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NCM116 - Metabolic - Endocrine Disorders
NCM116 - Metabolic - Endocrine Disorders
NCM-116
METABOLIC AND
CARE OF CLIENTS WITH PROBLEMS IN
NUTRITION AND GASTRO-INTESTINAL,
METABOLISM AND ENDOCRINE,
ENDOCRINE
PERCEPTION AND COORDINATION
DISORDERS
Course Description
This course deals with concepts, principles, theories and
techniques of nursing care of at-risk and sick adult clients in any setting
with alterations/problems in nutrition, and gastro-intestinal,
metabolism and endocrine, perception and coordination, acute and
chronic toward health promotion, disease prevention, restoration,
maintenance, and rehabilitation. The learners are expected to provide
safe, appropriate and holistic nursing care to at-risk and sick adult
client utilizing the nursing process.
Dear students
This module is dedicated to the students of the College of Allied
Medicine in Southern Luzon State University to support the flexible
learning during this time of pandemic, I hope that this module will
prepare you to shape your future in health care.
mcabalsa@slsu.edu.ph
[0938-582-3052]
https://classroom.google
.com/u/0/h
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OVERVIEW
This learning module discusses on of the largest organ in the body which serves a variety of
important functions in maintaining health and protecting the individual from damage.
Liver function is complex, and liver dysfunction affects all body systems. For this reason, the
nurse must understand how the liver functions and must have expert clinical assessment and
management skills to care for patients undergoing complex diagnostic and treatment procedures. The
nurse also must understand technologic advances in the management of liver disorders. Liver
disorders are common and may result from a virus, exposure to toxic substances such as alcohol, or
tumors
In this learning module, you will determine and identify the importance of liver and its
functions. You will therefore understand the factors affecting liver function, the physiology of its
function, and specific measures that promote optimal good condition.
LEARNING OBJECTIVES
1. Identify the metabolic functions of the liver and the alterations in these functions that occur
with liver disease.
2 Explain liver function tests and the clinical manifestations of liver dysfunction in relation to
pathophysiologic alterations of the liver.
3 Relate jaundice, portal hypertension, ascites, varices, nutritional deficiencies, and hepatic
coma to pathophysiologic alterations of the liver.
4 Describe the medical, surgical, and nursing management of patients with esophageal varices.
5 Compare the various types of hepatitis and their causes, prevention, clinical manifestations,
management, prognosis, and home health care needs.
6 Use the nursing process as a framework for care of the patient with cirrhosis of the liver.
7 Compare the nonsurgical and surgical management of patients with cancer of the liver.
8 Describe the postoperative nursing care of the patient undergoing liver transplantation.
DISCUSSION
Liver or Hepatic disorders are common and may result from a virus or exposure to toxic substances
such as alcohol. Another liver disorder is cancer: hepatocellular carcinoma is a highly malignant
tumor that is difficult to treat and often fatal.
Liver function is complex, and liver dysfunction affects all body systems. For this reason, the nurse
must understand how the liver functions and must have expert assessment and clinical management
skills to care for patients undergoing complex diagnostic and treatment procedures. The liver plays
additional roles in detoxification of chemicals and synthesis and storage of important nutrients and
The liver is especially important in the regulation of glucose and protein metabolism.
The liver is also active in fat metabolism. Fatty acids can be broken down for the production of
energy and the production of ketone bodies (acetoacetic acid, beta-hydroxybutyric acid, and acetone).
Vitamin and Iron Storage Vitamins A, B, and D and several of the B-complex vitamins are stored in
large amounts in the liver. Certain substances, such as iron and copper, are also stored in the liver.
Drug Metabolism
The liver metabolizes many medications, such as barbiturates, opioids, sedative agents,
anesthetics, and amphetamines.
Bile Formation
Bile is continuously formed by the hepatocytes and collected in the canaliculi and bile ducts.
It is composed mainly of water and electrolytes such as sodium, potassium, calcium, chloride, and
bicarbonate, and it also contains significant amounts of lecithin, fatty acids, cholesterol, bilirubin, and
bile salts.
