This document provides an outline and objectives for a nursing assignment on the assessment and management of patients with hepatic disorders. It covers topics such as the anatomy and physiology of the liver, causes of liver disease, signs and symptoms of hepatic dysfunction including jaundice, portal hypertension and ascites. It also discusses management of conditions like hepatic encephalopathy, bleeding esophageal varices, hepatitis, cirrhosis and cancer of the liver. Nursing interventions are focused on activity tolerance, nutrition, skin integrity and preventing complications.

1. SALALE UNIVERSITY COLLEGE OF HEALTH
SCIENCE DEPARTMENT OF NURSING.
Assignment of adult health nursing I
Title: chemotherapy induced hypersensitivity
reaction
Prepared by: Tolossa Negusie id 192/2015
Submitted to: mr.Tadele .K(assistant professor)
July,2023
Fitche,Ethiopia
1

2. Outlines
objectives
Introduction
Anatomy and physiology of liver
Disease and Investigation of liver
Signs and Symptoms Associated with
Hepatocellular and Obstructive Jaundice
pathogenesis and assessment of ascites
management and prevention of patients with
hepatic diseases
2

3. Objectives
After completing this topic the learner could able to
describe:
 Introduction liver disorders, causes and treatment
 Anatomy and physiology of liver
 Disease and Investigation of liver
 Signs and Symptoms Associated with
Hepatocellular and Obstructive Jaundice
 pathogenesis and assessment of ascites
 management and prevention of patients with
hepatic diseases
3

4. Introduction
 Liver is the Largest gland of the body
Located in the upper right abdomen.
 A very vascular organ that receives blood
from the GI tract via the portal vein and from
the hepatic artery.
 Metabolic Functions of liver
 Glucose metabolism ,Ammonia conversion
Protein metabolism, Vitamin and iron storage,
Drug metabolism ,Bile formation and
Bilirubin excretion.
4

5. Introductions
 Assessment of hepatic disorders involves
history taking, physical examination, and
diagnostic studies.
 Hepatic disorders can be caused by Malnutrition
related to alcoholism, Infection, Anoxia
,Metabolic disorders, Nutritional deficiencies
,Hypersensitivity states and trauma.
 Hepatic dysfunctions are manifested by:
Jaundice
 Portal hypertension, ascites, and varices .
 Management and prevention of hepatic
dysfunction is depends on their cause and
clinical manifestations
5

6. Assessment and Management of
Patients With Hepatic Disorders
6

7. Anatomy and Physiology of the Liver
 Liver is the Largest gland of the body Located
in the upper right abdomen.
 A very vascular organ that receives blood from
the GI tract via the portal vein and from the
hepatic artery.
7

8. LIVER AND BILIARY SYSTEM
8

9. SECTION OF LIVER LOBULE
9

10. Metabolic Functions
 Glucose metabolism
 Ammonia conversion
 Protein metabolism
 Vitamin and iron storage
 Drug metabolism
 Bile formation
 Bilirubin excretion
10

11. Additional Diagnostic Studies
Liver biopsy
Ultrasonography
CT
 MRI
Other
11

12. Liver Function Studies
 Serum aminotransferases: AST, ALT, GGT, GGTP,
LDH
 Serum protein studies
 Pigment studies: direct and indirect serum
bilirubin, urine bilirubin, and urine bilirubin and
urobilinogen
 Prothrombin time
 Serum alkaline phosphatase
 Serum ammonia
 Cholesterol 12

13. Hepatic Dysfunction
 Acute or chronic (more common)
 Cirrhosis of the liver disease
 Causes:
 Malnutrition related to alcoholism.
 Infection, Anoxia ,Metabolic disorders
 Nutritional deficiencies ,Hypersensitivity
states
13

14. Manifestations
 Jaundice
 Portal hypertension,
 ascites, and varices
 Hepatic encephalopathy or coma
 Nutritional deficiencies
 Hematologic problems
 Endocrine problems
14

15. Jaundice
 Yellow- or green-tinged body tissues,
sclera, and skin due to increased serum
bilirubin levels (>2.5 mg/dL)
 Types
 Hemolytic
 Hepatocellular
 Obstructive
 Hereditary hyperbilirubinemia
 Hepatocellular and obstructive jaundice
types are most associated with liver
disease.
15

