Nonalcoholic Fatty Liver Disease (NAFLD)

Nonalcoholic Fatty Liver Disease (NAFLD)

The purpose of this paper is to address the following clinical scenario with the use of your textbook, external credible literature, and/or reliable electronic sources. Use the guide below to draft your paper and review the rubric to ensure you have met the assignment criteria. The expected length of the paper is approximately 4-5 pages, which does not include the cover page and reference page(s).

James Alvarez is a 52 y.o., recently divorced, Latino male; new patient who arrives at the community health clinic for an appointment with a primary care Nurse Practitioner. His chief complaint of abdominal pain and vomiting, fatigue, and weight loss. He notes that although he has experienced overall weight loss, his stomach “looks huge.” As his history is taken, he notes no alcohol use.  In speaking with him, the Nurse Practitioner notices a yellow tinge to the whites of his eyes. During examination, the Nurse Practitioner notes organomegaly in the right upper quadrant.

ORDER A PLAGIARISM -FREE PAPER NOW

Please use the following headings/subheadings as a guide to draft your paper:

Introduction (including purpose statement)

What would be your priority diagnosis for Mr. Alvarez?

Identify the organ and describe the pathophysiological processes, which may have caused the organomegaly.

Develop a comprehensive and holistic plan of care for this patient based on James\’ diagnosis.Nonalcoholic Fatty Liver Disease (NAFLD)

Conclusion

Within your description, place in bold font the key pathophysiological concepts (terms).

Include recommendations for follow-up with the Nurse Practitioner.

Incorporate a population-based component to Mr. Alvarez\’ plan of care.

In regards to APA format, please use the following as a guide:

Include a cover page and running head (this is not part of the 4-5 page limit)

Include transitions in your paper (i.e. headings or subheadings)

Use in-text references throughout the paper

Use double space, 12 point Times New Roman font

Spelling, grammar, and organization are appropriate

Include a reference list (this is not part of the 4-5 page limit)

Attempt to use primary sources only. That said, you may cite reliable electronic sources (i.e. ANA)

The provided case study is on James Alvarez, a 52-year-old Latino patient who is newly divorced. James presents to a community health clinic with abdominal pain, vomiting, fatigue, and weight loss as the primary complaints. James reports that his stomach still looks huge, notwithstanding the overall weight loss. The primary care nurse practitioner assessing James notes that the patient has no history of alcohol consumption. During the interaction, the nurse practitioner observes a yellow tinge at the white of James’s eyes and observes organomegaly in James’s upper right quadrant. With this in mind, this essay provides a priority diagnosis for Mr. Alvarez, identifies the organ and describes the pathophysiological processes leading to organomegaly, and develops an all-inclusive holistic plan of care for Mr. Alvarez.

Priority Diagnosis for Mr. Alvarez

With the symptoms provided, liver cirrhosis is likely the priority diagnosis for James Alvarez. Cirrhosis is the last stage of liver fibrosis caused by liver diseases such as chronic alcoholism or hepatitis. While these two are frequent causes, liver cirrhosis is also caused by other factors such as non-alcoholic fatty liver disease. The damage to the liver done by cirrhosis is irreversible. However, further damage can be limited. Initial symptoms of patients with liver cirrhosis are fatigue, weight loss, and weakness. As the disease progresses, patients start experiencing symptoms such as jaundice and abdominal swelling.

Further, Mr. Alvarez is of Latino descent, a highly susceptible population to Nonalcoholic Fatty Liver Disease (NAFLD).  Among Latinos, the disease has been categorized as the seventh leading cause of death (Saab et al., 2016).  The high prevalence and severity of NAFLD among the Latino population are linked to the interaction of genetic elements, the prevalence of chronic illnesses such as diabetes or metabolic syndrome, and access to healthcare services.

