Inflammation: Cirrhosis
Liver Pathology
o Largest organ, located in upper right quadrant.
o 1.5 L of blood enters each minute.
o Metabolic, hematologic, bile production
o Hepatocytes: functional cells of the liver surrounded by capillaries and liver secretes bile
and the gallbladder stores the bile
o Kupffer center: Clean and detoxify: remove amino acids, old RBCs, nutrients, bacteria,
and debris from the blood
Liver Pathology
o Metabolic and hematologic regulation, and bile production
o Produces albumin -maintains normal fluid balance in the body. Poor albumin=ascites,
poor fluid balance. Can supplement with albumin
o Bile formation and secretion
o Iron storage
o Converts ammonia to urea and is excreted in urine. Ammonia is toxic to the brain.
Abnormal function can lead to hepatic cepalopathy.
o Coagulation and anticoagulation: produce proteins necessary for clotting.
o Metabolic detoxification
o Metabolizes medications.
o Storage of minerals and vitamins-helps absorb them.
o Liver cells have the ability to regenerate themselves within three weeks.
o Gylcogen regulation and storage
o Relases glucose into the blood
Inflammation
o Hepatitis is inflammation of liver and can lead to liver failure. Inflammation causes
scarring and sclerosis
o Bodies protective system against viruses and injury
o Inflammatory cells and cytokines send messages and inflammatory response begins:
warm, edema, swelling, fluid, redness, pain
Hepatitis: Inflammation of the liver
o Developing hepatitis is related to individual behavior and exposure
o Type A from fecal oral route. Given in homeless, IV drug users
o Hepatitis B.C can be transmitted through blood and body fluids
o Caused by a virus that impairs the livers ability to function
o Decreased ability of the liver to detoxify substances
o Decreased production of proteins and clotting factors
o Alters ability to store vitamins, fats, and sugars
o Viruses of hepatitis are classified according to letters ranging from A to G; most common
is A, B, C
Clinical Manifestations Hepatitis
-Abdominal pain
- irritability
- pruritus
- Jaundice
- nausea/vomiting
-fever
Laboratory abnormalities
*Elevated liver enzymes and alanine transaminase, elevated bilirubin,
Decreased albumin, elevated ammonia
Inflammation of the liver jaundice of skin or sclere and clay colored stools due to lack of bile
acids secreted by the liver to make stool its brown color
Amber urine liver unable to process bilirubinexcess bilirubin secreted in the stool
Acute vs Chronic
Acute: resolves within 6 months
Chronic: type B and C 6 months or a lifetime. Increases chance of liver cancer or cirrhosis. Type
C can decrease chances of liver cancer with antiviral therapy
Hepatitis A: Oral route or fecal from food, shellfish, water
-Close contact and unsanitary considitions. Can be resolves
-Vaccine recommended for healthcare workers, food handlers, travelers, homeless
Hepatits B: Can be acute or chronic. IS a vaccine
-Spread through blood, semen, vaginal fluidNeedles, piercings, unprotected sex, tattoos
-Vaccines available for newborns, healthcare workers,
-High risk for liver cancer.
Hepatits C: Can be acute or chronic
-Spread through body fluids, needles, piercings
-NO vaccine
Lab values
Liver enxymes: released when liver cells are damaged (ALT/AST)
-elevated when liver damage present
Bilirubin: product of heme metabolism
-bypriduct of RBC breakdown, patient will appear jaundiced if over 2.5
Serum albumin: produced in the liver; main determinant of plasma osmotic pressure
-What holds the fluids in the veins and arteries. Drops when someone has liver failure
Prothrombin time (PT/INR): the liver is involved in activating vitamin K
In liver damage, these clotting factors cannot be produced. In damage there is a longer clotting time
Complete blood count (CBC): Anemia common (low hgb)
Thrombocytopenia: common in patients with splenomegaly ( low platelets)
Ammonia: Produced by the GI tract and enters via the portal vein to the liver. Ammonia is toxic to
brain
Liver biopsy for liver cancer
Catscan/MRI
Endoscopy if there is buldging veins(esophageal varicies)
Cirrhosis: Result of many years of inflammation and injury to the liver resulting in severe
scarring
Causes:
Excessive alcohol
Vital hepatitis
Fatty liver disease
Clinical manifestations:
Early: may be asymptomatic for years, GI disturbance
Late: lethargy, weakness, change in mental status, increased abd girth, skin: bruising, edema,
pruitus, jaundice, GI bleed, dyspnea, confusion, asterixis, spider angiomata, palmar erythema
