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6. Drug Metabolism – enzymes in the liver would

Liver Failure convert the active drug into an inactive form,
decreasing the effect of the drug → excreting the
→ AKA: Hepatic Failure
drug from the body.
→ This refers to a condition in which the liver isn’t
working well enough to perform its functions 7. Bile Formation – bile is continuously formed by
(for example, manufacturing bile and ridding the hepatocytes in the liver and is stored in the
the body of harmful substances). gallbladder.
→ There is an inability of the liver to carry out its
8. Bilirubin Excretion – bilirubin is taken up into
functions.
→ Can result from acute liver injury, causing the hepatocytes from the liver sinusoids by
acute liver failure (ARF), or progressive passive diffusion and receptor-mediated
chronic liver disease such as cirrhosis. endocytosis. Unconjugated bilirubin will be
converted by the hepatocytes into conjugated form
for it to be excreted by the body and some of it will
be entering the systemic circulation which will
eventually go into the kidney for it be excreted by
the kidney. This conjugated bilirubin that escapes
reuptake into the hepatocyte is excreted in the
urine via the kidney.

→ Irrespective of the cause of liver injury,

inflammation results in damage to hepatocytes,
1. Glucose Metabolism – the excess glucose will
known as “hepatitis.”
be delivered in to the liver and will be stored into
the hepatocytes, and when the body needs glucose, → Injured areas are surrounded by scar tissues
the hepatocytes will be releasing these glucoses leading to fibrosis, and after a period of time
for use via the process of gluconeogenesis. progressive fibrosis results in cirrhosis or
replacement of the normal hepatic tissue with
2. Ammonia Conversion – ammonia is detoxified fibrotic tissue.
in the liver by converting it into urea for it to be
excreted by the body.
3. Protein Metabolism – liver converts excess
proteins into fatty acids and triglyceride which are
then exported and stored into the adipose tissue → AKA Fulminant Hepatic Failure
4. Fat Metabolism – if the availability of glucose is
→ It results in a rapid deterioration of liver function
limited there would be a metabolism of fat by the in a person without prior liver disease.
liver for it to be converted into fatty acids which
will then be used as energy by the body. → Loss of liver function that occurs rapidly – in days
or weeks.
5. Vitamin and Iron Storage – vitamins and iron
→ The cellular insult results in massive cell necrosis
will be stored inside the liver.
leading to a multiorgan dysfunction.

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waxes, varnishes, and other chemicals. Others:

Chlorinated naphthalene, arsenic, phosphorus.
6. Autoimmune disease: autoimmune hepatitis - a
disease in which the immune system attacks the
liver cells causing inflammation and injury.
7. Diseases of the veins in the liver: Budd-Chiari
syndrome, can cause blockages in the veins of the
Common dysfunctions in ACF liver and lead to ALF.
8. Metabolic disease: Wilson's disease and acute
fatty liver of pregnancy
9. Cancer. Cancer that either begins in or spreads in
the liver causing the liver to fail.
10. Shock. Overwhelming infection (sepsis) and shock
can severely impair blood flow to the liver, causing
liver failure.
11. Heat stroke. Extreme physical activity in a hot
environment can trigger ALF.

→ A slow deterioration that evolves over years

1. Acetaminophen overdose. Taking too much leading to cirrhosis.
acetaminophen (Tylenol, others) is the most
→ Liver dysfunction potentially can be reversed early
common cause of ACF.
as the liver has a regenerative capability; however,
2. Prescription medications. Some prescription fibrotic changes are irreversible resulting in
medications such as antibiotics, NSAIDs and chronic dysfunction and eventual end-stage liver
anticonvulsants, can cause ARF. disease.

3. Herbal supplements. Herbal drugs and

supplements such as kava and ephedra, skullcrap
and pennyroyal, have been linked to ALF. → A chronic disease characterized by replacement
4. Hepatitis and other viruses. Hepatitis A, of normal liver tissue with diffuse fibrosis that
hepatitis B and hepatitis E; Other viruses like disrupts the structure and function of the liver.
Epstein-Barr virus, cytomegalovirus and herpes → The portion of the liver chiefly involved in
simplex virus. cirrhosis consists of the portal and the
5. Toxins: poisonous wild mushroom Amanita periportal spaces where the bile canaliculi of
phalloides, which sometimes mistakes for one that each lobule communicate to form the liver bile
is safe to eat and Carbon tetrachloride is another ducts.
toxin that can cause ARF. It is an industrial → These areas become the sites of inflammation.
chemical found in refrigerants and solvents for

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- Usually, the result of chronic biliary obstruction

and infection (cholangitis)
- Less common that the other 2 types.

▪ The bile ducts become occluded with

inspissated (thickened) bile and pus.
▪ The liver attempts to form new bile channels.
▪ Overgrowth of tissue made up largely of
disconnected, newly formed bile ducts and
surrounded by scar tissue.

1. Chronic hepatitis B or C infection

- With a chronic HBV infection, large areas of the
liver can become permanently scarred and
nodules may form.

1. Alcoholic Cirrhosis - Blood cannot flow freely through scarred liver

tissue.
- The scar tissue characteristically surrounds the
portal areas. 2. Alcohol-related liver disease

- Most frequently due to chronic alcoholism.

- Most common type of cirrhosis.

2. Post necrotic Cirrhosis

- There are broad bands of scar tissue as a late
result of a previous bout of acute viral hepatitis.

