Liver Failure

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  1. Livers main functions
    • blood filter
    • glucose....stored as glycogen
    • vitamins ABDK
  2. What happens when ammonia levels are too high?
  3. What happens when V. D isnt around?
    cant absorb calcium....hypocalcemia
  4. LIver is important to make bile soooo....
    we can emulcify fats.

    so fat soluble things can be converted to water soluble products and then excreted in the urine
  5. How does the liver detoxify the body?
    • uses Kupffer cells (phagocytes) to remove bacteria
    • breaks down drugs for excretion
    • catabolizes hormones
  6. What is so important about the liver catabolizing hormones?
    If hormones dont get broken down they will continue to have their effect on the body.

    males-have estrogen/progesterone.....doesnt get removed they will grow boobs (gynohermastia)

    females-have testosterone and doesnt get removed they will have facial hair (hirtshuim)
  7. How much liver do we need to have functioning to survive?
    only 10%....and the liver regnerates itself.  So stop drinking now!!
  8. What is cirrhosis?
    irreversible chronic inflammatory disease

    characterized by massive degeneration and destruction of hepatocytes, resulting in a disorganized lobular pattern of regneration
  9. Laennecs Cirrhosis
    caused by alcohol

    liver cells become damaged and die.  Fibrotic tissue replaces liver cells, causing the liver to shrink.  Liver becomes unable to carry out its functions
  10. Biliary Cirrhosis
    begins with inflammation or obstruction, and intrahepatic bile duct destruction....chronic obstruction causes increased pressure in the bile ducts causing an accumulation of bile.  Necrosis to edema to fibrosis....scar tissue causes destruction of liver

    result is portal hypertension and liver failure
  11. Cardiac Cirrhosis
    seen in persons with severe right sided heart failure causing high pressure in the IVC....heart cant pump blood in to circulation, causing the liver to become anoxic...resulting in necrosis and fibrosis
  12. 2 ways to get liver failure that is common.....
    • Hepatitis from tattoos
    • drug overdose....tylenol
  13. Early symptoms of liver failure
    • weakness
    • anorexia
    • weight loss
    • ascites.....causing abdominal discomfort/anorexia
    • lack of energy
  14. Cardiovascular symptoms of liver failure
    • warm, flushed skin
    • htn...but then decreases
    • bounding pulses
    • dysrhythmias
    • Portal hypertension
    • activity intolerance
    • edema
  15. Why do you see dysrhythmias with liver failure?
    changes in electrolytes....K
  16. Respiratory problems seen with liver failure
    • breathe rapidly and shallow
    • Ineffective breathing pattern
  17. How can ascites affect a persons breathing?
    fluid puts pressure on the diaphragm and prevents the lungs from expanding normally

    result is dyspnea and hyperventilation
  18. Renal issues from liver failure?
    causes decreased renal perfusion so have decreased UO
  19. Neurologic symptoms from liver failure
    • range from irritated and restless to coma
    • most occur from accumulation of ammonia causing encephalopathy
  20. Hematologic problems seen with liver failure?
    deficient in clotting factors

    so the person will bleed....which will increase ammonia....which will cause encephalopathy
  21. Protein and the liver....
    when a person starts to have liver issues they are encouraged to have a diet high in protein.  But once encephalopathy occurs, then they can not eat protein anymore
  22. Person with clotting problems will show this how?
    • bruising
    • epistaxis
    • gingival bleeding
    • pettechiae
    • anemia
    • DIC
  23. ADH and liver failure
    • initially na and water retention occur in the intravascular spaces from decreased metabolism of ADH.  
    • As the liver becomes congested and portal pressure increases the fluid will seep into the peritoneal cavity (ascites) and plasma volume will decrease
    • When plasma volume decreases the compensatory mech. of releasing ADH occurs causing more water and sodium retention, resulting in dilutional HYPONATREMIA
  24. K, Ca and Mag with liver failure
    Hypokalemia from diarrhea, aldosterone accum and diuretics

    Hypocalcemia from decreased dietary intake and decreased absorption of V. D

    Hypomagnesia from the livers inability to store magnesium
  25. Fetor hepaticus
    fecal breath odor from sever liver failure and accumulation of Methyl-mercaptan
  26. Portal hypertension causes....
    esophageal varices
  27. Infection and liver failure
    because there is dysfunction in the filtering of Kupffer cells, which are phagocytes....they are more likely to get infections
  28. Dermatologic symptoms of liver failure
    • jaundice from accumulation of billi
    • palmar erythema-red soles of feet
    • spider angioma
    • pruritis
  29. Where will you see jaundice first?
    submucosal area of the tongue
  30. What predisposes a person with liver failure to emboli?
    the liver will lose it's ability to remove activated clotting factors from the blood....=clots
  31. How do you become malnourished with liver failure?
    • liver cant metabolise and store:
    • V. A, B12, D
    • iron
    • glucose
    • fat
  32. S/S of encephalopathy
    • tremors
    • slurred speech
    • impaired decision making
    • confusion
    • coma
  33. How do you remove fluid in the abdomen (ascites)?  But then what?

    person will be able to breathe better and BP will decrease from decreased pressure in the abdomen...but they may tank, so give them albumin before to help them maintain BP
  34. Supplemental vitamins to give person with liver failure
  35. People with liver failure will have impaired skin do I help with this
    • turn frequently
    • massage bony prominences
    • keep skin clean and dry
  36. Patients with ascites need to remove.....from their diet?
  37. Antidote for acetaminophen OD?
    Mucomyst...given over several days

    7.5 grams of Tylenol is lethal
Card Set:
Liver Failure
2014-11-21 21:06:26
liver failure

Liver Failure N176
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