Bilirubin Excretion
Bilirubin is a pigment derived from the breakdown of hemoglobin by cells of the
reticuloendothelial system, including the Kupffer cells of the liver.
ASSESSMENT
1. HEALTH HISTORY
1. If liver function test results are abnormal, the patient may need to be evaluated for liver disease. In
such cases, the health history will focus on exposure of the patient to hepatotoxic substances or
infectious agents.
2. The patient’s occupational, recreational, and travel history may assist in identifying exposure to
hepatotoxins (e.g., industrial chemicals, other toxins) responsible for illness. The patient’s history of
alcohol and drug use, including but not limited to the use of injectable drugs, provides additional
information about exposure to toxins and infectious agents.
3. A careful medication history to assess hepatic dysfunction should address all prescribed and over-
the counter medications, herbal remedies, and dietary supplements used by the patient currently and
in the past.
4. Lifestyle behaviors that increase the risk for exposure to infectious agents are identified.
5. Injectable drug use, sexual practices, and a history of foreign travel are all potential risk factors for
liver disease. The amount , duration and type of alcohol consumption.
6. The family history includes questions about familial liver disorders that may have their etiology in
alcohol abuse or gallstone disease, as well as other familial or genetic diseases, such as
hemochromatosis, Wilson’s disease, or alpha-1 antitrypsin disease.
6. The history also includes reviewing symptoms that suggest liver disease such as .
1.Jaundice
2.Malaise and weakness fatigue
3. Pruritus
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PHYSICAL EXAMINATION
1. The nurse assesses the patient for physical signs that may occur with liver dysfunction, including
pallor of chronic illness and jaundice.
2. The skin, mucosa, and sclerae are inspected for jaundice, and the extremities are assessed for
muscle atrophy, edema, and skin excoriation secondary to scratching.
3. The nurse observes the skin for petechiae or ecchymotic areas (bruises), spider angiomas, and
palmar erythema.
PHYSICAL EXAMINATION
1. The male patient is assessed for unilateral or bilateral gynecomastia and testicular atrophy due to
endocrine changes.
2. The patient’s cognitive status (recall, memory, abstract thinking) and neurologic status are
assessed. The nurse observes for general tremor, asterixis, weakness, and slurred speech.
PHYSICAL EXAMINATION
1. The nurse assesses the abdomen for dilated abdominal wall veins, ascites, and a fluid wave
(discussed later).
2. The abdomen is palpated to assess liver size and to detect any tenderness over the liver.
Methods for Palpating the Liver
PHYSICAL EXAMINATION
Tenderness of the liver implies recent acute enlargement with consequent stretching of the liver
capsule. The absence of tenderness may imply that the enlargement is of long-standing duration.
Diagnostic Evaluation
1. LIVER FUNCTION TESTS: More than 70% of the parenchyma of the liver may be damaged
before liver function test results become abnormal. Function is generally measured in terms of serum
enzyme activity (i.e., alkaline phosphatase, lactic dehydrogenase, serum aminotransferases) and
serum concentrations of proteins (albumin and globulins), bilirubin, ammonia, clotting factors, and
lipids.
LIVER BIOPSY
1. Liver biopsy is the removal of a small amount of liver tissue, usually through needle aspiration. It
permits examination of liver cells.
2. The most common indication is to evaluate diffuse disorders of the parenchyma and to diagnose
space- occupying lesions. Liver biopsy is especially useful when clinical findings and laboratory tests
are not diagnostic of liver disease.
POST PROCEDURE
1. Immediately after the biopsy, assist the patient to turn onto the right side; place a pillow under the
costal margin, and caution the patient to remain in this position, recumbent and immobile, for several
hours. Instruct the patient to avoid coughing or straining.
2. Measure and record the patient’s pulse, respiratory rate, and blood pressure at 10- to 15-minute
intervals for the first hour, then every 30 minutes for the next 1 to 2 hours or until the patient’s
condition stabilizes.
3. If the patient is discharged after the procedure, instruct the patient to avoid heavy lifting and
strenuous activity for 1 week.
JAUNDICE
When the bilirubin concentration in the blood is abnormally elevated, all the body tissues, including
the sclera and the skin, become yellow-tinged or greenish- yellow, a condition called jaundice.
