Hepatic Failure Flashcards
What is ‘acute fatty liver of pregnancy’?
Acute fatty liver of pregnancy is the accumulation of fat within
the hepatocytes. It typically occurs during the third trimester of
pregnancy. About half of the patients with this condition
exhibits signs of HELLP syndrome (hemolysis, elevated liver
enzymes, and low platelet count).
Chestnut DH, Polley LS, Tsen LC, Wong CA. Chestnut’s
Obstetric Anesthesia. Philadelphia, PA: Mosby Elsevier; 2009:
1015
How does end-stage liver disease affect the
systemic vascular resistance, cardiac output, and
mixed-venous oxygen saturation?
End stage liver disease is generally associated with a very low
SVR, and an increased cardiac output and mixed venous
oxygen saturation.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 712.
What are the symptoms of acute hepatic failure?
Jaundice, malnutrition, hypoglycemia, coagulopathy,
hypoalbuminemia, depressed immune function, altered
mentation, prolonged prothrombin time, respiratory alkalosis,
and renal impairment.
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 192-
193.
What does the term ‘fulminant hepatic failure’ mean?
Fulminant hepatic failure is defined as liver failure with
encephalopathy that develops within 2-8 weeks following the
onset of illness in a patient with no previous history of liver
disease.
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 192.
What laboratory findings are consistent with the
development of acute liver failure?
Elevated aminotransferase levels, prolonged prothrombin time,
hypoglycemia, hyponatremia, hypokalemia, hyperinsulinemia
and lactic acidosis, are all consistent with acute liver failure.
Respiratory alkalosis may appear due to hyperventilation.
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 193.
How is systemic vascular resistance affected by
acute liver failure?
It is usually decreased, resulting in hypotension. Patients who
developed cerebral edema due to acute liver failure, however,
may exhibit hypertension and bradycardia.
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 192-
193.
What are the characteristics of hepatorenal
syndrome?
Hepatorenal syndrome is oliguric renal failure that can occur
with acute liver failure.
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Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 770-772.
What are some factors that could precipitate hepatic
encephalopathy in patients with cirrhosis?
Gastrointestinal hemorrhage, diuretics, azotemia, constipation,
increased dietary protein intake, and hypokalemia can all
produce an increase in serum ammonia levels which can
precipitate hepatic encephalopathy in patients with cirrhosis.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1311.
What is the treatment for acute fatty liver of
pregnancy?
The treatment for acute fatty liver of pregnancy is immediate
termination of the pregnancy. If left untreated, this condition
progresses to acute liver failure and death.
Chestnut DH, Polley LS, Tsen LC, Wong CA. Chestnut’s
Obstetric Anesthesia. Philadelphia, PA: Mosby Elsevier; 2009:
1015-1016.
How does biliary obstruction affect coagulation?
The gastrointestinal absorption of vitamin K relies on the
secretion of biliary enzymes. As vitamin K levels decrease, the
clotting factors reliant on vitamin K for their synthesis (II, VII, IX,
and X) are impaired, resulting in a decreased coagulability.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1304
What are the typical clinical findings in a patient with
cirrhosis?
Typical findings in a patient with cirrhosis include: right-to-left
shunting, hypoxemia, hyperventilation, increased right atrial
filling pressures, decreased systemic vascular resistance,
increased cardiac output, decreased blood viscosity due to
anemia, hyponatremia, hypokalemia, hypomagnesemia,
hypoalbuminemia, and hypoglycemia.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 712.
What are the presenting symptoms of acute fatty
liver of pregnancy?
Patients exhibit viral-like symptoms (malaise, nausea, and
vomiting) and right upper quadrant pain. Jaundice develops
within one to two weeks.
Chestnut DH, Polley LS, Tsen LC, Wong CA. Chestnut’s
Obstetric Anesthesia. Philadelphia, PA: Mosby Elsevier; 2009:
1015-1016.
What patients have the highest incidence of
nonalcoholic fatty liver disease?
It is more common in males and the incidence increases with
age. The incidence is highest in Hispanics (45%).
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1314.
What are the treatment options for nonalcoholic fatty
liver disease?
Weight loss and bariatric surgery weight loss can significantly
improve and even cure this condition.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 320-321
What are the signs and symptoms of alcoholic
hepatitis?
Alcoholic hepatitis is characterized by jaundice and virus-like
symptoms. The AST and ALT may be elevated as much as ten
times normal. The AST level is typically much higher than the
ALT level.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1301.
