Acute hepatic Failure Flashcards Preview

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Flashcards in Acute hepatic Failure Deck (11):
1

Etiology of hepatic failure

Infections, drugs(acetaminophen), toxins, hypoperfusion, metabolic disorders, surgery

2

FHF pathophysiology

Occurs over 1-3 week
Encephalopathy within 8 weeks
Massive necrosis of hepatocytes
Impaired bilirubin conjugation
Decreased clotting factor production
Depressed glucose synthesis
Decreases lactate clearance

3

Coma grade staging

Stage 1- mild confusion and slurred speech
Stage 2- lethargy and asterixis
Stage 3- marked confusion(somnolence)
Stage 4- coma

4

High lab studies

Bilirubin, liver enzymes, ammonia, prothrombin time, INR

5

Low lab studies

Albumin and coagulation factors

6

Signs and symptoms

Headache
Hyperventilation- early
Hypo ventilation - late
Jaundice
Palmar erythema
Spider nevi- bruises
Edema
Asterixis

7

Management of ammonia

Remove or decrease nitrogenous waste in large intestine
Neomycin- decrease bacterial flora and ammonia formation
Lactulose- traps ammonia and causes large intestinal propulsion

8

Treatment of acute bleeding

Vitamin k
Fresh frozen plasma
Coagulation factor replacement
Blood transfusions
Platelets

9

Multiway stem organ involvement

Brain- cerebral edema
Kidneys- renal failure
Lungs- respiratory failure
Cardio- hemodynamic instability

10

Nursing management

Protect the patient from injury- one on one, seizure precautions, low bed, floor may
Watch for complication- neurologic and respiratory failure
Educate patient and family

11

Fulminant hepatic failure

Rapid deterioration w/ no history of liver issues
Seen through coagulopathies INR grater than 1.5 PT greater than 30 oozing blood from anywhere
Hepatic encephalopathy- high ammonia interferes with glutamate causing changes in mental status
Mortality rate very high