Liver Disease Detection and Management

The assignment provided is an in-depth analysis of liver disease, covering topics such as jaundice detection, alcoholic liver cirrhosis, non-alcoholic fatty liver disease, and the role of systemic inflammation. It includes references to various studies and articles on the subject, including a randomized clinical trial on colchicine treatment for alcoholic cirrhosis. The document is suitable for students in medical or health-related fields who need to understand the complexities of liver disease and its management.

Running head: ACUTE CARE NURSING
Acute Care Nursing
Name of the Student
Name of the University
Author Note

1ACUTE CARE NURSING
Case Study 3
Answer 1
The main cause behind the development of liver cirrhosis by Mr Nathan James is his
hepatitis C infection which he had encountered 10 years ago. This is because, according to
the reports published by Chen and Morgan (2006), chronic hepatitis C is the leading cause of
chronic liver disease and liver cirrhosis. Chen and Morgan (2006) have further opined that
nearly one third of the chronically ill patient of hepatitis C develops progressive liver injury
followed by fibrosis and eventual development of liver cirrhosis over a period of 20 to 30
years. Approximately 75 to 85% of hepatitis C virus infected individual will progress towards
chronic hepatitis C infection and these individuals are more susceptible towards developing
extrahepatic manifestations along with compensated and decompensated liver cirrhosis (Chen
& Morgan, 2006).
The main risk factor which further made Mr Nathan James susceptible towards
developing liver cirrhosis is consumption of alcohol. According to the case study, Mr James
used to consume 2 cans of beer per day. Alcohol is the main contributing risk factor behind
the development of liver cirrhosis or is also responsible for developing alcohol-induced liver
cirrhosis (Askgaard et al.2015). However, from the case study, it is still not clear whether Mr
Nathan James have developed alcoholic or non-alcoholic liver disease. Askgaard et al. (2015)
have opined that regular drinking tendency or the pattern of drinking is associated with the
development of liver cirrhosis.
The liver cirrhosis has hampered both the physical and mental state of Mr James. In
the physiological parameter, it can be easily detected from the case study that he is spitting
blood stained sputum along with weight loss and loss of appetite. Mr James has also
developed certain unexplained scars over his arms along with distended abdomen, oedema in

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the ankles and mild jaundice. In the mental scale, Mr James irritated. Apart from Mr James,
his family will also get affect. According to Golics et al. (2013), there is a significant impact
on the quality of life of the members of family with patients of chronic disease. The family
members of the patients experience worriedness, frustration and stress such that the members
of the family are more emotionally affected by illness in comparison to the patient (Golics et
al. 2013).
Answer 2
Signs and Symptoms Pathophysiology
Spitting blood stained
sputum
The liver an important role in blood coagulation. Coagulation
defects arising out of liver disease predispose to an increased
bleeding tendency. This bleeding is manifested via excretion of
blood stained sputum. However, the sputum is not arising out of
pulmonary infection and hence no chest pain or shortness of
breath is experienced
Loss of appetite The main pathophysiological mechanisms behind the clinical
conditions that is responsible for the development of loss of
appetite among the cirrhotic patients like Mr Nathan James is an
ill-balanced metabolic state of the body. The reason behind this
is multiple factors which intertwine and thus giving rise of loss
of appetite as primary manifestation. Some of the important
factors responsible for loss of appetite and subsequent
malnourishment include inadequate offer of nutrients,
diminished synthetic capacity of the hepatic cells,
hypermetabolic state and impaired absorption of nutrients from

