Unique Characteristics of the Liver: Primary Functions (Nursing)

00:00 And that is how the liver is involved in carrying out over 500 essential tasks. It takes most of its blood right from the mesenteric arteries into the portal vein. It filters it through those lobules and hepatocytes in your liver, and that's where the magic of over 500 essential tasks happen. Now, here're 3 major categories to think of the tasks that the liver does. There's no way you can memorize 500, so I want you to have these 3 solidly in your mind. 1) It detoxifies, and that's a really good thing; 2) It makes protein, so it synthesizes proteins; and 3) It produces chemicals that help digest food. Okay, so why do we need to know what the liver does? Because if I have liver disease, if I have liver damage, I don't detox things well, I don't make very good protein, and I'm not very good at digesting my food. Now, let's talk about why that's a problem. First, let's talk about detoxification. Well, it detoxes things like drugs. So, let's say I take a Tylenol (acetaminophen), that's a very common over-the-counter medication.

01:14 I'm kind of achy, and so I take acetaminophen. Well, that's metabolized in your liver. If my liver is damaged, I'm not going to be able to metabolize that drug. It puts me at an increased risk for acetaminophen toxicity. Let's say I'm drinking. We'll talk a little bit more about alcohol later, but the liver is very involved in detoxifying the alcohol that you ingest. If I have liver damage, I'm going to be in increased risk for damage from alcohol because my liver just can't process it. What if my liver is not good at synthesizing protein? Well hey, you need protein in your bloodstream because that's the big molecule of albumin. Right? Albumin we need to be big because it stays in our intravascular space and our bloodstream. Albumin is charged in a way that attracts sodium. Why do I care? Well, wherever sodium goes, water follows. Right? So, sodium is what brings water and keeps it in my intravascular space, but the sodium is attracted to albumin which is a protein. My liver is very involved in making sure I have enough protein.

02:30 So, if my liver isn't functioning well, I don't have enough protein in my intravascular space to do what? Right, to attract sodium because of the way it's charged and therefore, the water doesn't stay in my intravascular space. It shifts out into my tissues. So, let's back up the truck.

02:52 My liver is damaged, so I'm not very good at detoxifying things in my body that need to be detoxified. I don't have enough protein available, and one of the problems with that is fluid is going to be in inappropriate places. I'm going to be edematous, and when you see somebody with liver damage, they tend to have that big, like watermelon belly, and that's because they've got edema or ascites in their abdomen. Now, last it produces chemicals that help you digest food. If I can't digest my food effectively, then I'm going to be malnourished. Even though I'm eating food, I'm not going to be able to use it because remember the role the liver plays, I take a bite of, let me imagine for just a minute, ugh, French fries, some of my favorite food. Right? Not healthy for me but I do love a good French fry. So, if I eat a French fry, I swallow it, I chew it, it goes down into my stomach, moves through into my small intestine, then my gut breaks up the nutrients which there's really not as much as if I'd eaten something healthy like lean chicken and broccoli, that would have been better, but I didn't. So, let's work with the French fry. So, I ate the French fries in my gut. It sends it back up to my liver through those mesenteric veins, portal vein. Now, it's in my liver. My liver can't get what I need out of that food because it just doesn't have the right chemicals that will help digest food. Also, think about bile. The liver is the producer of bile, the tiny little hepatocytes. Right? Those little cells that are inside the lobules, that's what makes bile. So, there again, I'm not going to have bile to break that up and bile really helps with fatty foods, and sadly, French fries are delicious, but they are pretty fatty food. So, your patients with liver disease, they won't be able to detox as well. They will have trouble making protein synthesis, so they're going to have fluid volume deficit. You know, they're going to have fluid volume deficits intravascularly because it's going to be shifting out of their intravascular space and into their tissues, and you're not going to be able to digest food as effectively.