HEPATIC FAILURE

TITO A. GALLA

HEALTHY LIVER

LIVER FUNCTION

METABOLISM DETOXIFICATION PROCESS PROTEIN SYNTHESIS MANUFACTURE OF CLOTTING FACTOR PRESERVATION OF IMMUNOCOMPETENCE

COMMON CAUSE OF FULMINANT HEPATIC FAILURE

ACETAMINOPHEN (TYLENOL) VIRAL INFECTION ACUTE FATTY LIVER HYPOVOLEMIC SHOCK WILSON’S DISEASE

ACETAMINOPHEN (TYLENOL)

VIRAL HEPATITIS

ACUTE FATTY LIVER

HYPOVOLEMIC SHOCK

WILSON’S DISEASE

CHRONIC CAUSE OF LIVER FAILURE

CIRRHOSIS LONG TERM RIGHT-SIDED HEART FAILURE NECROTIC DAMAGE

CIRRHOSIS

OTHER DRUGS THAT CAUSED HEPATIC FAILURE

TETRACYCLINE- to treat infxn ISONIAZID- long txt affects liver/PTB MAOI- Monoamine Oxidase- antidepressant

VALPROIC ACID- to treat convulsion AMIODARONE- to treat dysrhythmias MYTHYLDOPA- to treat hpn AMANITA MUSHROOM- hallucinogenic

AMANITA MUSHROOM

OTHER CONDITIONS

SEPTIC SHOCK- toxic and bacteria

HEAT STROKE- exposure to sun ACUTE CIRCULATORY FAILURE

SIGNS AND SYMPTOMS

GI BLEEDING AGITATION COMA RENAL FAILURE RESPIRATORY DISTRESS

COMPLICATIONS OF HEPATIC FAILURE

HEPATIC ENCEPHALOPATHY HEPATORENAL SYNDROME GI HEMORRHAGE HYPOGLYCEMIA RESPIRATORY FAILURE SPONTANEOUS BACTERIAL

PERITONITIS

HEPATIC PORTAL VEIN

ESOPHAGEAL VARICES

ESOPHAGEAL VARICES

HEPATIC ENCEPHALOPATHYMANIFESTATIONS

PERSONALITY CHANGES SLURRED SPEECH AGITATION PROGRESS TO COMA ASTERIXIS REVERSE SLEEP

HEPATIC ENCEPHALOPATHY MEDICATIONS

LACTULOSE NEOMYCIN METRONIDAZOLE MANITOL

OTHER MEDICATIONS

COLLOID – hetastarch/plasma protein fraction

- for ascites CRYSTALLOID – normal

saline/ringers lactate- to prevent hypoglycemia

CLOTTING – vitamin k / fresh frozen plasma

HEPATORENAL SYNDROME

ALTERATION IN BLOOD CIRCULATION

ELECTROLYTES IMBALANCE HYDROGEN IONS ACCUMULATION VASOACTIVE SUBSTANCE

ACCUMULATES DECREASE FILTRATION OF

GLOMERULUS OLIGURIA

MEDS AND INTERVENTION FOR HEPATORENAL SYNDROME

LIVER TRANSPLANT TRANSJUGULAR INTRAHEPATIC

PORTOSYSTEMIC SHUNT (TIPS) LIVER DIALYSIS

VITAL SIGNS

SBP - less than 90 mmHg HR - more than 120 bpm TEMP - mildly elevated RR - tachypneic

DIAGNOSTIC AND LABORATORY

SERUM BILIRUBIN - elevated AST (SGOT) - elevated ALT (SGPT) - elevated PROTHROMBIN TIME - prolonged

PHYSICAL EXAMINATION

NEUROLOGIC MILD CONFUSION TO COMA PERSONALITY CHANGES ASTERIXIS – flapping tremor

PULMONARY CRACKLES LABORED RESPIRATION

PHYSICAL EAMINATION GASTROINTESTINAL

HEMATEMESIS AND MELENA ASCITES HEPATOMEGALY/SPLEENOMEGALY FETOR HEPATICUS – bad breath DIARRHEA

SKIN JAUNDICE SPIDER NEVI- dilated capilary ECCHYMOSIS AND PETECHIAE – local hemorrhage PRURITUS- itching EDEMA

JAUNDICE