Jaundice becomes clinically evident when the serum bilirubin level exceeds 2.5 mg/dL (43 fmol/L).
Types of Jaundice
There are several types of jaundice: hemolytic, hepatocellular, obstructive, or jaundice due to
hereditary hyperbilirubinemia. Hepatocellular and obstructive jaundice are the two types commonly
associated with liver disease.
Hemolytic Jaundice ( Prehepatic jaundice) Hemolytic jaundice is due to excessive break down of
Red blood cells.
Causes
1. Sickle cell anemia
2. Malaria
3. Thalassemia
4.Auto immune disorders
5.Massive hemorrhage
Obstructive Jaundice
Obstructive jaundice is a particular type of jaundice and occurs when the essential flow of bile
to the intestine is blocked and remains in the bloodstream. Obstructive jaundice of the extra hepatic
type may be caused by occlusion of the bile duct by a gallstone, an inflammatory process, a tumor, or
pressure from an enlarged organ.
Hereditary Hyperbilirubinemia
Hereditary Hyperbilirubinemia : Increased serum bilirubin levels (hyperbilirubinemia)
resulting from several inherited disorders can also produce jaundice. Gilbert’s syndrome is a familial
disorder characterized by an increased level of unconjugated bilirubin that causes jaundice. Although
serum bilirubin levels are increased, liver histology and liver function test results are normal, and
there is no hemolysis. This syndrome affects 2% to 5% of the population. Other conditions that are
probably caused by inborn errors of biliary metabolism include Dubin–Johnson syndrome (chronic
idiopathic jaundice, with pigment in the liver) and Rotor’s syndrome (chronic familial conjugated
hyperbilirubinemia without pigment in the liver); “benign” cholestatic jaundice of pregnancy, with
retention of conjugated bilirubin.
Cirrhosis is a chronic disease characterized by replacement of normal liver tissue with diffuse
fibrosis that disrupts the structure and function of the liver. There are three types of cirrhosis or
scarring of the liver.
HEPATIC CIRRHOSIS OR LIVER CIRRHOSIS HEPATIC CIRRHOSIS or Cirrhosis of the liver is
characterized by scarring. It is a chronic disease in which there has been diffuse destruction and
fibrotic regeneration of hepatic cells.
2. Postnecrotic cirrhosis, in which there are broad bands of scar tissue as a late result of a previous
bout of acute viral hepatitis. 3. Biliary cirrhosis, in which scarring occurs in the liver around the bile
ducts. This type usually is the result of chronic biliary obstruction and infection (cholangitis); it is
much less common than the other two types.
Clinical manifestations
Onset is insidious; may take years to develop. Clinical manifestations include intermittent jaundice
and fever. Initially the liver is enlarged, hard, and irregular, but eventually it atrophies. Early
complaints include fatigue, anorexia, ankle edema in the evening, epistaxis and bleeding gums, and
weight loss.
A) Chronic dyspepsia, constipation, or diarrhea.
B) Plasma albumin is reduced, leading to edema and contributing to ascites.
C) Anemia and poor nutrition lead to fatigue and weakness, wasting, and depression.
Clinical manifestations
D) Deterioration of mental function from lethargy to delirium to coma and eventual death.(Additional
include deterioration of mental function with impending hepatic encephalopathy and hepatic coma)
E) Estrogen-androgen imbalance causes spider angiomata and palmar erythema; menstrual
irregularities in females; testicular and prostatic atrophy, gynecomastia, loss of libido, and impotence
in males.
F) VITAMIN DEFICIENCY AND ANEMIA (Because of inadequate formation, use, and storage of
certain vitamins (notably vitamins A, C, and K), signs of their deficiency are common, particularly
hemorrhagic phenomena associated with vitamin K deficiency).
