l
OMo
ARc
PSD|
23
541
57
Exam 3-Summar
yPr
imar
yConcept
sOf
Adul
tNursi
ng
Pr
imar
yConcept
sOfAdul
tNur
sing(
NovaSout
heast
ernUni
ver
sit
y)
, l
OMo
ARc
PSD|
23
541
57
Ch
a p
ter49As
ses
sme
nta
ndMa
nag
eme
ntofPa
tie
ntswi
thHe
pat
ic
Di
sorde
rs
F
unc
tio
nso
fth
eli
ver
Gl
ucoseMe t
aboli
sm
Glu
coseistakenupfromtheporta
lvenousb l
oodbythe
li
verandconver
tedint
oglycogen,
whichisstor
edinth
e
hepat
ocytes.Whenthebodyneedsglucose,t
he
gly
cogenisthenconver
tedbackint
oglucoseand
rel
easedint
othebloodst
ream.
AmmoniaConversi
on
Li
verconver
tsammo nia
,whichisatoxi
cby p
roductof
aminoacidsfr
omp rot
ei
n,toureatobee x
crete
dinthe
uri
ne.
Pr
ote
in
Met
abol
is
mFa
t
Met
abol
is
m
Vi
taminandIronStorage
Vit
aminsA, B,D,ands e
veral
oftheB-compl
exv i
taminsare
s
tor
edi ntheli
veraswe l
lasir
ona ndcop
per.
Bi
l
eF ormati
on
Bil
eisco nti
nuousl
yformedbytheh e
p at
ocy
tes.Bi
les a
lts
a
resyn t
hesiz
edb ythehepat
ocyte
sf r
omc h
oleste
rol
a
nda reneededforfatemuls
ifi
cat
ion(di
gest
ion).Very
f
ewoft hebil
esaltsareexc
rete
dinf e
ces,a
nda ct
u al
ly
r
etu
rnt otheli
ver
.
Bi
li
rub
in
Ex
cret
ionDr
ug
Meta
boli
sm
Di
agn
ost
icE
val
uat
ion
L
ive
rF u
n ct
ionTe
st’
s(L
FT)
Pi
gme ntSt
udi
es(Ser
umb i
li
rub
in,Uri
neb
il
ir
ubi
n)–
Thesest
udi
esme as
ureth
ea bil
i
tyoft
heli
vert
o
conj
ugat
eandexc
ret
ebil
i
rubi
n.
,Protei
nSt udies(Seru malbu min,
etc.)–Pr otei
nsa r
e
man ufac
tu r
edb yt h
eliver.Thei
rlevelsma yb eaff
ected
i
nav ar
ietyofli
ve ri
mp airments:albumi saff
e c
tedin
ci
rr
h osis
, chr
onich epati
tis,ede
ma ,an da s
cit
e s)
.
Prothromb i
nTi me( 100%)–Pr ot
hromb i
nt i
mewi l
lbe
pr
olo ngedinli
ve rdise
as e.
SerumAl kali
n ePhos phatase
AST( 10 -
40)–L ivere nz
yme sthatwillbee l
e v
atedifli
vercel
l
dama ge
ALT( 8-40)–L ive
re nzyme sthatwillbee l
evatedifli
vercel
l
dama ge
GGT, GGTP, LDH–Va l
uesa reelevat
e dina l
coholabuse
Ammon i
a–Ammon ialevelsri
seinliverfail
ure
Choles t
erolStudi
es
HDL( go odch oles
terol)Males:35=7 0,Females35-8
5
L DL(badc holester
ol)L es
sth a
n1 30
, l
OMoARc
PSD|
2354
157
L
ive
rBiopsy
Pre
-procedu r
e
Ch eckc oagul
ationtests–Ma nyp a
tient
swithli
ver
diseasehavec lot
tin
gd efect
sa n
da reatri
skfor
bleeding
Informe dconsen t
Ba seli
nev i
tal
sig ns
E ducatet hepa ti
e n
tont hep roce
d ur
e,wh atto
exp e
c td ur
in gt hep roce
d u
re,a fte
r-e
ffect
s
an t
ici
pated,r est
ri
c t
ions of a cti
vi
ty a nd
mo nit
ori
ngp rocedurestofol
low.
