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Liver Function
- Filters blood from GI tract
- Conversion and secretion of bilirubin (Product of breakdown of hem)
- Sole source of albumin (pulls fluid into kidneys for excretion)
- Produces bile
- Production of clotting factors
- Storage of vitamins
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Liver Disease: Signs and Symptoms
- Edema (Ascites)
- Dark colored urine
- Light colored stools
- Abdominal pain (URQ)
- Jaundice
- Asterixis (Flapping tremor)
- Coagulopathy (easy bruising)
- -----Clotting factors not produced bc liver damaged
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Liver Failure
- Often occurs gradually
- Signs/symptoms
- -----Hepatic encephalopathy
- -----Mental status changes due to liver damage
- Treatment
- -----Liver transplant (end stage/chronic)
- -----Supportive measures while take its course (chronic viral)
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Chronic liver failure
- More common
- Hep B/C
- ETOH abuse
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Acute liver failure
- Rare
- Occurs within 48hrs of damage of liver
- Tylenol overdose
- Poisonous wildness mushroom
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Liver Injury
- Parenchymal regeneration
- ----Depending on severity
- Formation of scar
- ----Depending on severity
- Fibrosis – cirrhosis
- ----Parenchymal regeneration and scar formation cause fibrosis and enough fibrosis causes cirrhosis
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Cirrhosis
- Group of end-stage diseases of the liver
- Combination of two lesions
- ----Fibrosis
- ----Regeneration nodules
- Caused by ETOH abuse and Hep C
- When 80% tissue fibrotic there is a significant loss of liver function
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Cirrhosis Signs/Symptoms
- Interferes with liver function
- Storage and release of blood
- Metabolism
- ----Drugs as well as it used to be (can’t tolerate it as well)
- Regulation
- ----Na and fluid regulation
- Production
- ----Problem with clotting
- ----Occurs over many yrs.
- Fatigue, weight loss, jaundice, ascites
- Can go undetected if mild
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Cirrhosis Diagnosis
- Lab values
- ----ALT, AST elevated if liver damaged
- ----Albumin: low bc liver not producing it
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Cirrhosis Treatment
- Maximize function
- Minimizing toxic factors
- No cure
- Prognosis: Transplantation
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Liver disease complications
- Jaundice
- Portal hypertension
- Hepatic encephalopathy
- Ascites
- Hepatorenal syndrome
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Jaundice (Icterus)
- Due to:
- overproduction of bilirubin
- defect in bilirubin metabolism
- liver disease
- obstruction of bile flow
- Classified according to location
- ----Pre-hepatic
- ----Hepatic
- ----Post-hepatic Ex: gallstones
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Jaundice PT implications
- Pt needs to REST!!
- Don’t over fatigue
- Walking program vs heavy duty exercises
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Portal Hypertension
- Abnormally high BP in the portal venous system
- Result of obstruction
- ----Fluid backs up into GI track
- Sx
- ----Varices (Dilated fragile bv, Potential for bleeding and GI bleeding)
- ----Ascites
- ----Splenomegaly
- Dx
- ----Endoscopy
- Management
- ----Band ligation- Can tie off varices
- ----B-blockers
- ----Prevent portal pressure
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