Liver failure Flashcards
why is liver failure so detrimental?
because the liver has many functions
the liver has an enoromous functional reserve, what does this mean?
need lots of damage to be done before it is apparent it is failing
liver failure is a loss of
greater than 80% functional capacity
liver failure can be ____ or ____
acute or chronic
liver failure has a very high ______
mortality rate (about 50%-60% with die)
some examples of causes of liver failure
- cirrhosis (end stage liver disease) (chronic)
- fuliminant hepatits (acute) (fuliminant used to describe a severe condition that arises quickly without warning)
- toxic liver damage (alcohol abuse) (acute)
patho and mnfts of liver failure
-hepatic insufficiency causing multi-organ failure
what is the organs that fail/main things that happen with liver failure?
- Hematogly
- Metabolism
- Hepatorenal syndrome
- Hepatic encephalopathy
Hematogly in liver failure is the?
defective hemostasis(preventing blood loss) & anemia d/t: -imparied protein synthesis (clotting factors & fibrinogen)--proteins comprimise clotting facotrs & fibrinogen clotting impaired
- depressed marrow function (relationship between marrow & liver, when liver is defective, membrane or erythrocyte defective causing hemolysis) (also causing thrombocytopenia & leukopenia)
- inadequate clearance of clotting factors (DIC-disseminated intravascular coagulation)–which is very serious thrombi or emboli develops and spreads through blood vessel
- GI bleeds (if varix or other damage clotting is impaired and cannot stop)
metabolism problems in liver failure
- inadequate bilirubin clearance (jaundice)
- hypoalbuminemia (liver produces other protein albumin, liver failure causing deficiency of albumin)—this can lead to edema and ascities (edema will remain in interstitial space then moves into body cavity causing ascites)
- defective urea cycle, Hyperammonemia(ammonia breakdown by liver, cannot breakdown without being proccesed causing a build up of nitrogenous waste, causing TOXICITY PROBLEMS)
- decrease in estrogen catabolsim, Hyperestrogeneism (liver is responsible for breakdown of estrogen) (in men this will lead to atrophy to testes, loss of libido, in women it will lead to loss of libido & risk of sterility)
-
Hepatorenal syndrome in liver failure
- idiopathic renal failure
- Severe renal ischemia (causing infarction kidneys will be dying) (happens because of 3rd spacing which will cause a decrease in blood volume causing a decrease in blood perfusion to organs -KIDNEYS)
- 3 direct things tell us kidneys are not functioning: Oliguria, Axothemia and increase in creatinine
with liver failure _____ will happen and it is ______ why
with liver failure, renal failure will happen and it is unclear why (idiopathic renal failure)
hepatic encephalopathy in liver failure
- CNS mnfts of liver failure
- toxic compounds not detoxified (eg. ammonia) d/t: liver impairment and portosytemic shunts
- early mnfts are asterixis & hyperflexia
- can cause confusion or coma or death
what are the early mnfts of hepatic encephalopathy
asterixis(flapping of plams, which can be induced by pushing back)
hyperflexia (exaggerated reflexes)
what is the treatment of liver failure
- treat underlying cause (if it is hepatitis causing the problem or cirrhoisis causing the problem)
- symptomatic mangement
- treat complications ( such as portal hypertension, ascities, kidney failure, hepatic encephalopathy )
- non-absorbable abx (normal flora in gut metabolize, a by product is nitrogenous products, reduce so production of ammonia from them is decreased)
- purgative (potent laxative to clear gut of proteins, when breakdown of proteins a by product is ammonia)
- liver transplant in many cases (difficult & major issues with transplant)
