1. HEPATIC FAILURE TITO A. GALLA

2. HEALTHY LIVER

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

4. COMMON CAUSE OF FULMINANT HEPATIC FAILURE  ACETAMINOPHEN (TYLENOL)  VIRAL INFECTION  ACUTE FATTY LIVER  HYPOVOLEMIC SHOCK  WILSON’S DISEASE

5. ACETAMINOPHEN (TYLENOL)

6. VIRAL HEPATITIS

7. ACUTE FATTY LIVER

8. HYPOVOLEMIC SHOCK

9. WILSON’S DISEASE

10. CHRONIC CAUSE OF LIVER FAILURE  CIRRHOSIS  LONG TERM RIGHT-SIDED HEART FAILURE  NECROTIC DAMAGE

11. CIRRHOSIS

12. 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

13. AMANITA MUSHROOM

14. OTHER CONDITIONS  SEPTIC SHOCK- toxic and bacteria  HEAT STROKE- exposure to sun  ACUTE CIRCULATORY FAILURE

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

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

17. HEPATIC PORTAL VEIN

18. ESOPHAGEAL VARICES

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

21. HEPATIC ENCEPHALOPATHY MEDICATIONS  LACTULOSE  NEOMYCIN  METRONIDAZOLE  MANITOL

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

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

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

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

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

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

28. 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

29. JAUNDICE