Liver Diseases and Related Conditions

Key Terms and Definitions

• Alcohol Withdrawal: Occurs after stopping heavy and prolonged alcohol intake; symptoms include tremors, confusion, delusions, hallucinations, tachycardia, hypertension, and sweating.
• Ascites: Fluid accumulation in the peritoneal cavity due to portal hypertension.
• Asterixis: Coarse tremor in wrists and fingers.
• Cirrhosis: Liver scarring that alters liver function, often due to chronic liver inflammation.
• Esophageal Varices: Distended veins in the esophagus from portal hypertension.
• Fetor Hepaticus: Fruity or musty breath odor associated with liver disease.
• Hepatic Encephalopathy: Cognitive disorder from liver failure, includes symptoms like confusion and tremors.
• Hepatitis: Liver inflammation, can be viral or due to toxins.
• Hepatopulmonary Syndrome: Complication of cirrhosis affecting pulmonary function.
• Hepatorenal Syndrome: Kidney complications from advanced liver disease.
• Jaundice: Yellowing of skin and eyes from increased bilirubin.
• NAFLD & NASH: Accumulation of liver fat not due to alcohol, can lead to cirrhosis.

Cirrhosis

• Pathophysiology: Irreversible scarring that impairs liver function by blocking blood flow and bile ducts.
• Types:
  • Postnecrotic: From hepatitis or toxins.
  • Alcoholic: From chronic alcohol use.
  • Biliary: From bile duct obstruction.
• Complications:
  • Portal Hypertension: Increased pressure in portal vein causing collateral circulation and varices.
  • Ascites and Varices: Fluid accumulation and risk of bleeding from thin-walled veins.
  • Biliary Obstruction: Reduced bile production affecting fat-soluble vitamin absorption.
  • Hepatic Encephalopathy: Cognitive symptoms from high ammonia levels.
• Management:
  • Fluid Management: Low-sodium diet, diuretics, paracentesis.
  • Hemorrhage Prevention: Beta-blockers, endoscopic therapies for varices.
  • Confusion Management: Lactulose to reduce ammonia.

Nonalcoholic Fatty Liver Disease (NAFLD)

• Risk Factors: Obesity, diabetes, metabolic syndrome.
• Management: Lifestyle changes focused on weight loss and nutrition.

Hepatitis

• Types:
  • HAV: Fecal-oral transmission, usually mild.
  • HBV: Blood-borne, can become chronic.
  • HCV: Blood-borne, often asymptomatic.
  • HDV: Requires HBV for replication.
  • HEV: Waterborne, self-limiting.
• Prevention: Vaccinations available for HAV and HBV, safe practices to avoid transmission.
• Management:
  • Nutritional Support: Balanced diet with carbohydrates and proteins.
  • Activity Management: Rest to promote liver healing.
  • Drug Therapy: Antivirals for chronic types, supportive care for acute.

Liver Transplantation

• Indications: End-stage liver disease, liver failure not responding to treatment.
• Complications:
  • Acute Rejection: Requires monitoring and immunosuppressive therapy.
  • Infections: Prophylactic antibiotics, good hygiene.
  • Biliary and Vascular Issues: Require immediate medical attention.
• Post-Transplant Management: Long-term immunosuppression, monitoring for complications, lifestyle modifications.

Patient Education and Health Promotion

• Avoidance: Emphasize avoiding alcohol and harmful drugs, adherence to medication regimens, and regular follow-up care.
• Vaccination and Screening: Encourage vaccinations and screening for those at risk.
• Support Systems: Utilize interprofessional teams, community resources, and support groups for ongoing care and lifestyle management.