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IM 7 Test 2 > Hepatic Failure > Flashcards

Hepatic Failure Flashcards

1
Q

functions of the liver

A

Produces - clotting factors, proteins, bile

Detox - remove med, bilirubin, drugs, alchol, bacteria

Storage - glycogen, vitamins, minerals

Metabolize - nutrients from food

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2
Q

etiology of acute liver failure X4

A

viruses, drug use, genetic disease, poison

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3
Q

what viruses cause acute liver failure

A

Hep A, B, C

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4
Q

what drugs often cause acute liver failure X2

A

acetaminophen overdose

TB meds

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5
Q

what is the most common cause of acute liver failure

A

acetaminophen OD

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6
Q

acetaminophen OD antidote X2

A

acetylcystine, activated charcoal

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7
Q

what genetic disease causes acute liver failure

A

wilsons disease

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8
Q

what is wilsons disease

A

excess copper buildup targeting brain and liver

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9
Q

what is the most common poison causing acute liver failure

A

mushrooms

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10
Q

what is cirrhosis

A

any chronic liver disease

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11
Q

when does liver failure become chronic

A

> 6 months

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12
Q

s/s of liver failure/cirrhosis X9

A

fatigue

hepatomegaly

jaundice

ascites

skin lesions

hematologic disorders

endocrine disturbancies

peripheral neuropathies

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13
Q

first clinical sign of cirrhosis

A

change in mentation

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14
Q

is jaundice early or late s/s

A

early

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15
Q

why do liver failure pts have bruises

A

no clotting factors

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16
Q

endocrine system changes

A

elevated testosterone

elevated estrogen

elevated aldosterone

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17
Q

hematologic disorders of liver failure X4

A

thrombocytopenia

leukopenia

anemia

coagulation disorders

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18
Q

when is thrombocytopenia a medical emergency

A

platelets <20K

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19
Q

normal WBC range

A

5-10K

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20
Q

what is leukopenia

A

low white blood cells

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21
Q

how does WBC change from chronic to acute failure

A

may raise initially then decrease as time goes on

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22
Q

normal hgb for males

A

12-18

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23
Q

normal hct in males

A

42-52

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24
Q

normal hct in females

A

47-57

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25
when do you transfuse males and females
when hgb is <7 in males and <6.2 in females
26
asterixis
hand tremors/flapping
27
dyspepsia
indigestion
28
fector hepaticus
strong, musty breath
29
caput medusae
giant, pronounced veins on ascites stomach
30
wound healing vitamins
ADEK
31
normal ammonia level
10-80
32
ammonia during liver failure
increases
33
AST/ALT during liver failure
increased
34
bilirubin normal
<1
35
bilirubin during liver failure
increased, 2.5+
36
lactic acid during liver failure
increased
37
PTT, PT, INR during liver failure
increased
38
normal ast
0-35
39
what does AST say
if liver is diseased or damaged
40
normal ALT
0-35
41
why would AST/ALT be normal in chronic failure
all the cells have died off
42
PT normal
11-12.5 seconds
43
INR normal
0.8-1.1
44
critical INR
>5
45
what does INR measure
accuracy of PT
46
albumin in liver failure
decreases
47
glucose in liver failure
decreases
48
K, Na, Mg in liver failure
decreases
49
platelets in liver failure
decreases
50
RBC's in liver failure
decreases
51
WBC's in liver failure
decreases
52
normal alkaline phosphate
30-120
53
alkaline phosphate in liver failure
varies - will be increased when cirrhotic
54
Creatinine in liver failure
varies
55
dx studies for liver failure X5
ultrasound fibro scan upper endoscopy radioisotope liver scan liver biopsy
56
what is a fibro scan
measures fibrosis/scarring of liver
57
gold standard test for cirrhosis
liver biopsy
58
post-op biopsy risks
bleeding bed rest until MD order
59
which side does pt lay on post liver biopsy
right side to decrease r/o hemorrhage
60
benzos X2
lorazepam midazolam
61
anesthetic agents in liver failure
propofol
62
transfusions in liver failure X2
fresh frozen plasma, and/or whole blood
63
what does portal hypertension lead to X3
esophageal and/or gastric varices splenomegaly ascites
64
complications of cirrhosis X7
portal HTN peripheral edema hepatic encephalopathy hepatorenal syndrome metabolic acidosis sepsis multiorgan failure
65
lab value associated with hepatic encephalopathy
elevated ammonia
66
what are varices
enlarged or swollen veins caused by HTN
67
how do you prevent bleeding for varices
beta blockers
68
how do you stop bleeding in varices
vasopressors EGD banding/sclerotherapy balloon tamponade therapy
69
what does sandostatin do
inhibit release of vasoconstriction hormones
70
when is a portacaval shunt done
only if portal vein is blocked, dead, necrotic
71
ascites med tx X2
albumin and diuretic therapy
72
ascites procedure tx
paracentesis
73
what position should a person with ascites be in
high fowlers
74
NI for paracentesis X6
pt voids immediately before ``` monitor for: hypovolemia electrolytes BP HR dressing ```
75
what is hepatic encephalopaty
the liver is unable to convert increased ammonia which crosses the BBB
76
S/S of HE X9
``` confusion lethargy/coma personality changes asterixis fine motor problems musty breath seizures hyperventilation suppressed gag reflex ```
77
normal ICP
normal 5-15
78
complications of HE
brain swelling organ failure
79
tx of HE
Correct cause Lower ICP lower ammonia levels
80
how do you lower ICP X3
minimal stimulatoin oxygenation and ventilatoin osmotic diuretics
81
how do you lower ammonia levels
lactulose rifaximin
82
common lactulose SE
3-5 stools/day
83
what does rifaximin do
decreases ammonia production
84
why is mannitol used in HE
crosses the BBB
85
nutrition in liver failure
high in calores protein supplement increase carbs mod-low fat

IM 7 Test 2 (6 decks)

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