Liver Failure Flashcards by Marissa Robertson

liver function

ddetoxification
coagulation
nutrition
storage
metabolism
excretion of medications

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acute liver failure

loss of liver fx
elevated liver tests (inflammation/hepatocyte destruction)
prolonged coagulation
altered mental status
decreased toxin clearance

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liver failure due to cirrhosis

scarring of liver due to poor liver fx
similar s/s to acute liver failure
systemic changes due to portal htn

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symptoms show @

80-90% hepatic fx

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most common complication of liver disorders

portal hypertension:
splenomegaly
esophageal varices
ascites
hepatic encephalopathy
heptopulmonary syndrome
portopulmonary htn
hepatorenal syndrome
hyponatremia
hepatic pleural effusion

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progression of liver damage

healthy liver
hepatic steatosis
hepatic fibrosis
hepatic cirrhosis

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normal portal venous pressure

3 mmHG

>10 mmHg = complications due to resistance of blood flow through portal venous system

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noncirrhotic causes of portal htn

prehepatic: portal vein thrombosis/narrowing of portal vein
posthepatic: severe R-sided CHF, hepatic vein outflow obstruction

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jaundice

caused by hyperbilirubinemia

body unable to clear bilirubin caused by degradation of RBCs

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unconjugated bilirubin

tightly bound to albumin, insoluble
causes: gilbert syndrome, hemolytic anemias, resorption of blood from hemorrhage, thalassemia, pernicious anemia, neonatal jaundice

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conjugated bilirubin

loosely bound to albumin, nontoxic, soluble

causes: dubin-johnson syndrome, impaired bile flow

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Jaundice w/ bilirubin in urine

excretion defect
hepatobiliar disease (extrahepatic cholestasis, intrahepatic cholestasis)

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jaundice w/out bilirubin in urine

overproduction of bilirubin
hepatic uptake impairment
conjugation impairment

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hepatitis A

shed through stool 2-3 wks before & 1 week after onset of jaundice
self-limiting (not chronic)
spread through contaminated water, fecal-oral
RNA virus
Acute onset
DX: +HAVIgM

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hepatitis B

impairs liver function by replication of hepatocytes, particle bind to host hepatocyte
spread through infected blood, body fluids, sex, perinatal
DNA virus
insidious onset
chronic
DX: +HBsG & HBcAG IgM

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hepatitis c

adaptive immune response
virus impairs immune response by impacting interferon
spread through infected blood (sex, prinatal)
RNA virus
insidious onset
chronic
+HCV PCR

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hepatits D

patho unknown
altered immune response occurs
only in those infected w/ hepatitis B
RNA virus
insidious onset 
chronic
\+ HDV RNA

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hepatitis E

exact patho unknown
spread through contaminated water, fecal-oral
RNA virus
acute
\+HEV IgM

hepatitis w/ vaccine

Hepatitis A and B

Hepatitis A tx

symptom management:
rest
nutrition
fluid management

Hepatitis B tx

determined by disease severity

hepatitis c tx

based on genotype
interferon-alfa
oral-based therapies

hepatitis d tx

pegylated interferon-alfa

hepatitis e tx

hand hygiene

supportive care

hepatitis prodromal

begins c. 2 weeks after exposure client highly contagious nonspecific symptoms n/v anorexia cough low-grade fever

hepatitis icterus

begins c. 2 wks after prodromal phase can last up to 6 wks jaundice, tea-colored urine, clay-colored stools, enlarged/tender liver, prolonged PT/INR

hepatitis recovery

begins as jaundice resolves 6-8 weeks after exposure enlarged/tender liver can continue liver profile returns to normal after 12 wks post jaundice

autoimmune hepatitis

significantly elevated immunoglobulin levels progressive, inflammatory liver disease untreated = cirrhosis and failure requiring transplant

autoimmune hepatitis causes

genetic and environmental triggers hla DR3 or DR4 more aggressive gene deletions

autoimmune hepatitis s/s

``` many asymptomatic progressive fatigue recurring jaundice amenorrhea weight loss arthralgieas ```

autoimmune hepatitis dx

liver biopsy

autoimmune hepatitis tx

immunosuppression corticosteroids, methotrexate, cyclosporine lack of response to meds is common = worsening of condition

alcoholic liver disease

damage to liver and function 3rd most common preventable death in U.S only small % of those who drink heavily will develop

RF for alcoholic liver disease

men >30g alcohol/day women >15g alcohol/day men 46-64 most likely to be hospitalized

non alcoholic fatty liver

strongly linked to obesity | fatty liver becomes insulin resistant increasing risk for disease

mild non alcoholic fatty liver

steatosis | >5% hepatic lipid accumulation

severe nonalcoholic fatty liver: nonalcoholic steatohepatitis (NASH)

inflammation and damage of hepatocytes | may progress to cirrhosis

non alcoholic fatty liver s/s

few symptoms elevated AST/ALT metabolic syndrome (obesity, diabetes, dyslipidemia)

non alcoholic fatty liver tx

weight loss vitamin E bariatric surgery

acute liver failure

``` loss of hepatocyte fx w/out cirrhosis damage over days/weeks usually drugs (acetaminophen) viruses, toxins, autoimmune response high mortality rate ```

acute liver failure s/s

coagulopathy & AMS "hallmark signs" jaundice

acute liver failure dx

``` history (overdose/viral exposure) AST ALT bilirubin coagulopathy ```

acute liver failure tx

elevate HOB frequent neuro checks volume replacement if needed N-acetylcystine (if acetaminophen overdose)