Liver Failure Flashcards
What is liver failure?
Liver failure is when the liver is losing or has lost all of its function. It is a life threatening condition that requires immediate medical care.
What are the 3 most important functions of the liver?
- Producing bile
- Storing glycogen
- Removing toxins from the bloodstream
What is the differences between liver disease and liver failure?
Liver disease refers to any condition that causes damage to the liver and may affect its function.
Liver failure is the term for the liver losing some or all functionality. Liver disease can often result in liver failure.
What is acute liver failure?
, in which symptoms develop rapidly, usually in people with no preexisting liver disease
What is chronic liver failure?
in which symptoms develop gradually as a result of cirrhosis
Liver transplantation is often needed to survive
describe 6 functions of the liver
1)carbohydrate metabolism
2) fat metabolism
3) protein synthesis / catabolism
4) bile synthesis
5) storage (iron, vitamins, glycogen, copper)
6) detoxification (drugs, hormones)
what are some structural features of the liver
hepatocytes
sinusoids
portal tracts (artery, portal vein, bile duct)
central veins
acinar architecture
what are some responses of the liver to injury
- fatty change
- ballooning/ hydropic degen
- hepatocyte necrosis
- cholestasis
5.inflammation - neoplasia
fibrosis & regen - cirrhosis
What is jaundice?
A yellowing of the skin and eyes
caused by high blood bilirubin
What is cholestasis?
A condition where bile cannot flow from the liver to the duodenum
what does cholestasis cause to be elevated in the blood
bilirubin
alkaline phosphatase
what plugs the cannaliculi in cholestasis
bile
what are the 3 types of hepatic cause of jaundice
- Pre-hepatic
- Hepatic
- Post-hepatic
What is pre-hepatic jaundice?
bilirubin is not conjugated and therefore builds up in the blood
can happen if the liver is overwhelmed by bilirubin with increased RBC destruction
what may cause increased RBC destruction?
RBC membrane problem:
genetic- hereditary spherocytosis
acquired - autoimmune haemolytic anaemia
RBC cytoplasm
genetic- G6PDH deficiency
- haemaglobinopathies - sickle, thalassemia
acquired- malaria
what is hepatic jaundice?
- toxic - damage to the liver
- unable to conjugate and excrete bilirubin
causes of hepatic jaundice
- immaturity of liver enzymes
-enzyme defects
-viral hepatitis
-alcoholic hepatitis
what is post hepatic jaundice?
bile is conjugated but there is obstruction to bile flow
Causes of post hepatic jaundice?
congenital - biliary atresia
acquired - bile duct problem
in the lumen - gall stone, tumour (adenoma), worm
in the wall - tumour (cholangiocarcinoma)
outside the wall - tumour (ca head of pancreas)
what happens in acute liver failure
damage to majority of hepatocytes
2 main pathways of acute liver failure?
- acute liver damage
- decompensation (failure) in chronic liver disease
causes of acute liver failure?
- acute liver damage - toxic, viral, ischaemic
leads to massive liver cell necrosis
leads to acute liver failure
- chronic liver disease with an exacerbating factor e.g alcohol
causes acute decline
leads to acute liver failure
Name 5 specific causes of acute liver failure:
- Alcohol liver disease
- Paracetamol overdose
- Viral hepatitis (ABE)
- Acute fatty liver of pregnancy
- Idiosyncratic reaction to medication
what does liver necrosis lead to the release of?
transaminases
why does liver necrosis lead to jaundice?
failure of bilirubin metabolism
spills out into the blood and bodily tissues
why does liver necrosis lead to encephalopathy?
Failure to detoxify nitrogenous compounds
What is encephalopathy?
A broad term for any brain disease that alters brain function or structure.
why can liver necrosis lead to bleeding?
failure to synthesise clotting factors II, VII, IX,X (1972)
What is hepatorenal syndrome?
Rapidly developing renal failure secondary to cirrhosis
What is the treatment for acute liver failure?
transplantation in very severe cases
supportive and manage complications
how may the liver respond if the person survives acute liver failure?
liver may regenerate and return to normal
or develop post-necrotic cirrhosis
what is biliary disease?
Blockage of biliary tree from extrinsic compression, pancreatitis, lymphoma or metastatic carcinoma of lymph nodes in the porta hepatis
What are 4 causes of chronic hepatitis?
- Hepatitis BCD
- Autoimmune
- Drugs
- Metabolic disease
What is Wilson’s disease?
excessive accumulation of copper in liver, brain, kidney, cornea; inherited disorder of copper metabolism
what happens to the liver cells in chronic hepatitis?
liver cell necrosis and inflammation
fibrosis of the liver tissue
what is steatosis?
Fatty liver
alcoholic hepatitis histology?
F: Fatty change
N: Necrosis
H: hyaline
B: Ballooned cell
what is non-alcoholic fatty liver disease related to?
- Obesity
- Metabolic syndrome
classic histopathological signs of non-alcoholic fatty liver disease?
ballooning / fibrosis +- inflammation
What are the 2 main types of biliary disease?
- Primary biliary cholangitis
- Primary sclerosing cholangitis
what is primary biliary cirrhosis?
Autoimmune granulomatous destruction of intrahepatic bile ducts
usually diagnosed by serology
what is primary scelorising cholangitis?
portal inflammation with periductal sclerosis
best diagnosed by imaging
What does an increase in portal pressure result in?
- Splenomegaly
- Varices
- Acites
What is caput medusae?
Caput medusae is the appearance of distended and engorged paraumbilical veins, which are seen radiating from the umbilicus across the abdomen to join systemic veins. The name caput medusae is Latin for “head of Medusa”.
What are 5 complications of liver cirrhosis?
- Variceal haemorrhage
- Spontaneous bacterial peritonitis
- Chronic liver failure
- Hepatocellular carcinoma
what is deterioration into acute liver failure precipitated by?
alcohol binge
dehydration
infection
GI bleed
surgery
A patient with hepatitis B asks why HIV testing is being done.
Which response should the nurse make to this patient?
“Hepatitis B and HIV have the same modes of transmission.”
A patient with a toothache of 3 weeks’ duration has severely increased liver enzymes and acute liver failure is diagnosed.
Which contributing factor should the nurse identify as the most likely cause of the patient’s illness?
Use of large amounts of acetaminophen for pain
A patient with a history of drug abuse is diagnosed with acute liver failure that developed over the last few weeks.
In addition to coagulopathy, for which manifestation should the nurse assess this patient?
Encephalopathy
A patient is diagnosed with nonalcoholic fatty liver disease.
The nurse should assess this patient for which additional health problem?
Metabolic syndrome
A patient with newly diagnosed cirrhosis of the liver vomits bright red blood.
Which should the nurse suspect is causing this patient’s bleeding?
Esophageal varices
Which secondary disease process should the nurse identify as being associated with portal hypertension?
Esophageal varices
A patient with ascites is at risk for which systemic complication?
Hepatorenal failure
A patient is found to have portal hypertension.
Which underlying condition most likely contributed to the development of this health problem?
Cirrhosis
