Liver Failure

Question 1

liver failure acute or chronic

Answer 1

both: acute (reversible) or chronic (irreversible)

Question 2

etiology

Answer 2

• cirrhosis
• hepatitic C
• fulminant hepatitis (acute, very severe)
• toxic liver damage (ex. alcohol)

Question 3

how is hematology affected

Answer 3

• defective hemostasis
• dec hematopoiesis
• GI bleeds occur

Question 4

how are clotting factors impacted

Answer 4

• dec synthesis of clotting factors & fibrinogen

- inadequate clearance of clotting factors so clotting factors remain active –> DIC

Question 5

how is hematopoiesis impacted

Answer 5

• dec hematopoiesis –> deficiency of blood cells
• causes anemia d/t dec RBC prod + prod of dysfx RBCs w/ membranes that are susceptible to lysing
• thrombocytopenia (risk of bleeding) + leukopenia (immunocompromised pt)

Question 6

how do GI bleeds occur

Answer 6

• portal HTN causes blood to back up into GIT –> varices that can rupture
• d/t impaired clotting factor synthesis, clotting can’t be initiated so a GI bleed results

Question 7

how is metabolism affected

Answer 7

• inadequate bilirubin clearance
• hypoalbuminemia
• defective urea cycle
• dec estrogen catabolism

Question 8

why does inadequate bilirubin clearance occur

Answer 8

• bilirubin is combined w/ glucoronic acid in the liver to be converted into a form that is soluble in water
• if this ^ fx dec, then bilirubin cannot be broken down and excreted –> jaundice (excess bilirubin)
• ALSO, excess RBC lysing results in further bilirubin buildup

Question 9

why does hypoalbuminemia (low levels of albumin in blood) occur

Answer 9

dec OP –> fluid shifts out of vessels –> edema & ascites

Question 10

why does defective urea cycle occur

Answer 10

• breakdown of proteins results in production of ammonia (toxic)
• liver converts ammonia into less toxic form (urea) which is then excreted
• w/ dec liver fx, there is a builup of ammonia causing inc toxicity –> hyperammonemia

Question 11

how is dec estrogen catabolism impacted

Answer 11

• liver fx to breakdown estrogen impaired resulting in hyperestrogenism
• results in males & females having: inc estrogen –> infertility + l/o libido; males: atrophy of tests, impotence; females: menstruation issues, sterility

Question 12

what does hepatorenal syndrome consist of

Answer 12

• idiopathic renal failure
• severe renal ischemia
• oliguria

Question 13

how does severe renal ischemia occur

Answer 13

portal HTN results in inc of blood in portal system, therefore, less blood is circulating to kidneys –> ischemia

Question 14

oliguria

Answer 14

small amounts of urine + azotemia (inc nitrogen-containing compounds + wastes, such as creatinine in blood)

Question 15

hepatic encephalopathy

Answer 15

• CNS mnfts of liver failure
• dec detoxifying capabilities of liver w/ failure
• blood bypasses liver through alternative channels via portosystemic shunts
• toxic compounds remain in circulation and travel to brain leading to hepatic encephalopathy

Question 16

mnfts of hepatic encephalopahy

Answer 16

early mnfts:

• asterixis (palm flapping –> hand tremor when wrist bent back)
• hyperreflexia (exaggerated reflexes found upon Px, such as tendon reflex)
• confusion, coma and death r/t CNS failure

Question 17

tx

Answer 17

• treat underlying cause
• symptomatic management
• treat cmplx (ex. varices, ascites, portal HTN)
• non-absorbable Abx (Abx act on normal flora in bowel to minimize amount of ammonia produced)
• purgative (laxative to eliminate protein in gut so ammonia isn’t produced)
• liver transplant