Liver Failure

Question 1

What is liver failure

Answer 1

Acute or chronic
80% loss of fx capacity
50% mortality rate

Question 2

Cause of Liver Disease

Answer 2

Several eg.

1) toxic liver disease
2) cirrhosis
3) fulminant hepatitis

Question 3

Patho of Liver Disease

Answer 3

Hepatic insufficiency > multi organ failure

Question 4

What are the 4 major concerns of Liver Disease?

Answer 4

Hematology
Metabolism
Hepatorenal syndrome
Encephalopathy

Question 5

Describe the concerns with Hematology

Answer 5

Defective hemostasis and anemia d/t

1) impaired protein synthesis: clotting factors and fibrinogen
2) decreased marrow function: thrombocytopenia and leukaemia
3) impaired clearance of activating clotting factors (DIC or disseminated intravascular coagulation
4) GI bleeds

Question 6

Metabolism

Answer 6

Impaired clearance of bilirubin: jaundice

Defective urea cycle: hyperammonemia

Hypoalbuminemia: edema and ascites

Hyperestrogenism: poor libido, atrophy of testes, infertility, amenorrhea

Question 7

Hepatorenal Syndrome

Answer 7

Severe renal ischemia

SPLANCNIC: abdominal organs

Splancnic vasodilation, engorgement of blood in abdominal organs and whatever organs not associated with abdominal area are constricted
(Renal artery)

= renal failure
=oliguria, azotemia (build up of nitrogenous waste), creatinine

Question 8

Encephalopathy

Answer 8

Toxic build up of chemicals travel to brain through the blood and impacts the brain

Liver impairment, portosystemic shunts, confusion, coma, death??

Early Mnfts: asterixis and hyperflexia

Question 9

Tx of Liver Disease

Answer 9

Reverse the cause

Mnfts and complications = help reversal

Purgative= potent laxative (clears proteins and other sources of ammonia from the bowel..ammonia is the problem because liver can’t deal with it)

Non Absorptive Abx: abx travel through gut without being absorbed. NF metabolize and make ammonia and abx target the NF so this won’t happen