Medical Surgical Nursing

Other Manifestations of Liver Dysfunction

A. Edema and Bleeding

 Many patients with liver dysfunction develop generalized edema from

hypoalbuminemia that results from decreased hepatic production of albumin.

 The production of blood clotting factors by the liver is also reduced, leading to

an increased incidence of bruising, epistaxis, bleeding from wounds, and, as

described above, GI bleeding.

B. Vitamin Deficiency

 Decreased production of several clotting factors may be due, in part, to deficient

absorption of vitamin K from the GI tract. This probably is caused by the

inability of liver cells to use vitamin K to make prothrombin.

 Absorption of the other fat-soluble vitamins (vitamins A, D, and E) as well as

dietary fats may also be impaired because of decreased secretion of bile salts

into the intestine.

 The threat of these avitaminoses provides the rationale for supplementing the

diet of every patient with chronic liver disease (especially if alcohol-related)

with ample quantities of vitamins A, B complex, C, and K and folic acid

C. Metabolic Abnormalities

 Abnormalities of glucose metabolism also occur; the blood glucose level may

be abnormally high shortly after a meal , but hypoglycemia may occur during

fasting because of decreased hepatic glycogen reserves and decreased

gluconeogenesis.

 Because the ability to metabolize medications is decreased, medications must be

used cautiously and usual medication dosages must be reduced for the patient

with liver failure.

 Many endocrine abnormalities also occur with liver dysfunction because the

liver cannot metabolize hormones normally, including androgens or sex

hormones.

 Gynecomastia, amenorrhea, testicular atrophy, loss of pubic hair in the male,

and menstrual irregularities in females may occur.

D. Pruritus and Other Skin Changes

 Patients with liver dysfunction resulting from biliary obstruction commonly

develop severe itching (pruritus) due to retention of bile salts. Patients may