LIVER METABOLISM

4 stages of hepatic encephalopathy

1 Mild lack of awareness-Shortened attention span Impaired addition or subtraction; mild asterixis or tremor 2 Lethargic-Disoriented; Inappropriate behavior Obvious asterixis; Slurred speech 3 Somnolent but arousable Gross disorientation; Bizarre behavior Muscular rigidity and clonus; Hyperreflexia 4 Coma Coma Decerebrate posturing

What is hepatorenal syndrome?

is a type of progressive kidney failure. As the kidneys stop functioning, toxins begin to build up in the body. Eventually, this leads to liver failure. It is only seen in people with severe liver damage and is almost always caused by cirrhosi

treatment for cirrhosis

remove the cause (alcohol/drugs); wholesome diet; Interferon; liver damage is somewhat irreversible, but the liver can function with some damage and has the ability to repair itself to a limited degree; liver transplant

What are the major causes and signs/symptoms of cirrhosis?

Cirrhosis is severe scarring of the liver and poor liver function seen at the end of chronic liver disease. The scarring is most often caused by long-term exposure to toxins such as alcohol or viral infections

How is ammonia formed

Deamination of amino acids results in the production of ammonia. The liver contains a system of carrier molecules and enzymes which quickly converts the ammonia (and carbon dioxide) into urea.

What causes jaundice

Some underlying conditions that may cause jaundice are:• Acute inflammation of the liver - may impair the ability of the liver to conjugate and secrete bilirubin, resulting in a buildup of bilirubin. • Inflammation of the bile duct - may prevent the secretion of bile and removal of bilirubin, causing jaundice

What is portal hypertension

A vascular disorder of the liver characterized by increased resistance to portal blood flow at the level of the sinusoids with the development of venous collaterals and ascites

What are LFTs?

Alanine transaminase (ALT). This is an enzyme that helps to process proteins.When the liver is injured or inflamed (as in hepatitis), the blood level of ALT usually rises. Aspartate aminotransferase (AST). This is another enzyme usually found inside liver cells. When a blood test detects high levels of this enzyme in the blood it usually means the liver is injured in some way Alkaline phosphatase (ALP). This enzyme occurs mainly in liver cells next to bile ducts, and in bone. The blood level is raised in some types of liver and bone disease.

How is albumin produced

Albumin is synthesized in the liver as preproalbumin, which has an N-terminal peptide that is removed before the nascent protein is released from the rough endoplasmic reticulum. The product, proalbumin, is in turn cleaved in the Golgi vesicles to produce the secreted albumin (Human albumin is often used to replace lost fluid and help restore blood volume in trauma, burns and surgery patients)

LFT

Albumin. This is the main protein made by the liver, and it circulates in the bloodstream. The ability to make albumin (and other proteins) is affected in some types of liver disorder. A low level of blood albumin occurs in some liver disorders. Total protein. This measures albumin and all other proteins in blood Bilirubin. This chemical gives bile its yellow/green colour. A high level of bilirubin in your blood will make you jaundiced ('yellow'). Bilirubin is made from haemoglobin. It is particularly high if the flow of bile is blocked

What is hepatic encephalopathy

Syndrome of impaired mental and neuromuscular function that develops in liver failure, can cause a wide variety of psychiatric and neurological abnormalities. Divided into 4 stages of increasing severity

How do diseases of the liver affect metabolism of drugs?

The capacity of the liver to metabolise drugs depends on hepatic blood flow and liver enzyme activity, both of which can be affected by liver disease and can influence the binding of a drug to plasma proteins. modify the kinetics of drugs biotransformed by the liver

LIVER FUNCTIONS

This organ plays a major role in metabolism and has a number of functions in the body, including glycogen storage, decomposition of red blood cells, plasma protein synthesis, hormone production, and detoxification. It lies below the diaphragm in the abdominal-pelvic region of the abdomen. It produces bile, an alkaline compound which aids in digestion via the emulsification of lipids. The liver's highly specialized tissues regulate a wide variety of high-volume biochemical reactions, including the synthesis and breakdown of small and complex molecules, many of which are necessary for normal vital functions.

BLOOD TO THE LIVER

Unlike other organs, the liver receives blood from two major blood vessels. The hepatic artery brings oxygen-rich blood from the heart. The hepatic portal vein brings blood rich in digested nutrients from the intestine. This means excess nutrients can be removed and stored before blood circulates around the body.

nursing implications for a paracentesis

Verify presence of an informed consent. • Weigh prior to paracentesis. • Assess vital signs for baseline. • Have client void immediately prior to the test to avoid bladder puncture. • Position seated, either on the side of the bed or in a chair, with feet supported