16. 16

17. Signs and Symptoms Associated with
Hepatocellular and Obstructive Jaundice
Hepatocellular
 Patient may appear mildly or severely ill.
 Lack of appetite, nausea, weight loss ,Malaise,
fatigue, weakness
 Headache, chills, and fever if infectious in origin
Obstructive
 Dark orange-brown urine and light clay-colored
stools Dyspepsia and intolerance of fats, impaired
digestion and Pruritus 17

18. Portal Hypertension
 Obstructed blood flow through the liver results in increased
pressure throughout the portal venous system.
 Results in:
 Ascites
 Fluid accumulation in the peritoneal cavity
 Increased abdominal girth and weight gain
 Esophageal varices and gastric varices
 Varicosities that develop from elevated pressures in the veins,
p rone to rupture
 Development of other collateral circulation
 Systemic hypertension 18

19. Ascites - Fluid in Peritoneal Cavity Due To:
 Portal hypertension resulting in increased
capillary pressure and obstruction of venous
blood flow .
 Vasodilation of splanchnic circulation (blood flow
to the major abdominal organs)
 Changes in the ability to metabolize aldosterone,
increasing fluid retention
 Decreased synthesis of albumin, decreasing
serum osmotic pressure
 Movement of albumin into the peritoneal cavity
19

20. Pathogenesis of Ascites
20

21. 21

22. Assessment of Ascites
 Record abdominal girth and weight daily.
 Patient may have striae, distended veins, and
umbilical hernia.
 Assess for fluid in abdominal cavity by
percussion for shifting dullness or by fluid wave.
 monitor for potential fluid and electrolyte
imbalances
 Dehydration ,Hypokalemia ,hyponatremia
 Monitor for signs of spontaneous bacterial
peritonitis 22

23. Paracentesis
23

24. TIPS
24

25. Hepatic Encephalopathy and Coma
 Complication of liver disease result from the accumulation
of ammonia and other toxic metabolites in the blood and
have Stages 1, 2, 3, 4
 Assessment
 EEG
 Changes in level of consciousness; assess neurologic
status frequently Potential seizures
 Fetor hepaticus ,
 Asterixis ,
 Monitor fluid, electrolyte, and ammonia levels
25

26. 26

27. Medical Management
 Eliminate precipitating cause.
 Lactulose to reduce serum ammonia levels
 IV glucose to minimize protein catabolism
 Protein restriction
 1-1.5 g/kg daily, or less if acute
 Small , frequent meals
 Vegetable protein over animal protein when
possible
27

28. Cont.…
Reduction of ammonia from GI tract by gastric
suction, enemas, oral antibiotics
Discontinue sedatives, analgesics, and
tranquilizers.
Monitor for and promptly treat complications
and infection
28

29. Bleeding of Esophageal Varices
 Occurs in about 1/3 of patients with cirrhosis
and varices
 First bleeding episode has a mortality of 30-
50%.
 Manifestations include hematemesis, melena,
general deterioration, and shock.
 Patients with cirrhosis should undergo
screening endoscopy every 2 years.
29

30. Balloon Temponade
30

31. Endoscopic sclerotherapy
31

32. Esophagial Banding
32

33. Nursing Management of the Patient with
Bleeding Esophageal Varices
 Close monitoring of vital signs
 Monitor patient’s condition frequently, including
emotional responses and cognitive status.
 Monitor for associated complications such as
hepatic encephalopathy resulting from blood
breakdown in the GI tract and delirium related to
alcohol withdrawal.
33

34. Nursing Management of the Patient with
Bleeding Esophageal Varices
 Monitor treatments, including tube care and GI
suction.
 Saline lavage as ordered
 Oral care
 Quiet, calm environment and reassuring manner
 Implement measures to reduce anxiety and
agitation.
 Teaching and support of patient and family
34

35. Hepatitis
Viral hepatitis:
 A systemic viral infection that causes
necrosis and inflammation of liver cells with
characteristic symptoms and cellular and
biochemical changes, hepatitis A, B, C, D, E
Nonviral hepatitis:
 Toxin- and drug-induced
35

