Please enable JavaScript.
Coggle requires JavaScript to display documents.
Metabolism: Acute liver failure - Coggle Diagram
Metabolism: Acute liver failure
Pathophysiology
Stimulus triggers an inflammatory response
Kupffer cells start recruiting neutrophils, monocytes, macrophages and inflammatory cytokines
Liver becomes engorged causing RUQ pain and tenderness
Neutrophils further damage the liver
Liver cell apoptosis occurs driving more neutrophils to the area further exacerbating the liver and inflammatory response
Drugs and chemicals can cause direct toxicity, increasing inflammatory response
Inflammation causes tissue necrosis
Liver regeneration (healing) comes back as fibrous scar tissue - not healing hepatocytes
Lobular pattern becomes distorted which will increase pressure in portal circulation
Hepatocytes become less functional
Reduction in ability to detoxify and metabolize substances
Decrease in clotting factors (bleeding disorders!!!)
Decreased albumin production (ascites!)
Loss of glucose regulation (
hypo
glcemia because loss of gluconeogenesis) can't regulate bilirubin metabolism
Can't shunt blood properly
Symptoms
RUQ pain
Hypoglycemia
Ascites / enlarged abdomen
Tachycardia and HTN
Confusion/AMS
Bleeding
Jaundice
Slurred speech
Asterixis
Lethargy
Risk factors
Poor hygiene
Tattoos, body piercings
weight (underweight w/ acetaminophen)
Alcohol consumption and abuse
Genetics
Age
Obesity
Complications
Bleeding esophageal varices
Jaundice
Ascites
Hepato
renal [syndrome]
Portal hypertension
Spontaneous bacterial peritonitis
Coagulation defects
Portal
Brain herniation
Treatments
Octreotide (GI bleeding)
NG stomach decompression
N-acetylcystine
Mechanical ventilation
Activated Charcoal
Labs
ALT/AST
Low albumin
PT prolonged
Increased bilirubin
INR >1.5
Low protein
Ammonia
GLucose (decrease)
CBC
Viral serology
Acetaminophen levels
Diagnostics
CT
MRI
Biopsy
Ultrasound