HEPATIC FAILURE TITO A. GALLA. HEALTHY LIVER LIVER FUNCTION  METABOLISM  DETOXIFICATION PROCESS  PROTEIN SYNTHESIS  MANUFACTURE OF CLOTTING FACTOR.

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Presentation transcript:

HEPATIC FAILURE TITO A. GALLA

HEALTHY LIVER

LIVER FUNCTION  METABOLISM  DETOXIFICATION PROCESS  PROTEIN SYNTHESIS  MANUFACTURE OF CLOTTING FACTOR  PRESERVATION OF IMMUNOCOMPETENCE

COMMON CAUSE OF FULMINANT HEPATIC FAILURE  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  CIRRHOSIS  LONG TERM RIGHT-SIDED HEART FAILURE  NECROTIC DAMAGE

CIRRHOSIS

OTHER DRUGS THAT CAUSED HEPATIC FAILURE  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  SEPTIC SHOCK- toxic and bacteria  HEAT STROKE- exposure to sun  ACUTE CIRCULATORY FAILURE

SIGNS AND SYMPTOMS  GI BLEEDING  AGITATION  COMA  RENAL FAILURE  RESPIRATORY DISTRESS

COMPLICATIONS OF HEPATIC FAILURE  HEPATIC ENCEPHALOPATHY  HEPATORENAL SYNDROME  GI HEMORRHAGE  HYPOGLYCEMIA  RESPIRATORY FAILURE  SPONTANEOUS BACTERIAL PERITONITIS

HEPATIC PORTAL VEIN

ESOPHAGEAL VARICES

HEPATIC ENCEPHALOPATHY MANIFESTATIONS  PERSONALITY CHANGES  SLURRED SPEECH  AGITATION  PROGRESS TO COMA  ASTERIXIS  REVERSE SLEEP

HEPATIC ENCEPHALOPATHY MEDICATIONS  LACTULOSE  NEOMYCIN  METRONIDAZOLE  MANITOL

OTHER MEDICATIONS  COLLOID – hetastarch/plasma protein fraction - for ascites  CRYSTALLOID – normal saline/ringers lactate - to prevent hypoglycemia  CLOTTING – vitamin k / fresh frozen plasma

HEPATORENAL SYNDROME  ALTERATION IN BLOOD CIRCULATION  ELECTROLYTES IMBALANCE  HYDROGEN IONS ACCUMULATION  VASOACTIVE SUBSTANCE ACCUMULATES  DECREASE FILTRATION OF GLOMERULUS  OLIGURIA

MEDS AND INTERVENTION FOR HEPATORENAL SYNDROME  LIVER TRANSPLANT  TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT (TIPS)  LIVER DIALYSIS

VITAL SIGNS  SBP- less than 90 mmHg  HR- more than 120 bpm  TEMP- mildly elevated  RR- tachypneic

DIAGNOSTIC AND LABORATORY  SERUM BILIRUBIN- elevated  AST (SGOT)- elevated  ALT (SGPT)- elevated  PROTHROMBIN TIME- prolonged

PHYSICAL EXAMINATION  NEUROLOGIC MILD CONFUSION TO COMA PERSONALITY CHANGES ASTERIXIS – flapping tremor  PULMONARY CRACKLES LABORED RESPIRATION

PHYSICAL EAMINATION  GASTROINTESTINAL HEMATEMESIS AND MELENA ASCITES HEPATOMEGALY/SPLEENOMEGALY FETOR HEPATICUS – bad breath DIARRHEA  SKIN JAUNDICE SPIDER NEVI- dilated capilary ECCHYMOSIS AND PETECHIAE – local hemorrhage PRURITUS- itching EDEMA

JAUNDICE