36. Hepatitis A (HAV)
 Fecal-oral transmission
 Spread primarily by poor hygiene; hand-to-
mouth contact, close contact, or through food
and fluids
 Incubation: 15-50 days
 Illness may last 4-8 weeks.
 Mortality is 0.5% for younger than age 40 and
1-2% for those over age 40.
 Manifestations: mild flu-like symptoms, low-
grade fever, anorexia, later jaundice and dark
urine, indigestion and epigastric distress,
enlargement of liver and spleen
 Anti-HAV antibody in serum after symptoms
appear 36

37. Management
 Prevention
 Good hand washing, safe water, and
proper sewage disposal
 Vaccine
 Immunoglobulin for contacts to provide
passive immunity.
 Bed rest during acute stage
 Nutritional support
37

38. Hepatitis B (HBV)
 Transmitted through blood, saliva, semen, and
vaginal secretions, sexually transmitted,
transmitted to infant at the time of birth
 A major worldwide cause of cirrhosis and liver
cancer
 Risk factors: high risk sexual behavior, IV drug
use, healthcare worker, dialysis patient,
tattoos/piercings with contaminated needles
38

39.  Long incubation period: 1-6 months
 About 10% will become chronic carriers
 Manifestations: insidious and variable, similar to
hepatitis A
 The virus has antigenic particles that elicit
specific antibody markers during different stages
of the disease
39

40. Management Prevention
 Bed rest (acute)
 Nutritional support
 Vaccine: for persons at high risk, routine
vaccination of infants
 Standard precautions/infection control
measures
 Screening of blood and blood products
 Avoidance of high risk sexual practices
 Medications for chronic hepatitis type B include
alpha interferon and antiviral agents:
lamivudine (Epivir), adefovir (Hepsera) -
reduce viral load, improve liver function, slow
progression to cirrhosis.
40

41. Hepatitis C
 Transmitted by blood, including needle sticks
and sharing of needles; less commonly, sexual
contact.
 A cause of 1/3 of cases of liver cancer and the
most common reason for liver transplant
 Risk factors similar to hepatitis B
 Incubation period is variable (15-160 days)
 Symptoms are usually mild, possibly
asymptomatic
 Chronic carrier state frequently occurs.
-Increases risk of liver cancer and cirrhosis
41

42. Management
 Prevention Screening of blood
 Prevention of needlesticks (2% chance for
seroconversion) for health care workers
 Measures to reduce spread of infection as with hepatitis B
 Alcohol encourages the progression of the disease, so
alcohol and medications that affect the liver should be
avoided.
 Antiviral agents: interferon and ribavirin
-Patient response to therapy is variable based on genotype
and compliance.
42

43. Hepatitis D and E
Hepatitis D
 Only persons with hepatitis B are at risk for
hepatitis D.
 Transmission is through blood and sexual
contact.
 Symptoms and treatment are similar to hepatitis
B, but patient is more likely to develop fulminant
liver failure and chronic active hepatitis and
cirrhosis.
43

44. Hepatitis E
 Transmitted by fecal-oral route
 Incubation period 15-65 days
 Resembles hepatitis A and is self-limited, with
an abrupt onset.
 No chronic form.
44

45. Other Liver Disorders
Nonviral hepatitis
 Toxic hepatitis
- Resembles viral hepatitis, due to exposure to
toxic agents
 Drug-induced hepatitis
-Medication induced; leading cause
acetaminophen
45

46. Fulminant hepatic failure
 Clinical syndrome of sudden and severely
impaired liver function in a previously healthy
person
 Prognosis much worse than chronic liver failure
 Rapid development of jaundice, coagulation
defects, renal failure, lyte imbalance, CV
abnormalities, infection, hypoglycemia,
encephalopathy, cerebral edema
 Requires rapid recognition and treatment
46

47. Nursing Process: The Care of the Patient with
Cirrhosis of the Liver: Assessment
 Focus on onset of symptoms and history of
precipitating factors and Alcohol use/abuse
 Dietary intake and nutritional status
 Exposure to toxic agents and drugs
 Assess mental status.
 Abilities to carry out ADL, maintain a job, and
maintain social relationships
 Monitor for signs and symptoms related to the
disease.
47