Clinical manifestations
Compensated Decompensated Intermittent mild fever Ascites Jaundice Vascular spiders Weakness,
Muscle wasting and Weight loss Palmar erythema (reddened palms) and Unexplained epistaxis
Continuous mild fever, Clubbing of fingers Ankle edema Purpura (due to decreased platelet count)
Spontaneous bruising Vague morning indigestion ,Flatulent dyspepsia and abdominal pain Epistaxis
Hypotension Firm, enlarged liver Sparse body hair and White nails Splenomegaly Gonadal atrophy
Preliminary studies indicate that colchicine, an anti-inflammatory agent used to treat the
symptoms of gout, may increase the length of survival in patients with mild to moderate cirrhosis.
Improved survival has been observed in patients with alcoholic cirrhosis. Colchicine is believed to
reverse the fibrotic processes in cirrhosis, and this has improved survival.
Assessment:
1. Nursing assessment focuses on the onset of symptoms and the history of precipitating factors,
particularly long-term alcohol abuse, as well as dietary intake and changes in the patient’s physical
and mental status.
2. The patient’s past and current patterns of alcohol use (duration and amount) are assessed and
documented. It is also important to document any exposure to toxic agents encountered in the
workplace or during recreational activities.
3. The nurse assesses the patient’s mental status through the interview and other interactions with the
patient; orientation to person, place, and time is noted.
4. The nurse assesses nutritional status, which is of major importance in cirrhosis, by daily weights
and monitoring of plasma proteins, transferrin, and creatinine levels.
Complications
1. Bleeding and hemorrhage
2. Hepatic encephalopathy (Hepatic encephalopathy and coma, possible complications of cirrhosis,
may present as deteriorating mental status and dementia as well as physical signs such as abnormal
voluntary and involuntary movements).
3. Fluid volume excess
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NURSING DIAGNOSES
1. Activity intolerance related to fatigue, general debility, muscle wasting, and discomfort.
2. Imbalanced nutrition, less than body requirements, related to chronic gastritis, decreased GI
motility, and anorexia.
3. Impaired skin integrity related to compromised immunologic status, edema, and poor nutrition. 4.
Risk for injury and bleeding related to altered clotting mechanisms.
5. Disturbed Thought Processes related to deterioration of liver function and increased serum
ammonia level.
6. Imbalanced Nutrition: Less Than Body Requirements related to anorexia and GI disturbances
7. Impaired Skin Integrity related to edema, jaundice, and compromised immunologic status
Nursing Interventions
1. PROMOTING REST 2. IMPROVING NUTRITIONAL STATUS 3. PROVIDING SKIN CARE
(Providing careful skin care is important because of subcutaneous edema, the patient’s immobility,
jaundice, and increased susceptibility to skin breakdown and infection. Frequent position changes are
necessary to prevent pressure ulcers).
4. REDUCING RISK OF INJURY (The nurse protects the patient with cirrhosis from falls and other
injuries. The side rails should be in place and padded with blankets in case the patient becomes
agitated or restless. )
PORTAL HYPERTENSION
Portal hypertension is abnormally high blood pressure in the portal vein (the large vein that
brings blood from the intestine to the liver) and its branches. Obstructed blood flow through the
damaged liver results in increased blood pressure (portal hypertension) throughout the portal venous
system. Although portal hypertension is commonly associated with hepatic cirrhosis, it can also occur
with non cirrhotic liver disease.
Portal hypertension is defined as the elevation of the hepatic venous pressure gradient to > 5
mmhg.
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ASCITES
ASCITES Ascites is of Greek derivation ("askos") and refers to a bag or sack and describes
pathologic fluid accumulation within the peritoneal cavity. Most patients (85%) with ascites have
cirrhosis.
Peritoneal cavity
It is a potential space between the parietal peritoneum and visceral peritoneum, the two
membranes separate the organs in the abdominal cavity from the abdominal wall.
Peritoneal fluid
It is a normal, lubricating fluid found in the peritoneal cavity. The fluid is mostly water with
electrolytes, antibodies, white blood cells, albumin, glucose and other biochemical. Reduce the
friction between the abdominal organs as they move around during digestion.
Ascites is defined as the accumulation fluid in the peritoneal cavity ( abdominal cavity).
Pathophysiology
The mechanisms responsible for the development of ascites are not completely understood.
