Liver disease and complications

Liver items ask which failing job is killing the client right now: clotting and varices, ammonia and the brain, or fluid in the belly crowding the lungs. Active upper GI bleed sequences live in GI bleeding and obstruction; this chapter owns the cirrhosis map around them.

What cirrhosis breaks

A scarred liver cannot clear toxins, make clotting factors, or keep portal blood flowing easily. Portal hypertension backs blood into esophageal and gastric varices and pushes fluid into the abdomen as ascites. Lost synthetic function means easy bruising and prolonged bleeding. Failed detox means ammonia rises and the brain slows. Name which failure is in front of you before you pick a first action.

Bedside baseline for any advanced liver client: fall risk, bleeding precautions, daily weights, and a neuro check that catches subtle confusion early. The distractor is treating “sleepy” as rest when it is early encephalopathy, or scrubbing fragile skin until it bleeds.

Varices and ascites

Varices are thin-walled veins under high pressure. Vomiting bright red blood or coffee-ground material with tachycardia and hypotension is the same upper-bleed emergency as elsewhere — airway, oxygen as needed, large-bore access, volume support, NPO, notify — but the cirrhotic client may crash faster and tolerate less volume overload. Do not force an NG tube without a clear order when varices are known; mechanical trauma can start a catastrophic bleed.

1. Hematemesis + unstable vitals: emergency bleed pathway now.
2. Known varices: no blind NG; follow ordered endoscopy/band or drug pathway.
3. Avoid straining, rough food teaching when varices are active as ordered.

Ascites is portal pressure plus low oncotic pull dumping fluid into the peritoneum. The abdomen swells, the diaphragm rises, and breathing shortens. Nursing moves are measurement and gentle unloading: sodium restriction as ordered, diuretics carefully, daily weights and girth, elevate the head of the bed for work of breathing, and prepare for paracentesis when ordered — watch for hypotension after large-volume taps and give albumin when the protocol says so.

• Sudden weight jump or tighter belly → assess breathing and notify.
• After paracentesis: vitals, puncture site, and volume status.
• Spontaneous bacterial peritonitis can look like worsening ascites plus fever/pain — escalate.

Hepatic encephalopathy

When the liver cannot clear ammonia and related toxins, neurons misfire. Early cues are sleep inversion, mild confusion, and handwriting change; later you see asterixis (liver flap), marked confusion, and coma. Lactulose acidifies the gut and promotes stools that carry ammonia out — the goal is soft, frequent stools as ordered, not watery collapse. If the client has severe diarrhea, dehydration, or hypokalemia, hold and notify per protocol rather than “pushing more until clean.”

Protein teaching is nuanced on exams: during active encephalopathy, follow the ordered restriction or modified intake; when stable, adequate protein for healing returns under dietitian guidance. Antibiotics that reduce gut ammonia-producing bacteria appear in some stems as ordered adjuncts. The wrong answer is a high-protein celebration tray for a confused client “to build strength.”

Jaundice, itch, and daily teaching

Bilirubin backs up when the liver cannot conjugate or drain bile. Skin and sclera yellow, urine darkens, stools lighten, and bile salts itch. Cool baths, mild soap, trimmed nails, and ordered antipruritics beat hot showers that worsen itch. Alcohol cessation, infection avoidance, and medication review (many drugs are hepatically cleared) keep the next tip into failure from starting. Pancreatitis and surgical GI recovery stay in the GI-bleed chapter when those stems appear — link there rather than re-teaching lipase and NPO rules here.

Priority map