48. Nursing Process: The Care of the Patient
with Cirrhosis of the Liver: Diagnosis
 Activity intolerance
 Imbalanced nutrition
 Impaired skin integrity
 Risk for injury and bleeding
48

49. Collaborative Problems/Potential Complications
 Bleeding and hemorrhage
 Hepatic encephalopathy
 Fluid volume excess
49

50. Nursing Process: The Care of the Patient with
Cirrhosis of the Liver: Planning
 Goals may include increased participation in
activities, improvement of nutritional status,
improvement of skin integrity, decreased
potential for injury, improvement of mental
status, and absence of complications.
50

51. Activity Intolerance
 Rest and supportive measures
 Positioning for respiratory efficiency
 Oxygen
 Planned mild exercise and rest periods
 Address nutritional status to improve strength.
 Measures to prevent hazards of immobility
51

52. Imbalanced Nutrition
 Vitamin supplementation (A, C, K, folic acid)
 Encourage patient to eat small, frequent meals
may be better tolerated.
 Consider patient preferences.
 Supplemental vitamins and minerals, especially B
complex; provide water-soluble forms of fat-
soluble vitamins if patient has steatorrhea
 High-calorie diet, sodium restriction for ascites
 Protein is modified to patient needs & restricted if
patient is at risk for encephalopathy.
52

53. Other Interventions
 Impaired skin integrity
 Frequent position changes
 Gentle skin care
 Measures to reduce scratching by the patient
 Risk for injury
 Measures to prevent falls
 Measures to prevent trauma related to risk for
bleeding Careful evaluation of any injury related to
potential for bleeding
53

54. Cancer of the Liver
Primary liver tumors
 Few cancers originate in the liver usually associated with
hepatitis B and C (I,e.Hepatocellular carcinoma).
 Liver is a frequent site of metastatic cancer.
Manifestations
 Pain, dull continuous ache in RUQ, epigastrium, or back,
weight loss, loss of strength, anorexia, anemia may occur.
 Jaundice if bile ducts occluded, ascites if obstructed portal
veins.
54

55. Nonsurgical Management of Liver Cancer
 Underlying cirrhosis, which is prevalent in
patients with liver cancer, increases risks of
surgery.
 Major effect of nonsurgical therapy may be
palliative.
 Radiation therapy
 Chemotherapy
 Percutaneous biliary drainage
 Other nonsurgical treatment
55

56. Surgical Management of Liver Cancer
 Treatment of choice for HCC if confined to one
lobe and liver function is adequate
 Liver has regenerative capacity.
 Types of surgery
 Lobectomy
 Cryosurgery
 Liver transplant
56

57. LIVER TRANSPLANT
57

58. Summary
 Liver is the Largest gland of the body
Located in the upper right abdomen.
 A very vascular organ that receives blood
from the GI tract via the portal vein and
from the hepatic artery.
Metabolic Functions of liver
 Glucose metabolism ,Ammonia conversion
 Protein metabolism, Vitamin and iron
storage, Drug metabolism ,Bile formation
and
 Bilirubin excretion.
58

59. summary
 Assessment of hepatic disorders involves
history taking, physical examination, and
diagnostic studies.
 Hepatic disorders can be caused by Malnutrition
related to alcoholism, Infection, Anoxia
,Metabolic disorders, Nutritional deficiencies
,Hypersensitivity states and trauma.
 Hepatic dysfunctions are manifested by:
Jaundice, Portal hypertension, ascites, and
varices .
 Management and prevention of hepatic
dysfunction is depends on their cause and
clinical manifestations
59

60.  A systemic viral infection that causes necrosis
and inflammation of liver cells with
characteristic symptoms and cellular and
biochemical changes, hepatitis A, B, C, D, E.
 Few cancers originate in the liver usually
associated with hepatitis B and C
(I,e.Hepatocellular carcinoma).
Treatment of hepatic disorders
 Radiation therapy
 Chemotherapy
 Percutaneous biliary drainage Lobectomy
 Cryosurgery
 Liver transplant
 Other medical managements.
60

61. References
1. National library of medicine
2. UW medicine
3. The Leeds teaching hospital
4. Google sources
61

62. 62