Portal hypertension and the resulting increase in capillary pressure and obstruction of venous blood
flow through the damaged liver are contributing factors. The failure of the liver to metabolize
aldosterone increases sodium and water retention by the kidney. Sodium and water retention,
increased intravascular fluid volume, and decreased synthesis of albumin by the damaged liver all
contribute to fluid moving from the vascular system into the peritoneal space.
Clinical Manifestations
1. Increased abdominal girth and rapid weight gain are common presenting symptoms of ascites. 2.
The patient may be short of breath and uncomfortable from the enlarged abdomen, and striae and
distended veins may be visible over the abdominal wall.
3. Fluid and electrolyte imbalances are common.
Medical Management
1. DIETARY MODIFICATION : The goal of treatment for the patient with ascites is a negative
sodium balance to reduce fluid retention. Table salt, salty foods, salted butter and margarine, and all
ordinary canned and frozen foods (foods that are not specifically prepared for low-sodium diets)
should be avoided.
2. DIURETICS: Use of diuretics along with sodium restriction is successful in 90% of patients with
ascites. Spironolactone (Aldactone), an aldosteroneblocking agent, is most often the first-line therapy
in patients with ascites from cirrhosis. Possible complications of diuretic therapy include fluid and
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Abdominal Paracentesis
Abdominal Paracentesis
PREPROCEDURE
1. Prepare the patient by providing the necessary information and instructions about the procedure
and by offering reassurance.
2. Instruct the patient to void.
3. Gather appropriate sterile equipment and collection receptacles.
4. Place patient in upright position on edge of bed with feet supported on stool, or place in chair.
Fowler’s position should be used for the patient confined to bed.
5. Place sphygmomanometer cuff around patient’s arm to allow monitoring of blood pressure during
the procedure.
PROCEDURE
1. The physician, using aseptic technique, inserts the trocar through a puncture wound below the
umbilicus.
2. Help the patient maintain position throughout procedure.
3. Measure and record blood pressure at frequent intervals from the beginning of the procedure.
4. Monitor the patient closely for signs of vascular collapse: pallor, increased pulse rate, or decreased
blood pressure.
POST PROCEDURE
1. Return patient to bed or to a comfortable sitting position.
2. Measure, describe, and record the fluid collected.
3. Label samples of fluid and send to laboratory.
4. Continue to monitor vital signs every 15 minutes for 1 hour, every 30 minutes over 2 hours, then
every hour over 2 hours and then every 4 hours. Monitor temperature after procedure and every 4
hours.
5. Assess for hypovolemia, electrolyte loss, changes in mental status, and encephalopathy.
6. Check puncture site when taking vital signs for bleeding and leakage.
7. Provide patient education (especially if patient is discharged after procedure) regarding monitoring
for bleeding or excess drainage from puncture site, avoiding heavy lifting or straining, changing
position slowly, and monitoring for fever.
Nursing Management
If a patient with ascites from liver dysfunction is hospitalized, nursing measures include
assessment and documentation of intake and output, abdominal girth, and daily weight to assess fluid
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status. The nurse monitors serum ammonia and electrolyte levels to assess electrolyte balance,
response to therapy, and indicators of encephalopathy.
Pathophysiology
1. Ammonia accumulates because damaged liver cells fail to detoxify and convert to urea the
ammonia that is constantly entering the bloodstream.
2. Ammonia enters the bloodstream as a result of its absorption from the GI tract and its liberation
from kidney and muscle cells. The increased ammonia concentration in the blood causes brain
dysfunction and damage, resulting in hepatic encephalopathy
1. Other factors unrelated to increased serum ammonia levels that may cause hepatic encephalopathy
in susceptible patients include excessive diuresis, dehydration, infections, surgery, fever, and some
medications (sedative agents, tranquilizers, analgesic agents, and diuretic medications that cause
potassium loss).
Clinical Manifestations
1. The earliest symptoms of hepatic encephalopathy include minor mental changes and motor
disturbances.
2. The patient appears slightly confused, has alterations in mood, becomes unkempt, and has altered
sleep patterns.
3. The patient tends to sleep during the day and have restlessness and insomnia at night. As hepatic
encephalopathy progresses, the patient may be difficult to awaken.