Duri
ngth eprocedure
, supportthepati
ent.
Post
-proced u
re
Plac ethepati
en tontherightsi
dea ndinst
ructt
he
pa t
ientt
oa voidcoug h
ingorstrai
ning.
Mo n i
torvit
alsi
g ns1 0-
15mi nut
esforfi
rsthour,
thene ve
ry30mi nut
esa f
ter
E ducatethepatienttoavoidheavyli
fti
ngand
strenuousactivi
tyfor1we ek
Ma
nif
est
ati
onsofHe
pat
icDy
sfu
nct
ion
L
iverdis
easecanb eacut
eo rchr
oni
c(wi
thchron
icb ei
ngthemost
c
ommon )
.Cir
rhosi
sischaract
eri
zedbyf
ibr
oti
ccha nge
sinthe
p
arenchymalcell
softheli
ver.
Iti
soft
enduetoalcohol
ismand
i
nfe
c t
ion(he
patit
is)
.Itr
esul
tsinanor
exi
a,met
abolicdi
sord
e r
s,a
nd
n
utri
ti
onaldefi
cie
ncies.
J
aundic
eisthewh e
nthescle
raeoftheeyeandski
nb ecometi
nge
d
y
ell
owor
gr
eeni
sh-
yell
ow.Isi
tduetothebil
ir
ubi
nconcentr
ati
on
i
nthebl
oodb ei
ngabnormal
lyhig
h(bil
i
rub
inabove2.5
i
swhenjaundi
ceisnoti
ceabl
e)
oHep a
tocecul
lu
larJaundi
ce
Causedbythei
nabil
it
yofdamagedli
vercel
lstocl
ear
bi
li
rubi
n.Thi
sisduetovir
alhe
pa t
it
is
,othervi
rus
es
OMo
ARc
PSD|
23
541
57
Exam 3-Summar
yPr
imar
yConcept
sOf
Adul
tNursi
ng
Pr
imar
yConcept
sOfAdul
tNur
sing(
NovaSout
heast
ernUni
ver
sit
y)
, l
OMo
ARc
PSD|
23
541
57
Ch
a p
ter49As
ses
sme
nta
ndMa
nag
eme
ntofPa
tie
ntswi
thHe
pat
ic
Di
sorde
rs
F
unc
tio
nso
fth
eli
ver
Gl
ucoseMe t
aboli
sm
Glu
coseistakenupfromtheporta
lvenousb l
oodbythe
li
verandconver
tedint
oglycogen,
whichisstor
edinth
e
hepat
ocytes.Whenthebodyneedsglucose,t
he
gly
cogenisthenconver
tedbackint
oglucoseand
rel
easedint
othebloodst
ream.
AmmoniaConversi
on
Li
verconver
tsammo nia
,whichisatoxi
cby p
roductof
aminoacidsfr
omp rot
ei
n,toureatobee x
crete
dinthe
uri
ne.
Pr
ote
in
Met
abol
is
mFa
t
Met
abol
is
m
Vi
taminandIronStorage
Vit
aminsA, B,D,ands e
veral
oftheB-compl
exv i
taminsare
s
tor
edi ntheli
veraswe l
lasir
ona ndcop
per.
Bi
l
eF ormati
on
Bil
eisco nti
nuousl
yformedbytheh e
p at
ocy
tes.Bi
les a
lts
a
resyn t
hesiz
edb ythehepat
ocyte
sf r
omc h
oleste
rol
a
nda reneededforfatemuls
ifi
cat
ion(di
gest
ion).Very
f
ewoft hebil
esaltsareexc
rete
dinf e
ces,a
nda ct
u al
ly
r
etu
rnt otheli
ver
.