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the hepatic cells in blood.
Odemain ankles and
distended abdomen
The most acceptable theory for behind accumulation of fluid as
ascites is peripheral arterial vasodilation. This leads to under
filling of circulatory volume. This in turn up-regulates
baroreceptor-mediated activation of sympathetic nervous
system, renin-angiotensin-aldosterone system and nonosmotic
synthesis of vasopressin to restore integrity of the circulatiry
system. The result of this is highwater-sodium retentionwhich is
identified as preascitic state. This condition simultaneously
evolvesas fluid retention or ascites, as the liver disease gradually
progresses towards worse.
Irritability Liver helps in the clearance of the toxic particles from the body.
In case of liver malfunction the toxic particles from the body is
not removed adequately and this give rise to irritability.
Mild Jaundice Bilirubin is generated in reticulo-endothelial cells via the
breakdown of haemoglobin. The sequence of biochemical
events isas follows: haemoglobin → haematin → protporphyrin
→ biliverdin → bilirubin. Bilirubin released from reticulo-
endothelial cells into the body fluid in unconjugated or
unconjugated form. This free bilirubin is then conjugated with
proteins like albumin or alpha globulin and remains in that
conjugated form and is not excreted out of body via kidneys. It
is the role of the liver to break protein bound bilirubin into water
soluble form via conjugating the same with glucuronide or
sulphate ions which is then excreted via kidneys. In liver

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cirrhosis, liver starts malfunctioning and thus adequate excretion
of bilirubin via kidneys is hampered. Extra bilirubin gets
deposited in the body leading to jaundice.
(Source: Tsochatzis, Bosch & Burroughs, 2014)
Answer 3
Corticosteroid is one of the most popular choices for treating the patient with alcohol
induced liver cirrhosis. Corticosteroid acts via reducing the secretion of the inflammatory
cytokines like intercellular adhesion molecule 1, tumour necrosis factor-α (TNF-α), IL-8 and
interlukin (IL)-6. Corticosteroid like gluco-corticoid inhibits the initial events occurring in an
inflammatory response. Gluco-corticoid inhibits vasodilatation via increasing the vascular
permeability that occurs after the inflammatory insult and thus they decrease the migration of
leukocyte towards the site of inflammation (Mathurin&Bataller, 2015). Thus cortico-steroid
or gluco-corticosteroid is effective in treating liver cirrhosis because according to Dirchwolf
and Ruf (2015), systemic inflammation and deregulation of the immune system are two most
important pathological pathways of the disease development. Here systemic inflammation is
mediated via activation of innate and adaptive immune cells which results in increase
production of inflammatory and pro-inflammatory cytokines.Mathurin andBataller (2015)is
of the opinion that upon administration of glucocorticoid, blood neutrophil leucocytosis
reaches the pick along with the decrease in the blood serum concentration of monocytes,
lymphocytes and esoniophills. Neutrophil leucocytosis inhibits the ability of neutrophil to
accumulate at the site of inflammation and thereby reducing inflammatory
response(Mathurin&Bataller, 2015).

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According to colchicine reduces acute injury of liver via inhibiting collagen secretion
and increasing collagen degradation and thus decreasing the rate of liver fibrosis. According
to Morgan et al. (2017), long term treatment of liver cirrhosis via colchicine does not
decrease the overall mortality or mortality specific to liver among the patients who are in
their advanced stage. The comprehensive impact of colchicine on morbidity of liver disease is
marginal. However, treatment with colchicine, a mitotic spindle inhibitor is associated with
decrease incidence of upper gastro-intestinal bleeding, hepatic encephalopathy and
spontaneous bacterial peritonitis. The clinical significance behind the lower incidence of less
gynecomastia, erythma and edema among the patients who are under colchicine treatment is
unclear(Morgan et al., 2017). Colchicine however, helps to reduce the number of
hospitalization, reduced rate of occurrence of hepatorenal syndrome. But the process by
which colchicine reduces hepatorenal syndrome is also not known till now (Morgan et al.,
2017).
Answer 4
According to Aron-Wisnewsky et al. (2012)oxygen saturation of patient must be in
between 90 to 100% but in case of Mr Nathan James, the SpO2: 88% on RA and 95% on 6L
through Hudson mask. The first nursing intervention will be to keep the oxygen saturation
steady via continuation of titrated oxygen supply via Hudson mask or via the application of
nasal canula. Proper oxygen saturation will also help to reduce the risk or chronicity of
tachypnoia. Aron-Wisnewsky et al. (2012) have opined that patients of liver cirrhosis has a
tendency to suffer from hypoxia and low amount of oxygen in blood of Mr James is the
indication towards hypoxic conditions and hence external supply of oxygen will helpful to
increase the oxygen saturation with the body.

