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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 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 HR TEMP RR - less than 90 mmHg more than 120 bpm mildly elevated tachypneic DIAGNOSTIC AND LABORATORY SERUM BILIRUBIN AST (SGOT) ALT (SGPT) PROTHROMBIN TIME - elevated elevated elevated 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