Clinical Manifestations
1. Asterixis ( flapping tremor of the hands) (Asterixis (also called the flapping tremor, or liver flap) is
a tremor of the hand when the wrist is extended, sometimes said to resemble a bird flapping its
wings.) may occur. Simple tasks, such as handwriting, become difficult. A handwriting or drawing
sample (e.g., star figure), taken daily, may provide graphic evidence of progression or reversal of
hepatic encephalopathy. Inability to reproduce a simple is referred to asconstructional apraxia
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Medical Management
Lactulose (Cephulac) is administered to reduce serum ammonia levels. It acts by several
mechanisms that promote the excretion of ammonia in the stool:
Possible side effects include intestinal bloating and cramps, which usually disappear within a
week. To mask the sweet taste, to which some patients object, lactulose can be diluted with fruit juice.
The patient is closely monitored for hypokalemia and dehydration. Other laxatives are not prescribed
during lactulose administration because their effects would disturb dosage regulation. Lactulose can
be administered by nasogastric tube or enema for patients who are comatose or in whom oral
administration is contraindicated or impossible.
Other aspects of management include intravenous administration of glucose to minimize
protein breakdown, administration of vitamins to correct deficiencies, and correction of electrolyte
imbalances (especially potassium).
NURSING ALERT (The patient receiving lactulose is monitored closely for the development
of watery diarrheal stools, because they ! indicate a medication overdose)
Additional principles of management of hepatic encephalopathy include the following
1. Therapy is directed toward treating or removing the cause.
2. Neurologic status is assessed frequently. A daily record is kept of handwriting and performance in
arithmetic to monitor mental status.
3. Fluid intake and output and body weight are recorded each day.
4. Vital signs are measured and recorded every 4 hours.
5. Potential sites of infection (peritoneum, lungs) are assessed frequently, and abnormal findings are
reported promptly.
6. Serum ammonia level is monitored daily.
7. Protein intake is restricted in patients who are comatose or who have encephalopathy that is
refractory to lactulose and antibiotic therapy.
8. Reduction in the absorption of ammonia from the GI tract is accomplished by the use of gastric
suction, enemas, or oral antibiotics.
9. Electrolyte status is monitored and corrected if abnormal.
10. Sedatives, tranquilizers, and analgesic medications are discontinued.
11. Benzodiazepine antagonists (flumazenil [Romazicon]) may be administered to improve
encephalopathy whether or not the patient has previously taken benzodiazepines.
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Nursing Management
The nurse is responsible for maintaining a safe environment to prevent injury, bleeding, and
infection. The nurse administers the prescribed treatments and monitors the patient for the many
potential complications. The nurse also communicates with the patient’s family to keep them
informed about the patient’s status, and supports them by explaining the procedures and treatments
that are part of the patient’s care.
Most primary liver tumours (90%) originate in the parenchymal cells and are hepatomas ( also called
hepatocellular carcinomas).
LIVER METASTASES
Metastases from other primary sites are found in the liver in about half of all advanced cancer cases
(Bacon & Di Bisceglie, 2000). Malignant tumors are likely to reach the liver eventually, by way of
the portal system or lymphatic channels, or by direct extension from an abdominal tumor.
Clinical Manifestations
1. The early manifestations of malignancy of the liver include pain, a continuous dull ache in the right
upper quadrant, epigastrium, or back.
2. Weight loss, loss of strength, anorexia, and anemia may also occur. The liver may be enlarged and
irregular on palpation.
3. With portal vein obstruction, ascites and esophageal varices occurs.
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Medical Management
Although surgical resection of the liver tumor is possible in some patients, the underlying
cirrhosis, so prevalent in cancer of the liver, increases the risks associated with surgery. Radiation
therapy and chemotherapy have been used in treating cancer of the liver with varying degrees of
success. Although these therapies may prolong survival and improve quality of life by reducing pain
and discomfort, their major effect is palliative.
SURGICAL MANAGEMENT
1. Surgical resection is the treatment of choice when HCC is con- fined to one lobe of the liver and
the function of the remaining liver is considered adequate for postoperative recovery.