The Organ and Pathophysiological Processes causing Organomegaly

The Interplay of Cellular and Molecular Factors

The liver is the organ involved. While liver cirrhosis has several causes, they share some pathological characteristics. For instance, they all develop hepatocytes’ degeneration and necrosis and the substitution of liver parenchyma tissues by fibrotic tissues and regenerative nodules, leading to loss of liver functioning. Multiple molecular and cellular factors interplay to initiate and cause liver cirrhosis progression (Geong et al., 2019). As an antecedent of cirrhosis, fibrosis is a vital pathological process in developing chronic liver infections to liver cirrhosis. Multiple types of cells lead to the pathogenesis of liver cirrhosis.

Hepatocytes are parenchyma cells surrounding the liver. However, the liver also has other non-parenchyma cells such as liver sinusoidal endothelial cells (LSECs), Kupffer cells (KCs), and hepatic stellate cells (HSCs). Notably, both parenchyma and non-parenchyma cells serve a profound role in the commencement and progression of fibrosis and cirrhosis. HSCs store vitamin A and other retinoids and are activated upon injury. The instigation of hepatic stellate cells plays a profound role in the progress of cirrhosis. The processes involved in this activation ultimately lead to liver fibrosis.Nonalcoholic Fatty Liver Disease (NAFLD)

LSECs constitute the lining of the endothelium. These cells secrete cytokine IL-33, which activates HSCs and cause liver fibrosis. The cells also contribute to hepatic dysfunction in liver cirrhosis. Kupffer cells (KCs) also play a notable role in the progression of liver cirrhosis. Injurious factors such as viruses activate these cells. In turn, activated cells damage hepatocytes by secreting harmful mediators. KC-mediated hepatic inflammation highly aggravates liver injury and fibrosis. Additionally, hepatocytes also contribute to liver fibrosis. The apoptosis of these cells is a mutual phenomenon in liver injury, leading to inflammation of tissues, fibrogenesis, and cirrhosis development.

Cytokines

Cytokine-mediated signaling pathways that control the activation of HSCs and fibrogenesis serve a role in the orchestration of liver cirrhosis. Involved cytokines include PDGF, TGF-β, TNF-α, Interferon, and ILs.

miRNAs

miRNAs are small coding RNAs that control the transcription and translation of genes. They play a profound role in several hepatic pathologies, including cirrhosis. Besides serving as biomarkers and liver fibrosis progression and HSC activation, miRNAs represent therapeutic targets for hepatic fibrosis and cirrhosis.

Cirrhosis results in tissue death, the collapse of the reticular network, changes in the liver’s vascular bed, and the wholesome nodular regeneration of the liver (Karlsen et al., 2015).  Mr. Alvarez is thus experiencing hepatic complications from his damaged liver. This accounts for the patient’s symptoms, including organomegaly, jaundice, and abdominal swelling.

Plan of Care

Mr. Alvarez‘s plan of care should start with the conduction of several tests to confirm the suspected liver cirrhosis. According to research, several laboratory tests are used to diagnose liver cirrhosis. Abdominal computed tomography (CT) scan should be performed to establish the severity of cirrhosis and other liver illnesses (Wang & WU, 2019).  The imaging test combines special x-ray equipment with refined computers to produce digital images of the liver. An abdominal ultrasound can also be conducted to assess the flow of blood to and from the liver. The ultrasound uses sound waves to produce liver images. Elastography is another imaging test that can be conducted to confirm liver cirrhosis. The test evaluates liver stiffness and is useful in diagnosing the severity of liver scarring (fibrosis). If untreated, fibrosis leads to cirrhosis. Elastography is highly useful in cirrhosis diagnosis as it detects stiffness not detectable by other imaging tests. An ultrasound or MRI performs it. Other useful tests in the diagnosis of cirrhosis are tissue biopsies and liver function tests. Tissue biopsy is where the radiologist examines a part of the liver tissue to analyze the degree of liver damage. On the other hand, the liver function test analyzes the patient’s blood for specific enzymes that signal the presence of liver damage.Nonalcoholic Fatty Liver Disease (NAFLD)