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Second nursing intervention, which must be done with 24 hours of emergency
department admission include intravenous injection of Lasix to Mr James. Lasix is
furosemide that is administered in order to reduce fluid within the body (oedema) caused via
conditions like liver disease, heart failure and kidney disease (Qavi, Kamal &Schrier, 2015).
Furosemide can also be define as water pill that helps in the formation of more urine and
thereby reducing excess fluid content of the body(Qavi, Kamal &Schrier, 2015).
Administration of Lasix will help in reducing the symptoms of Mr James like poor oxygen
saturation, swelling of the lower extremity of foot (ankles) and distended abdomen. However,
administration of Lasix should only be done after the approval from the medical practitioner
(doctor). According to the reports published by Thapaliya et al. (2013), administration of
Lasix have been found to provide positive results with patients of liver cirrhosis and who is
suffering from ascites and portal hypertension.
Immediate observance of fluid restricted diet (1500 ml) as per the orders coming from
the medical officer is third most important nursing intervention that must be employed
immediately after admission in emergency department. Along with fluid restricted diet, the
output of urine should be measured after each shift. This is because, according to the recent
report, renal dysfunction is the most common problem with the patients suffering from
advanced liver disease like liver cirrhosis(Runyon, 2013). More specifically, alterations in the
physiology of renal system in advanced to acute liver failure or liver cirrhosis with ascites
can predispose patients to a specific form of renal problems(Runyon, 2013). Mr James has
already displayed the signs and symptom of ascites for example distended stomach hence
observance of fluid restricted diet will help lower retention of fluid inside the body and
measurement of the urine output will help to ascertain the condition of the kidneys.
Another immediate nursing intervention include blood test for the detection of
bilirubin content in blood as Mr James’s sclera show evidence of mild jaundice. According to

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Wang et al. (2012) since cirrhosis, is the disease of liver, occurrence of jaundice is a common
phenomenon and hence detection of serum bilirubin will help to get a rough overview about
the condition of the liver.

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References
Aron-Wisnewsky, J., Minville, C., Tordjman, J., Lévy, P., Bouillot, J. L., Basdevant,
A., ...&Pépin, J. L. (2012). Chronic intermittent hypoxia is a major trigger for non-
alcoholic fatty liver disease in morbid obese. Journal of hepatology, 56(1), 225-233.
Askgaard, G., Grønbæk, M., Kjær, M. S., Tjønneland, A., &Tolstrup, J. S. (2015).Alcohol
drinking pattern and risk of alcoholic liver cirrhosis: a prospective cohort
study. Journal of hepatology, 62(5), 1061-1067.
Chen, S.L. & Morgan, T.R. (2006).The natural history of hepatitis C virus (HCV)
infection. International journal of medical sciences, 3(2), p.47.
Dirchwolf, M., &Ruf, A. E. (2015).Role of systemic inflammation in cirrhosis: From
pathogenesis to prognosis. World journal of hepatology, 7(16), 1974.
Golics, C. J., Basra, M. K. A., Salek, M. S., & Finlay, A. Y. (2013).The impact of patients’
chronic disease on family quality of life: an experience from 26
specialties. International journal of general medicine, 6, 787.
Mathurin, P., &Bataller, R. (2015).Trends in the management and burden of alcoholic liver
disease. Journal of hepatology, 62(1), S38-S46.
Morgan, T. R., Weiss, D. G., Nemchausky, B., Schiff, E. R., Anand, B., Simon,
F., ...&Lieber, C. (2017). Colchicine treatment of alcoholic cirrhosis: a randomized,
placebo-controlled clinical trial of patient survival. Gastroenterology, 128(4), 882-
890.
Qavi, A. H., Kamal, R., &Schrier, R. W. (2015).Clinical use of diuretics in heart failure,
cirrhosis, and nephrotic syndrome. International journal of nephrology, 2015.