2. In preparation for surgery, the patient’s nutritional, fluid, and general physical status is assessed
and efforts are undertaken to ensure the best physical condition possible. Support, explanation, and
encouragement are provided to help the patient prepare psychologically for the surgery.
3. Extensive diagnostic studies may be performed. Specific studies may include liver scan, liver
biopsy, cholangiography, selective hepatic angiography, percutaneous needle biopsy, peritoneoscopy,
laparoscopy, ultrasound, CT scans, MRI, and blood tests, particularly determinations of serum
alkaline phosphatase, AST, and GGT and its isoenzymes.
Lobectomy
(Removal of a lobe of the liver is the most common surgical procedure for excising a liver
tumor.
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Cryosurgery
In cryosurgery (cryoablation), tumors are destroyed by liquid nitrogen at −196° C. To destroy
the diseased tissue, two or three freeze-and-thaw cycles are administered via probes during open
laparotomy.
Liver transplantation (LT) is a life saving procedure for patients with end stage liver disease and its
complications, and for liver failure. LT is also curative for some hereditary metabolic disorders like
familial hypercholesterolemia and for selected cases of malignancies involving the liver, such as
hepatocellular carcinoma (HCC) and hepatoblastoma.
Removing the liver and replacing it with a healthy donor organ is another way to treat liver
cancer. Recurrence of the primary liver malignancy after transplantation, however, has been reported
to occur in 70% to 85% of cases, and the survival time after recurrence is brief. But transplant surgery
is performed infrequently because of its risks, its high cost, and the difficulty procuring organs.
Liver transplantation is used to treat life-threatening, end-stage liver disease for which no other form
of treatment is available. The transplantation procedure involves total removal of the diseased liver
and its replacement with a healthy liver in the same anatomic location (orthotopic liver
transplantation [OLT]).
Liver transplantation
Indications for Liver transplantation General indications for liver transplantation include:
1. irreversible advanced chronic liver disease
2. fulminant hepatic failure
3. metabolic liver diseases, and some hepatic malignancies. Examples of disorders that are indications
for liver transplantation include hepatocellular liver disease (e.g., viral hepatitis, drug- and alcohol-
induced liver disease, and Wilson’s disease) and cholestatic diseases (primary biliary cirrhosis,
sclerosing cholangitis, and biliary atresia).
COMPLICATIONS
infection.
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Pre-operative preparation
1. As ordered , begin immunosuppressant therapy to decrease the risk of tissue rejection, using such
drugs as cyclosporine, tacrolimus and corticosteroids.
2. Explain the need for lifelong therapy to prevent rejection.
3. Before transplant surgery, address the patients ( and family members) emotional needs.
4. The nurse and other health care team members provide the patient and family with full
explanations about the procedure, the chances of success, and the risks, rejection of organ including
the side effects of long-term immunosuppression.
5. Malnutrition, massive ascites, and fluid and electrolyte disturbances are treated before surgery to
increase the chance of a successful outcome.
Patient Teaching
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1. Before discharge the client teach the patient and family members to recognize the early indicators
of tissue rejection ( pain and tenderness in the RUQ or centre of the back, fever tachycardia, jaundice
and changes in colour in urine and stool )
2. The nurse provides written as well as verbal instructions about how and when to take the
medications. To avoid running out of medication or skipping a dose, the patient must make sure that
an adequate supply of medication is available.
A 36-year-old African man came to the United States from Philippins 3 years ago to live with
relatives. He is being treated for end-stage liver disease (ESLD) with cirrhosis related to hepatitis B
and is undergoing evaluation for liver transplantation. The sequelae of ESLD that he is experiencing
include encephalopathy and ascites. What would you anticipate this patient’s treatment regimen to
include? What medications would be most appropriate for him? What would you include in your
cultural assessment when you develop a preoperative teaching plan for this patient? What alternative
therapies might be used preoperatively? Once the patient receives a liver transplant, what medications
would you expect to be prescribed for him in addition to an immunosuppressant regimen?
Reference:
Brunner, L. and Suddarath, D. (2019). Text Book of Medical Surgical Nursing. 14 th Edition.
J.B. Lippincott Williams & Wilikins, Library of Congress Catalging-in- Publication Data
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