Path 3 Hepatic Failure

Front 1

HEPATIC FAILURE - JENNINGS - WEDNESDAY FEB 7

Front 3

what is acute hepatic failiure dominated by?

Back 3

loss of function, as a consequence of loss of hepatocytes

Front 4

what functions are lost in acute hepatic failure (4)?

Back 4

1) excretory; 2) exocrine; 3) synthetic; 4) metabolic

Front 5

whwhat occurs due to loss of excretory function?

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hyperbilirubinemia

Front 6

what occurs due to loss of exocrine function (4)?

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1) hypercholesterolemia (cholesterol is not being consumed by making bile); 2) steatorrhea; 3) vitamin deficiencies (A, D, E, K); 4) pruritis due to accumulation of bile salts

Front 7

what deficiencies may occur due to loss of synthetic function (6 - incomplete list)?

Back 7

1) albumin; 2) transferrin; 3) ceruloplasmin; 4) haptoglobin; 5) complement factors; 6) coagulation factor deficiencies

Front 8

what metabolic problems may occur in acute hepatic failure?

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1) glucose metabolism; 2) glucose synthesis; 3) ketone body synthesis; 4) fatty acid synthesis; 5) drug metabolism; 6) estrogen metabolism

Front 9

what is the picture of chronic hepatic failure like?

Back 9

loss of normal hepatic lobular architecture with resulting increase in portal system pressures and decreased hepatic function

Front 10

why is there decreased hepatic function?

Back 10

loss of hepatocyte-sinusoid relationship

Front 11

what are the consequences of portal hypertension (4)?

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1) ascites; 2) splenomegaly; 3) edema; 4) porto-caval shunting

Front 12

what leads to ascites?

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increased sinusoidal pressure results in fluid transudation into hepatic interstitial space with eventual overflow into peritoneal third space

Front 13

why is there protein in ascitic fluid?

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because proteins may enter hepatic interstitial space through space of Disse - the capillaries let out the proteins into the space of Disse where liver has receptors to sense protein levels

Front 14

what are consequences of splenomegaly from portal hypertension (2)?

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1) anemia; 2) thrombocytopenia

Front 15

why does edema result from portal hypertension?

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due to hypo-albuminemia, salt and water retention - complex mechanisms

Front 16

what problems does porto-caval shunting result in (5)?

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1) esophageal varices; 2) abnormal glucose tolerance test; 3) spontaneous infection; 4) compromised hepatic perfusion; 5) GI bleeding

Front 17

why is there spontaneous infection?

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liver takes out bacteria, and shunt removes Kupffer cell effect - bacteria grow in ascitic fluid

Front 18

what are two clinical syndromes seen in liver failure that we must know?

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1) hepatic encephalopathy; 2) hepatorenal syndrome

Front 19

what does hepatic encephalopathy start out as (3)?

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1) confusion; 2) restlessness; 3) asterixis

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what does it progress to (3)?

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1) convulsion; 2) coma; 3) death

Front 21

what are predisposing factors to hepatic encephalopathy (6)?

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1) decreased hepatic function; 2) GI hemorrhage; 3) protein load; 4) infection; 5) sedatives; 6) constipation

Front 22

what is true about all of these factors except sedatives?

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they involve increased protein load

Front 23

what happens in hepatorenal syndrome?

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structurally normal kidneys with adequate vascular volume and cardiac function fail

Front 24

what things are seen in the picture of hepatorenal failure (6)?

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1) azotemia; 2) hyperkalemia; 3) acidosis; 4) oliguria; 5) concentrated urine; 6) very low sodium

Front 25

what is true about the causes of both hepatorenal and hepatic encephalopathy?

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they are metabolic syndromes - brain is ok, kidneys are ok

Front 26

what is thought to be the cause of hepatorenal syndrome?

Back 26

liver fails to metabolize an intra-renal vasoregulator

Front 28

LIVER FUNCTION TESTING

Front 30

what are the three categories of causes of jaundice?

Back 30

1) pre-hepatic; 2) post-hepatic; 3) intra-hepatic

Front 31

what will bilirubin be like in pre-hepatic, what will urobilinogen levels be like, and will there be anything else seen?

Back 31

unconjugated, high urobilinogen

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what will bilirubin be like in post-hepatic, what will urobilinogen levels be like, and will there be anything else seen?

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conjugated bilirubin, low urobilinogen, with biliary enzymes

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what will bilirubin be like in intra-hepatic, what will urobilinogen be like, and will there be anything else seen?

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mixed conjugated and unconjugated, mixed urobilinogen, hepatocellular enzymes

Front 34

what is a short term test of liver synthetic function?

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coagulation factor VII (4-6 hour half life)

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what is a long term test of liver synthetic function?

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albumin (half life 21 days)

Front 36

what else can be used to test liver synthetic function?

Back 36

other plasma proteins

Front 37

what are two types of hepatic injury that can be tested in lab?

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1) hepatocellular; 2) biliary

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levels of what substances will rise when there is hepatocellular injury (3)?

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1) AST; 2) ALT; 3) LDH (isoform 5)

Front 39

levels of what substances will rise when there is biliary injury (2)?

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1) GGT; 2) alkaline phosphatase

Front 40

what patterns of liver damage were mentioned (4)?

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1) hepatocellular disease; 2) biliary disease; 3) pre-hepatic jaundice; 4) space occupying lesions