Liver Failure Flashcards
liver function
ddetoxification coagulation nutrition storage metabolism excretion of medications
acute liver failure
loss of liver fx elevated liver tests (inflammation/hepatocyte destruction) prolonged coagulation altered mental status decreased toxin clearance
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
symptoms show @
80-90% hepatic fx
most common complication of liver disorders
portal hypertension: splenomegaly esophageal varices ascites hepatic encephalopathy heptopulmonary syndrome portopulmonary htn hepatorenal syndrome hyponatremia hepatic pleural effusion
progression of liver damage
healthy liver
hepatic steatosis
hepatic fibrosis
hepatic cirrhosis
normal portal venous pressure
3 mmHG
>10 mmHg = complications due to resistance of blood flow through portal venous system
noncirrhotic causes of portal htn
prehepatic: portal vein thrombosis/narrowing of portal vein
posthepatic: severe R-sided CHF, hepatic vein outflow obstruction
jaundice
caused by hyperbilirubinemia
body unable to clear bilirubin caused by degradation of RBCs
unconjugated bilirubin
tightly bound to albumin, insoluble
causes: gilbert syndrome, hemolytic anemias, resorption of blood from hemorrhage, thalassemia, pernicious anemia, neonatal jaundice
conjugated bilirubin
loosely bound to albumin, nontoxic, soluble
causes: dubin-johnson syndrome, impaired bile flow
Jaundice w/ bilirubin in urine
excretion defect hepatobiliar disease (extrahepatic cholestasis, intrahepatic cholestasis)
jaundice w/out bilirubin in urine
overproduction of bilirubin
hepatic uptake impairment
conjugation impairment
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
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
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
hepatits D
patho unknown altered immune response occurs only in those infected w/ hepatitis B RNA virus insidious onset chronic \+ HDV RNA
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)
