Hepatic Failure Flashcards
functions of the liver
Produces - clotting factors, proteins, bile
Detox - remove med, bilirubin, drugs, alchol, bacteria
Storage - glycogen, vitamins, minerals
Metabolize - nutrients from food
etiology of acute liver failure X4
viruses, drug use, genetic disease, poison
what viruses cause acute liver failure
Hep A, B, C
what drugs often cause acute liver failure X2
acetaminophen overdose
TB meds
what is the most common cause of acute liver failure
acetaminophen OD
acetaminophen OD antidote X2
acetylcystine, activated charcoal
what genetic disease causes acute liver failure
wilsons disease
what is wilsons disease
excess copper buildup targeting brain and liver
what is the most common poison causing acute liver failure
mushrooms
what is cirrhosis
any chronic liver disease
when does liver failure become chronic
> 6 months
s/s of liver failure/cirrhosis X9
fatigue
hepatomegaly
jaundice
ascites
skin lesions
hematologic disorders
endocrine disturbancies
peripheral neuropathies
first clinical sign of cirrhosis
change in mentation
is jaundice early or late s/s
early
why do liver failure pts have bruises
no clotting factors
endocrine system changes
elevated testosterone
elevated estrogen
elevated aldosterone
hematologic disorders of liver failure X4
thrombocytopenia
leukopenia
anemia
coagulation disorders
when is thrombocytopenia a medical emergency
platelets <20K
normal WBC range
5-10K
what is leukopenia
low white blood cells
how does WBC change from chronic to acute failure
may raise initially then decrease as time goes on
normal hgb for males
12-18
normal hct in males
42-52
normal hct in females
47-57
when do you transfuse males and females
when hgb is <7 in males and <6.2 in females
asterixis
hand tremors/flapping
dyspepsia
indigestion
fector hepaticus
strong, musty breath
caput medusae
giant, pronounced veins on ascites stomach
wound healing vitamins
ADEK
normal ammonia level
10-80
ammonia during liver failure
increases
AST/ALT during liver failure
increased
bilirubin normal
<1
bilirubin during liver failure
increased, 2.5+
lactic acid during liver failure
increased
PTT, PT, INR during liver failure
increased
normal ast
0-35
what does AST say
if liver is diseased or damaged
normal ALT
0-35
why would AST/ALT be normal in chronic failure
all the cells have died off
PT normal
11-12.5 seconds
INR normal
0.8-1.1
critical INR
> 5
what does INR measure
accuracy of PT
albumin in liver failure
decreases
glucose in liver failure
decreases
K, Na, Mg in liver failure
decreases
platelets in liver failure
decreases
RBC’s in liver failure
decreases
WBC’s in liver failure
decreases
normal alkaline phosphate
30-120
alkaline phosphate in liver failure
varies - will be increased when cirrhotic
Creatinine in liver failure
varies
dx studies for liver failure X5
ultrasound
fibro scan
upper endoscopy
radioisotope liver scan
liver biopsy
what is a fibro scan
measures fibrosis/scarring of liver
gold standard test for cirrhosis
liver biopsy
post-op biopsy risks
bleeding
bed rest until MD order
which side does pt lay on post liver biopsy
right side to decrease r/o hemorrhage
benzos X2
lorazepam
midazolam
anesthetic agents in liver failure
propofol
transfusions in liver failure X2
fresh frozen plasma, and/or whole blood
what does portal hypertension lead to X3
esophageal and/or gastric varices
splenomegaly
ascites
complications of cirrhosis X7
portal HTN
peripheral edema
hepatic encephalopathy
hepatorenal syndrome
metabolic acidosis
sepsis
multiorgan failure
lab value associated with hepatic encephalopathy
elevated ammonia
what are varices
enlarged or swollen veins caused by HTN
how do you prevent bleeding for varices
beta blockers
how do you stop bleeding in varices
vasopressors
EGD banding/sclerotherapy
balloon tamponade therapy
what does sandostatin do
inhibit release of vasoconstriction hormones
when is a portacaval shunt done
only if portal vein is blocked, dead, necrotic
ascites med tx X2
albumin and diuretic therapy
ascites procedure tx
paracentesis
what position should a person with ascites be in
high fowlers
NI for paracentesis X6
pt voids immediately before
monitor for: hypovolemia electrolytes BP HR dressing
what is hepatic encephalopaty
the liver is unable to convert increased ammonia which crosses the BBB
S/S of HE X9
confusion lethargy/coma personality changes asterixis fine motor problems musty breath seizures hyperventilation suppressed gag reflex
normal ICP
normal 5-15
complications of HE
brain swelling
organ failure
tx of HE
Correct cause
Lower ICP
lower ammonia levels
how do you lower ICP X3
minimal stimulatoin
oxygenation and ventilatoin
osmotic diuretics
how do you lower ammonia levels
lactulose
rifaximin
common lactulose SE
3-5 stools/day
what does rifaximin do
decreases ammonia production
why is mannitol used in HE
crosses the BBB
nutrition in liver failure
high in calores
protein supplement
increase carbs
mod-low fat
