Liver Failure Flashcards
Ramble off some roles of the liver in Metabolism
- Metabolizes Carbs, Proteins and fats
- Converts glucose to glycogen for storage
- Provides bile for fat breakdown
- converts ammonia to urea for excretion (byproduct of protein metabolism)
- Breaks down fatty acids to Ketones (when glucose is in short supply)
- Vit storage and Metabolism
Role of the liver in maintaining blood
- “detoxifies” blood.
- Metabolizes OH and drugs
- Excretes bilirubin (in bile) which is a byproduct of hemoglobin breakdown
- Uses Vit K to synthesis prothrombin and other clotting factors
- Synthesizing plasma proteins, nonessential amino acids, Vit A and essential nutrients such as iron, Vit D, B12
Factors that affect liver risk assessment
Exposure to hepatotoxic chemicals or infectious agents
High risk sex practices
OH or drug abuse
Occupational and travel history
What’s the most common cause of liver disease in Canada? 2nd?
More common in men or women
Non-Alcoholic Fatty Liver Disease leading cause of liver disease in Canada.
…Hepatitis C next leading cause but decreasing
…Men
What is Cirrhosis?
Cirrhosis is common end result of many chronic liver disorders.
Diffuse scarring of liver – follows hepatocellular necrosis of hepatitis.
Inflammation – healing with fibrosis - Regeneration of remaining hepatocytes from regenerating nodules.
Loss of normal architecture & function.
What is the initial treatment of non viral hepatitis
Effective treatment aims to remove the causative agent by lavage, catharsis, or hyperventilation
Types VIral Hepatitis
Spread and severity
• Hep A
o Water or food or membrane contact, no carrier state, not chronic, short incubation
• Hep B
o STD/ spread through serum / body fluids, 10% chronic, can be carrier state, inc risk of liver complications
• Hep C
o Direct blood contact, chronic carrier state, chronic liver disease
• Hep D
o Must already have B
• Hep x
o Unknown virus
Diet for hepatitis
Small meals high in calories and protein. (even though ammonia may be high r/t protein breakdown) (May need to get NH3 under control and avoid protein initially)
What Diagnostics might tell us about liver function
- ALT, AST (not liver specific), GGT (OH)
- Albumin
- PT-INR (ability to meta. Vit K test)
- Liver biopsy
- CT, MRI US
What is the relationship between cirrhosis and protein loss/synthesis
Trade off between high ammonia levels and Malnutrition
The cirrhotic liver causes the body to breakdown proteins at a fast rate, quickly depleting stores and increasing body needs. While protein breakdown is elevated with cirrhosis, synthesis is decreased, which causes muscle wasting and a decrease in blood protein. Malnutrition is a major concern, so protein in diet is required.
However, some people with cirrhosis have high levels of ammonia, a by-product of protein metabolism, in their blood and may need to restrict protein intake to prevent adverse effects.
Changes seen in Alcoholic liver disease.
Reversible vs Permanent
Alcoholic Liver disease - Patterns
REVERSIBLE:
Fatty change,
Acute hepatitis
Chronic hepatitis with Portal fibrosis
PERMANENT
Cirrhosis, Chronic Liver failure
Neuro S and S of Liver failure
Asterixis Paraesthesias Dec LOC Sensory disturbances Behavorial changes Cognitive changes
Integument S and S of Liver Failure
Spider angiomas Palmar erythma Jaundice Pruritis Hair production Caput medusa Pigmentation Bruising White Nails
What are the possible causes of liver disease?
End and irreversible result?
Viral Hepatitis Autoimmune Hepatis OH non alcoholic fatty liver disease Non viral (Hepatotoxins/Chemicals)
Cirrhosis (scarring of the liver)
Possible Meds r/t to liver damage/failure
Abx- Bact in GI produce ammonia H2 Rec. Blocker- GI bleeding Ativan- withdrawal from alcohol Beta blockers- Dec POrtal Hypertension Lactulose- Bind to Ammonia Spironolactone- K sparring/Aldo blocking Diuretic
