Liver failure

Question 1

why is liver failure so detrimental?

Answer 1

because the liver has many functions

Question 2

the liver has an enoromous functional reserve, what does this mean?

Answer 2

need lots of damage to be done before it is apparent it is failing

Question 3

liver failure is a loss of

Answer 3

greater than 80% functional capacity

Question 4

liver failure can be ____ or ____

Answer 4

acute or chronic

Question 5

liver failure has a very high ______

Answer 5

mortality rate (about 50%-60% with die)

Question 6

some examples of causes of liver failure

Answer 6

• 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)

Question 7

patho and mnfts of liver failure

Answer 7

-hepatic insufficiency causing multi-organ failure

Question 8

what is the organs that fail/main things that happen with liver failure?

Answer 8

1. Hematogly
2. Metabolism
3. Hepatorenal syndrome
4. Hepatic encephalopathy

Question 9

Hematogly in liver failure is the?

Answer 9

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)

Question 10

metabolism problems in liver failure

Answer 10

• 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)

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Question 11

Hepatorenal syndrome in liver failure

Answer 11

• 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

Question 12

with liver failure _____ will happen and it is ______ why

Answer 12

with liver failure, renal failure will happen and it is unclear why (idiopathic renal failure)

Question 13

hepatic encephalopathy in liver failure

Answer 13

• 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

Question 14

what are the early mnfts of hepatic encephalopathy

Answer 14

asterixis(flapping of plams, which can be induced by pushing back)
hyperflexia (exaggerated reflexes)

Question 15

what is the treatment of liver failure

Answer 15

• 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)

Question 16

what 3 direct things tell us the kidneys are not functioning?

Answer 16

• oliguria ( decreased urine output)
• azotemia (build up of waste products in the circulation)
• increase in creatinine (kidneys cannot excrete)

Question 17

what is hemostasis?

Answer 17

the preventing of blood loss by vessels constricting & clotting