Lec 26 Flashcards
What is the definition of acute liver failure [3 parts/values]?
- coagulopathy [INR > 1.5]
- encephalopathy
- jaundice < 24 wks duration
no underlying chronic liver disease
What is fulminant vs subfulminant acute liver failure?
fulminant = encephalopathy < 8 weeks
sub-fulminant = encephalopathy > 8 weeks
Most common cause of acute liver failure worldwide?
acute Hep B
Most common cause of acute liver failure in the US?
acetaminophen
What is pathophysiology of cerebral edema in hepatic failure?
- excess NH3 to brain –> interacts wtih glutamate to form glutamine = has osmotic effect to draw water in
What is the difference hepatic encephalopathy and cerebral edema in hepatic failure?
hepatic encephalopahy = reversible chemical state
cerebral edema = physical condition of excess H20 in brain; occurs with late stages of hepatic encephalopathy
What is leading cause of death in patients with fulminant hepatic failure?
cerebral edema
What type of organisms primarily seen in sepsis with acute liver failure?
usually gram positive within 3 days of ICU stay
see fungal infections 2 wks after
What immuno defects in acute liver failure?
kupffer cell malfunction = macrophages of the liver
neutrophil malfunction
cell mediated immunity
What is pathophys of cardio dysfunction in acute liver failure?
- low systemic and pulm vascular resistance with compensatory increase in CO and metabolic rate –> leads to tissue hypoxia and lactic acidosis production
What are signs of cardiac dysfunction in liver failure?
- hypotension and tachycardia
- lactic acidsosi
What is mech of renal failure in liver failure?
- direct nephrotoxicity OR hepatorenal syndrome
What is hepatorenal syndrome?
- renal vasoconstriction secondary to systemic vasodilation seen in fulminant hepatic failure
- functional abnormality but reversible with liver recovery/transplant
What clinical features of hepatorenal syndrome?
- increased BUN and creatinine
- decreased urine output
with background of hepatic failure
What is mech of hypoglycemia in liver failure?
- defective gluconeogenesis
- inadequate hepatic uptake of insulin