ORDER A PLAGIARISM -FREE PAPER NOW

After confirming a positive diagnosis for liver cirrhosis, approaches to prevent further damage to the liver are initiated. While liver cirrhosis has no cure, the primary care nurse practitioner should recommend various approaches to help Mr. Alvarez by slowing the scarring and relieving his symptoms. The nurse practitioner should treat any underlying diseases causing cirrhosis through medications, weight loss, or alcohol treatment programs for patients consuming alcohol. For Mr. Alvarez, the primary care physician should recommend several approaches. First, the nurse should encourage the patient to initiate lifestyle modifications, including diet and physical exercise. Second, the nurse should prescribe medications to eliminate possible diseases that could be contributing to cirrhosis. Mr. Alvarez should be provided with medications to prevent gastrointestinal bleeding, beta-blockers to regulate his blood pressure, and diuretics to reduce fluid accumulation. The nurse should also ensure that the patient is up-to-date with vaccinations such as influenza, pneumonia, and hepatitis. It would also be imperative for the nurse to collaborate with the physician to prescribe drugs that reduce the level of toxins in the blood. Transjugular Intrahepatic Portosystemic Shunt (TIPS) is another mechanism that should be included in Mr. Alvarez’s plan of care. It involves the treatment of portal hypertension caused by liver cirrhosis. Here, the radiologist places a tube into the liver to bypass blood flow and directs the blood back to the heart.

In severe cases, a liver transplant is warranted. A liver transplant replaces a damaged liver with a healthy one from a donor. Continued follow-up by the nurses is warranted to prevent further complications (Fabrellas et al. (2020). The nurse practitioner should continue to follow –up with Mr. Alvarez in conjunction with the hospital’s hepatologist. Notably, the primary care nurse practitioner’s role will be profound to improve the health of Mr. Alvarez. The nurse will be responsible for care coordination, identifying signs of deterioration, assisting the patient with home health care, and providing patient education. His role is incredibly crucial through the care continuum and enhancement of Mr. Alvarez’s health.

Conclusion

In summary, liver cirrhosis has been identified as the priority diagnosis for Mr. Alvarez. The condition is irresolvable and with severe complications, if not adequately managed. Although alcohol consumption is the primary factor associated with liver cirrhosis development, other diseases such as the Nonalcoholic Fatty Liver Disease (NAFLD) are commonly linked to cirrhosis. Mr. Alvarez is of Latino descent, which predisposes him to a higher risk of contracting NAFLD. Various multifactorial factors, including pathological and cellular processes, cytokines, and miRNAs interplay to form the pathophysiological processes of liver cirrhosis. To develop an appropriate plan of care for Mr. Alvarez, cirrhosis diagnosis should be confirmed through imaging tests and appropriate management strategies initiated.Nonalcoholic Fatty Liver Disease (NAFLD)

References

Fabrellas, N., Carol, M., Palacio, E., Aban, M., Lanzillotti, T., Nicolao, G., Chiappa, M. T., Esnault, V., Graf‐Dirmeier, S., Helder, J., Gossard, A., Lopez, M., Cervera, M., Dols, L. L., Solà, E., Pose, E., Caraceni, P., Vargas, V., & Alessandria, C. (2020). Nursing care of patients with cirrhosis: The LiverHope nursing project. Hepatology, 71(3), 1106-1116. https://doi.org/10.1002/hep.31117

Geong, G. Y., Kang, S. H., & Lee, C. M. (2019). An updated review on the epidemiology, pathophysiology, etiology and diagnosis of liver cirrhosis. https://doi.org/10.20944/preprints201903.0128.v1

Karlsen, T. H., Lammert, F., & Thompson, R. J. (2015). Genetics of liver disease: From pathophysiology to clinical practice. Journal of Hepatology, 62(1), S6-S14. https://doi.org/10.1016/j.jhep.2015.02.025

Saab, S., Manne, V., Nieto, J., Schwimmer, J. B., & Chalasani, N. P. (2016). Nonalcoholic fatty liver disease in Latinos. Clinical Gastroenterology and Hepatology, 14(1), 5-12. https://doi.org/10.1016/j.cgh.2015.05.001

Wang, X., & Wu, B. (2019). Critical issues in the diagnosis and treatment of liver cirrhosis. Gastroenterology Report, 7(4), 227-230. https://doi.org/10.1093/gastro/goz024

Nonalcoholic Fatty Liver Disease (NAFLD)