Transcript hepatic failure

HEPATIC FAILURE
TITO A. GALLA
HEALTHY LIVER
LIVER FUNCTION
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METABOLISM
DETOXIFICATION PROCESS
PROTEIN SYNTHESIS
MANUFACTURE OF CLOTTING FACTOR
PRESERVATION OF IMMUNOCOMPETENCE
COMMON CAUSE OF FULMINANT
HEPATIC FAILURE
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ACETAMINOPHEN (TYLENOL)
VIRAL INFECTION
ACUTE FATTY LIVER
HYPOVOLEMIC SHOCK
WILSON’S DISEASE
ACETAMINOPHEN (TYLENOL)
VIRAL HEPATITIS
ACUTE FATTY LIVER
HYPOVOLEMIC SHOCK
WILSON’S DISEASE
CHRONIC CAUSE OF LIVER
FAILURE
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CIRRHOSIS
LONG TERM RIGHT-SIDED HEART FAILURE
NECROTIC DAMAGE
CIRRHOSIS
OTHER DRUGS THAT CAUSED
HEPATIC FAILURE
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TETRACYCLINE- to treat infxn
ISONIAZID- long txt affects liver/PTB
MAOI- Monoamine Oxidase- antidepressant
VALPROIC ACID- to treat convulsion
AMIODARONE- to treat dysrhythmias
MYTHYLDOPA- to treat hpn
AMANITA MUSHROOM- hallucinogenic
AMANITA MUSHROOM
OTHER CONDITIONS
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SEPTIC SHOCK- toxic and bacteria
HEAT STROKE- exposure to sun
ACUTE CIRCULATORY FAILURE
SIGNS AND SYMPTOMS
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GI BLEEDING
AGITATION
COMA
RENAL FAILURE
RESPIRATORY DISTRESS
COMPLICATIONS OF HEPATIC
FAILURE
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HEPATIC ENCEPHALOPATHY
HEPATORENAL SYNDROME
GI HEMORRHAGE
HYPOGLYCEMIA
RESPIRATORY FAILURE
SPONTANEOUS BACTERIAL
PERITONITIS
HEPATIC PORTAL VEIN
ESOPHAGEAL VARICES
ESOPHAGEAL VARICES
HEPATIC ENCEPHALOPATHY
MANIFESTATIONS
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PERSONALITY CHANGES
SLURRED SPEECH
AGITATION
PROGRESS TO COMA
ASTERIXIS
REVERSE SLEEP
HEPATIC ENCEPHALOPATHY
MEDICATIONS
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LACTULOSE
NEOMYCIN
METRONIDAZOLE
MANITOL
OTHER MEDICATIONS
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COLLOID – hetastarch/plasma
protein fraction
- for ascites
CRYSTALLOID – normal
saline/ringers lactate
- to prevent hypoglycemia
CLOTTING – vitamin k / fresh frozen
plasma
HEPATORENAL SYNDROME
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ALTERATION IN BLOOD
CIRCULATION
ELECTROLYTES IMBALANCE
HYDROGEN IONS ACCUMULATION
VASOACTIVE SUBSTANCE
ACCUMULATES
DECREASE FILTRATION OF
GLOMERULUS
OLIGURIA
MEDS AND INTERVENTION FOR
HEPATORENAL SYNDROME
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LIVER TRANSPLANT
TRANSJUGULAR INTRAHEPATIC
PORTOSYSTEMIC SHUNT (TIPS)
LIVER DIALYSIS
VITAL SIGNS
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SBP
HR
TEMP
RR
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less than 90 mmHg
more than 120 bpm
mildly elevated
tachypneic
DIAGNOSTIC AND LABORATORY
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SERUM BILIRUBIN
AST (SGOT)
ALT (SGPT)
PROTHROMBIN TIME
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elevated
elevated
elevated
prolonged
PHYSICAL EXAMINATION
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NEUROLOGIC
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MILD CONFUSION TO COMA
PERSONALITY CHANGES
ASTERIXIS – flapping tremor
PULMONARY
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CRACKLES
LABORED RESPIRATION
PHYSICAL EAMINATION
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GASTROINTESTINAL
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HEMATEMESIS AND MELENA
ASCITES
HEPATOMEGALY/SPLEENOMEGALY
FETOR HEPATICUS – bad breath
DIARRHEA
SKIN
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JAUNDICE
SPIDER NEVI- dilated capilary
ECCHYMOSIS AND PETECHIAE – local hemorrhage
PRURITUS- itching
EDEMA
JAUNDICE