholic liver disease is to ensure the total and immediate abstinence from alcohol. vitamins, especially thiamin, to correct the deficiencies that may have resulted from chronic alcohol abuse.
Chronic Liver Disease / Cirrhosis
Chronic liver disease is marked by the gradual destruction of liver tissue over time. Several liver diseases fall under this category, including the following: cirrhosis of the liver fibrosis of the liver
Cirrhosis is the seventh leading cause of death in the United States, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
Symptoms of cirrhosis
abnormal nerve function ascites - fluid build-up in the abdominal cavity. breast enlargement in men coughing up or vomiting blood curling of fingers (Dupuytren's contracture of the palms) gallstones hair loss itching jaundice - yellowing of the skin and eyes. kidney failure liver encephalopathy
Symptoms of cirrhosis continued:
muscle loss poor appetite portal hypertension redness of palms salivary gland enlargement in cheeks shrinking of testes spider-like veins in the skin weakness weight loss
The most common cause of cirrhosis is alcohol abuse. Other causes include the following:
The most common cause of cirrhosis is alcohol abuse. Other causes include the following: hepatitis and other viruses use of certain drugs chemical exposure bile duct obstruction autoimmune diseases obstruction of outflow of blood from the liver (i.e., BuddChiari syndrome) heart and blood vessel disturbances
Other causes include the following continued:
Alpha1-antitrypsin deficiency high blood galactose levels high blood tyrosine levels at birth
Diagnostic procedures for cirrhosis may include the following:
laboratory tests liver function tests - a series of special blood tests that can determine if the liver is functioning properly. liver biopsy - a procedure in which tissue samples from the liver are removed (with a needle or during surgery) from the body for examination under a microscope. cholangiography - x-ray examination of the bile ducts using an intravenous (IV) dye (contrast). computed tomography scan (CT or CAT scan) - a diagnostic imaging procedure using a combination of x-rays and computer technology to produce cross-sectional images ultrasound (Also called sonography.)
Treatment for cirrhosis:
Specific treatment for cirrhosis will be determined by your physician based on: your age, overall health, and medical history extent of the disease your tolerance for specific medications, procedures, or therapies expectations for the course of the disease your opinion or preference
What is fibrosis?
Fibrosis is the growth of scar tissue due to infection, inflammation, injury, or even healing. The overgrowth of scar tissue can occur in almost any organ. Fibrosis in the liver can inhibit the organ's proper functioning. Liver fibrosis is usually the result of cirrhosis.