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Acute Liver Failure (Metabolism) - Coggle Diagram
Acute Liver Failure (Metabolism)
Patho/ etiology
Insult to liver causes an inflammatory response
Acetaminophen OD
Prescription drugs (NSAIDs, ABX, phenytoin)
Viral infection
toxins
HELLP syndrome (preeclampsia)
metabolic disturbance
Widespread inflammation causes necrosis leaving scarred and ineffective liver tissue behind causing portal hypertension
Liver Kupffer cells (large macrophages that serve as first line of defense) recruit neutrophils, macrophages, cytokines and monocytes
Neutrophils exacerbate initial insult
Apoptosis of liver cells attracts further neutrophils
S&S
RUQ pain (liver engorgement)
hemorrhoids
spider angioma
LOC changes
Jaundice
bleeding
Complications
Loss of ability to metabolize or detoxify (poor drug clearance)
Loss of ability to produce clotting factors/ mediators
decreased albumin capacity (ascites)
loss of glucose (hypoglycemia) and bilirubin (hyperbili/ jaundice) metabolism
inability to shunt blood
portal hypertension
enlarged spleen
GI Bleed
esophageal varices
encephalopathy
Accumulation of neurotoxins (NH3)
confusion, convulsions, coma
slurred speech
slow movement
AMS
HERNEATION
spontaneous bacterial peritonitis
Collaborative Treatment
Address insult
transplant
Monitor for GI bleed (administer octreotide)
monitor for infection
protect airway
hemodynamic monitoring
platelets, FFP, VIT K
NPO
Labs/ diagnostic
CBC
INR/ PT
screen for viral infection
LFT
bilirubin
albumin
glucose
lactate
NH3
drug levels
Risk Factors
Viral infection (hepatitis, HSV)
pregnancy
Reye's syndrome
self treated chronic pain
alcohol abuse