3. Biliary Cirrhosis
- Scaring occurs in the liver around the bile ducts.

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3. Nonalcoholic fatty liver disease destruction of the bile ducts and the
hepatocytes.
- Nonalcoholic fatty liver disease – an umbrella
term for a range of liver conditions affecting - In addition, increased expression of the HLA
people who drink little to no alcohol. class II antigens in the liver occurs, rendering
the hepatocytes and bile duct epithelial cells
- The main characteristics of NAFLD is too much
more susceptible to activated T lymphocytes
fat stored in the liver cells.
exacerbating immunologically mediated
- Nonalcoholic steatohepatitis (NASH), an cytotoxicity.
aggressive form of fatty liver disease – marked
by liver inflammation and may progress to
advanced scarring (cirrhosis) and liver failure.

4. Autoimmune hepatitis
- Occurs when immune system attacks liver cells.
- Persistent inflammation within the liver causes
scarring.
5. Diseases that affect the bile ducts, such
as cholangitis
- A continuous destruction of small and medium
bile ducts occurs – mediated by activated CD4
and CD8 lymphocytes.
- Disruption of the normal bile flow (chronic
cholectasis) – retention and deposition of toxic
substances.
- The retention of toxic substances, such as bile
acids and copper, can cause a further secondary

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→ feeling unwell (malaise)

→ feeling tired or sleepy
→ nausea or vomiting
→ abdominal pain or swelling
→ yellowing of the skin and eyes (jaundice)
→ feeling confused or disoriented

The
may include:

→ feeling tired or fatigued

→ loss of appetite
→ nausea or vomiting
→ mild abdominal discomfort or pain

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Symptoms that can indicate the

include:
→ yellowing of the skin and eyes (jaundice)
→ easy bruising or bleeding
→ Biopsy. Taking a tissue sample from the liver to
→ feeling confused or disoriented see if scar tissue is present and can also aid in
diagnosing what may be causing the condition.
→ buildup of fluid in your abdomen, arms, or legs
Percutaneous needle biopsy:
→ darkening of your urine
→ severe skin itching

1. Inflammation: the liver is enlarged or inflamed.

2. Fibrosis. Scar tissue begins to replace healthy
tissue in the inflamed liver.
3. Cirrhosis. Severe scarring has built up, making it Transjugular Biopsy:
difficult for the liver to function properly
4. End-stage liver disease (ESLD). Liver function
has deteriorated to the point where the damage
can’t be reversed other than with a liver
transplant.
5. Liver cancer. The development and multiplication
of unhealthy cells in the liver can occur at any Esophagostomy/ Esophagoscopy:
stage of liver failure, although people with
cirrhosis are more at risk.

→ Liver blood tests (ALT/AST). Assess the levels of

various proteins and enzymes in the blood that can
be an indicator of the liver functions.
→ Blood Tests. A complete blood count (CBC) or test
for viral hepatitis or genetic conditions that can
cause liver damage.
→ Imaging tests. Imaging technology such
as ultrasound, CT scan, or MRI scan is done to
visualize the liver.

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▪ Place the patient on bed-rest to decrease the

metabolic needs of the liver
▪ Institute measures to prevent skin
breakdown.
▪ Monitor drugs that are metabolized or
detoxified by the liver, especially narcotics
and sedatives

▪ Monitor fluid balance.

▪ Assist with paracentesis that may be
instituted to reduce ascites.

▪ Monitor respiratory status and correlate with

arterial blood gas results.
▪ Administer oxygen as ordered.
▪ Administer sedatives and analgesics
cautiously.
▪ Assist the patient with maneuvers to improve
oxygenation.

▪ Monitor for signs of bleeding (eg, gastric

contents, stools, urine) and test for occult
blood.
▪ Administer blood and blood products as
ordered.

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▪ Institute measures for variceal bleeding as

needed, including beta blockers.
▪ Institute measures to provide for safety and
to minimize tissue trauma.
▪ Provide frequent small meals and a bedtime
snack containing carbohydrate to prevent
muscle wasting.
▪ Monitor for signs and symptoms of infection.

▪ Observe for changes in mentation.

▪ Administer cleansing enemas and cathartics
to keep the bowel empty.
▪ Monitor patient response to therapy through
neurologic assessments and serum ammonia
levels.
▪ Monitor the use of medications metabolized by
the liver.
▪ Institute protocols for acute upper GI
hemorrhage due to variceal rupture.

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▪ Monitor the patient’s temperature, urine output,

neurologic status and hemodynamic pressures.
▪ Provide education about immunosuppressive
drugs.

▪ Monitor level of consciousness, blood pressure,

volume status, blood and coagulation tests, and
signs and symptoms.
▪ Keep the head of the bed elevated 30 degrees,
with the patient’s head in the neutral position.
▪ Decrease stimulation, such as frequent
suctioning.
▪ Stay alert for hypercapnia and hypoxia; correct
these conditions as indicated and ordered.
▪ Manage fever aggressively with a fan, cooling
blanket, or both.
▪ Watch for signs and symptoms of infection and
possible sepsis; administer antibiotics, as
needed and ordered.
▪ Maintain strict glucose monitoring for possible
hypoglycemia or hyperglycemia.
▪ Provide nutritional support as ordered

Chances of developing liver failure can be reduced by:

• Being vaccinated for hepatitis B
• Cutting down on alcohol
• Maintaining a healthy weight and active
lifestyle
• Following directions when using medications
Liver Transplantation
like acetaminophen (Tylenol®)
▪ This involves removing the diseased liver and • Having a physical examination every year (at
replacing it with a liver from a healthy donor. least) with a primary care provider, with
After liver transplantation the nurse must: screening for obesity, high cholesterol, high
blood pressure and diabetes
▪ Assess the patient for such complications as
bleeding, infection, and rejection.

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