The liver is responsible for the elimination of bacteria from the blood and the excretion of drugs. It also stores vitamins A, D, E and K and minerals including copper and iron. When the body is in need of glucose, the liver can convert glycogen into glucose and release it. When the liver begins to fail, many body systems are affected.
History
Liver failure can have various causes. Viral hepatitis, a drug overdose or an obstruction may lead to liver failure. Viral hepatitis and alcohol can lead to scarring of the liver, called cirrhosis, which causes liver cells to die. Some drugs are toxic to the liver if an overdose is taken. Acetaminophen is an example of one such drug. Obstructions that cause liver failure may include gallstones or a tumor.
Central Nervous System Signs
Ammonia is produced as a result of bacteria breaking down protein in the bowel. The liver normally detoxifies ammonia and converts it to a product called urea, which is then excreted. When the liver fails, this function is impaired, allowing ammonia levels to rise in the bloodstream and enter the central nervous system. Ammonia is toxic to the nervous system. The rise in ammonia levels leads to muscle tremors, slurred speech, changes in mental status and sometimes coma.
Heart & Respiratory Signs
As the liver fails, other systems attempt to compensate for the changes in the body. With additional work placed on the heart, the person with liver disease will experience an increased heart rate, a warm feeling in his arms and legs and low blood pressure. He may develop a pleural effusion, which is a buildup of fluid in the space that surrounds the lungs. He is also at a higher risk of infections that can cause pneumonia. He will become short of breath with or without any physical exertion.
Additional Symptoms
As failure progresses and additional body systems are taxed, the person with liver disease will develop bleeding disorders, kidney failure and an accumulation of excess fluid in the abdomen. Bleeding disorders develop because clotting factors are impaired. The fluid accumulates because the kidneys are not ridding the body of excess fluid. The skin will become jaundiced. The yellow discoloration is caused by a yellow pigment called bilirubin. Bilirubin is one of several products released when hemoglobin is broken down. A distinct sweet fecal breath, caused by the obstruction or collapse of the bowels, is common in liver failure.
Treatment & Outcome
Liver disease is a progressive disorder, and treatment depends on the underlying cause. If the underlying cause, such as a obstruction, can be fixed, the liver failure can be treated. Additionally, treatment includes supportive care to manage fluid and electrolyte imbalances, bleeding problems and nutritional needs. For those in the end stages of liver failure, liver transplant is the only absolute cure for the disease.
References
- "Essentials of Critical Care Nursing"; McGraw Hill; 2006
- "Nursing 2005"; When Your Patient Is In Liver Failure; Whiteman & McCormick; 2005