Bi
li
rub
in
Ex
cret
ionDr
ug
Meta
boli
sm
Di
agn
ost
icE
val
uat
ion
L
ive
rF u
n ct
ionTe
st’
s(L
FT)
Pi
gme ntSt
udi
es(Ser
umb i
li
rub
in,Uri
neb
il
ir
ubi
n)–
Thesest
udi
esme as
ureth
ea bil
i
tyoft
heli
vert
o
conj
ugat
eandexc
ret
ebil
i
rubi
n.
,Protei
nSt udies(Seru malbu min,
etc.)–Pr otei
nsa r
e
man ufac
tu r
edb yt h
eliver.Thei
rlevelsma yb eaff
ected
i
nav ar
ietyofli
ve ri
mp airments:albumi saff
e c
tedin
ci
rr
h osis
, chr
onich epati
tis,ede
ma ,an da s
cit
e s)
.
Prothromb i
nTi me( 100%)–Pr ot
hromb i
nt i
mewi l
lbe
pr
olo ngedinli
ve rdise
as e.
SerumAl kali
n ePhos phatase
AST( 10 -
40)–L ivere nz
yme sthatwillbee l
e v
atedifli
vercel
l
dama ge
ALT( 8-40)–L ive
re nzyme sthatwillbee l
evatedifli
vercel
l
dama ge
GGT, GGTP, LDH–Va l
uesa reelevat
e dina l
coholabuse
Ammon i
a–Ammon ialevelsri
seinliverfail
ure
Choles t
erolStudi
es
HDL( go odch oles
terol)Males:35=7 0,Females35-8
5
L DL(badc holester
ol)L es
sth a
n1 30
, l
OMoARc
PSD|
2354
157
L
ive
rBiopsy
Pre
-procedu r
e
Ch eckc oagul
ationtests–Ma nyp a
tient
swithli
ver
diseasehavec lot
tin
gd efect
sa n
da reatri
skfor
bleeding
Informe dconsen t
Ba seli
nev i
tal
sig ns
E ducatet hepa ti
e n
tont hep roce
d ur
e,wh atto
exp e
c td ur
in gt hep roce
d u
re,a fte
r-e
ffect
s
an t
ici
pated,r est
ri
c t
ions of a cti
vi
ty a nd
mo nit
ori
ngp rocedurestofol
low.
Duri
ngth eprocedure
, supportthepati
ent.
Post
-proced u
re
Plac ethepati
en tontherightsi
dea ndinst
ructt
he
pa t
ientt
oa voidcoug h
ingorstrai
ning.
Mo n i
torvit
alsi
g ns1 0-
15mi nut
esforfi
rsthour,
thene ve
ry30mi nut
esa f
ter
E ducatethepatienttoavoidheavyli
fti
ngand
strenuousactivi
tyfor1we ek
Ma
nif
est
ati
onsofHe
pat
icDy
sfu
nct
ion
L
iverdis
easecanb eacut
eo rchr
oni
c(wi
thchron
icb ei
ngthemost
c
ommon )
.Cir
rhosi
sischaract
eri
zedbyf
ibr
oti
ccha nge
sinthe
p
arenchymalcell
softheli
ver.
Iti
soft
enduetoalcohol
ismand
i
nfe
c t
ion(he
patit
is)
.Itr
esul
tsinanor
exi
a,met
abolicdi
sord
e r
s,a
nd
n
utri
ti
onaldefi
cie
ncies.
J
aundic
eisthewh e
nthescle
raeoftheeyeandski
nb ecometi
nge
d
y
ell
owor
gr
eeni
sh-
yell
ow.Isi
tduetothebil
ir
ubi
nconcentr
ati
on
i
nthebl
oodb ei
ngabnormal
lyhig
h(bil
i
rub
inabove2.5
i
swhenjaundi
ceisnoti
ceabl
e)
oHep a
tocecul
lu
larJaundi
ce
Causedbythei
nabil
it
yofdamagedli
vercel
lstocl
ear
bi
li
rubi
n.Thi
sisduetovir
alhe
pa t
it
is
,othervi
rus
es
