Liver Failure Flashcards
Etiology
Cirrhosis
Hepatitis
Drug OD
Types of Cirrhosis
Laennecs
Postnecrotic
Biliary
Cardiac
Laennecs cirrhosis
Most common in the US
Caused by livers toxic rxns to alcohol
Postnecrotic cirrhosis
results from severe liver dz with widespread liver cell necrosis
usually caused by acute viral hepatitis or chemical hepatitis
Biliary cirrhosis
0 Begins with inflammation or obstruction and intrahepatic bile duct destruction
- Leads to nodular regeneration, cirrhosis with resultant portal HTN
Cardiac Cirrhosis
Results from severe Right sided CHF
Drug OD
Ie: Tylenol
Early sx of liver failure
weakness anorexia weight loss abdominal discomfort/pressure lack of energy
Respiratory sx
Ascites can cause dyspnea
Hypoxemia
Ineffective breathing pattern
Renal sx
UO decreases
Decreased renal perfusion
HRS: ARF R/T Liver failure
Neuro sx
mild personality changes to coma
HEPATIC ENCEPHALOPATHY
Excess ammonia enters CNS
Increased ammonia
High R/F fluid volume deficit
R/T hemorrhage
High R/F Fluid volume alteration
R/T ascites
Dietary sodium limited to
200-500mg/day
Fluid restricted to
1500cc/day
Measure DAILY
wt, I&O, abdominal girth
Meds given
Diuretics given with aldosterone antongist (spironlactone)
IV albumin to increase plasma oncotic pressure (keep fluids in vessels)
Therapeutic paracentesis for resp function
Peritoneovenous shunt for refractory ascites
Diet
High calories
High Protein
High vitamins
Note: those with encephaopathy should have low protein
Teaching
Take diuretics
Take H2 meds to prevent bleeding
Avoid tylenol
Avoid ETOH
Diversity
males (M>F)
Alcohol related in 65% cases
Mortality is higher in non-caucasians
Cardiovascular sx
Flushed skin, HTN, bounding pulses, enhanced precordial impulse
Dysarrhythmias can occur second to electrolyte changes
Portal HTN
Activity intolerance
Edema
Stages of Liver Failure
Prodromal
Impending coma
Stupor
Coma
GI sx
Ascites Coagulation problems Fector hepaticus: sweet almost fecal odor Anorexia diarrhea Malnutrition Nausea and vomiting Portal HTN results in rectal and esophageal varices Decreased protein metabolism Decr albumin
