Acute hepatic Failure

Question 1

Etiology of hepatic failure

Answer 1

Infections, drugs(acetaminophen), toxins, hypoperfusion, metabolic disorders, surgery

Question 2

FHF pathophysiology

Answer 2

Occurs over 1-3 week
Encephalopathy within 8 weeks
Massive necrosis of hepatocytes
Impaired bilirubin conjugation
Decreased clotting factor production
Depressed glucose synthesis
Decreases lactate clearance

Question 3

Coma grade staging

Answer 3

Stage 1- mild confusion and slurred speech
Stage 2- lethargy and asterixis
Stage 3- marked confusion(somnolence)
Stage 4- coma

Question 4

High lab studies

Answer 4

Bilirubin, liver enzymes, ammonia, prothrombin time, INR

Question 5

Low lab studies

Answer 5

Albumin and coagulation factors

Question 6

Signs and symptoms

Answer 6

Headache
Hyperventilation- early
Hypo ventilation - late
Jaundice
Palmar erythema
Spider nevi- bruises
Edema
Asterixis

Question 7

Management of ammonia

Answer 7

Remove or decrease nitrogenous waste in large intestine
Neomycin- decrease bacterial flora and ammonia formation
Lactulose- traps ammonia and causes large intestinal propulsion

Question 8

Treatment of acute bleeding

Answer 8

Vitamin k
Fresh frozen plasma
Coagulation factor replacement
Blood transfusions
Platelets

Question 9

Multiway stem organ involvement

Answer 9

Brain- cerebral edema
Kidneys- renal failure
Lungs- respiratory failure
Cardio- hemodynamic instability

Question 10

Nursing management

Answer 10

Protect the patient from injury- one on one, seizure precautions, low bed, floor may
Watch for complication- neurologic and respiratory failure
Educate patient and family

Question 11

Fulminant hepatic failure

Answer 11

Rapid deterioration w/ no history of liver issues
Seen through coagulopathies INR grater than 1.5 PT greater than 30 oozing blood from anywhere
Hepatic encephalopathy- high ammonia interferes with glutamate causing changes in mental status
Mortality rate very high