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Pathophysiology and Pharmacology 2 > Liver Failure > Flashcards

Liver Failure Flashcards

1
Q

liver function

A 
ddetoxification
coagulation
nutrition
storage
metabolism
excretion of medications
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2
Q

acute liver failure

A 
loss of liver fx
elevated liver tests (inflammation/hepatocyte destruction)
prolonged coagulation
altered mental status
decreased toxin clearance
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3
Q

liver failure due to cirrhosis

A

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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4
Q

symptoms show @

A

80-90% hepatic fx

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5
Q

most common complication of liver disorders

A 
portal hypertension:
splenomegaly
esophageal varices
ascites
hepatic encephalopathy
heptopulmonary syndrome
portopulmonary htn
hepatorenal syndrome
hyponatremia
hepatic pleural effusion
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6
Q

progression of liver damage

A

healthy liver
hepatic steatosis
hepatic fibrosis
hepatic cirrhosis

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7
Q

normal portal venous pressure

A

3 mmHG

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

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8
Q

noncirrhotic causes of portal htn

A

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

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9
Q

jaundice

A

caused by hyperbilirubinemia

body unable to clear bilirubin caused by degradation of RBCs

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10
Q

unconjugated bilirubin

A

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

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11
Q

conjugated bilirubin

A

loosely bound to albumin, nontoxic, soluble

causes: dubin-johnson syndrome, impaired bile flow

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12
Q

Jaundice w/ bilirubin in urine

A 
excretion defect
hepatobiliar disease (extrahepatic cholestasis, intrahepatic cholestasis)
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13
Q

jaundice w/out bilirubin in urine

A

overproduction of bilirubin
hepatic uptake impairment
conjugation impairment

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14
Q

hepatitis A

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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15
Q

hepatitis B

A

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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16
Q

hepatitis c

A

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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17
Q

hepatits D

A 
patho unknown
altered immune response occurs
only in those infected w/ hepatitis B
RNA virus
insidious onset 
chronic
\+ HDV RNA
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18
Q

hepatitis E

A 
exact patho unknown
spread through contaminated water, fecal-oral
RNA virus
acute
\+HEV IgM
19
Q

hepatitis w/ vaccine

A

Hepatitis A and B

20
Q

Hepatitis A tx

A

symptom management:
rest
nutrition
fluid management

21
Q

Hepatitis B tx

A

determined by disease severity

22
Q

hepatitis c tx

A

based on genotype
interferon-alfa
oral-based therapies

23
Q

hepatitis d tx

A

pegylated interferon-alfa

24
Q

hepatitis e tx

A

hand hygiene

supportive care

25
Q

hepatitis prodromal

A

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

26
Q

hepatitis icterus

A

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

27
Q

hepatitis recovery

A

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

28
Q

autoimmune hepatitis

A

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

29
Q

autoimmune hepatitis causes

A

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

30
Q

autoimmune hepatitis s/s

A 
many asymptomatic
progressive fatigue
recurring jaundice
amenorrhea
weight loss
arthralgieas
31
Q

autoimmune hepatitis dx

A

liver biopsy

32
Q

autoimmune hepatitis tx

A

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

33
Q

alcoholic liver disease

A

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

34
Q

RF for alcoholic liver disease

A

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

35
Q

non alcoholic fatty liver

A

strongly linked to obesity

fatty liver becomes insulin resistant increasing risk for disease

36
Q

mild non alcoholic fatty liver

A

steatosis

>5% hepatic lipid accumulation

37
Q

severe nonalcoholic fatty liver: nonalcoholic steatohepatitis (NASH)

A

inflammation and damage of hepatocytes

may progress to cirrhosis

38
Q

non alcoholic fatty liver s/s

A

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

39
Q

non alcoholic fatty liver tx

A

weight loss
vitamin E
bariatric surgery

40
Q

acute liver failure

A 
loss of hepatocyte fx w/out cirrhosis
damage over days/weeks
usually drugs (acetaminophen)
viruses, toxins, autoimmune response
high mortality rate
41
Q

acute liver failure s/s

A

coagulopathy & AMS “hallmark signs” jaundice

42
Q

acute liver failure dx

A 
history (overdose/viral exposure)
AST
ALT
bilirubin
coagulopathy
43
Q

acute liver failure tx

A

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

Pathophysiology and Pharmacology 2 (27 decks)

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