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Metabolism- Acute Liver Failure - Coggle Diagram
Metabolism- Acute Liver Failure
Pathophysiology & Etiology
Most common cause= acetaminophen overdose
Other causes= prescription drugs (antibiotics, NSAIDS, phenytoin, hepatotropic viruses, herpes, vascular problems like shock, tumors, and clots, toxic wild mushrooms, hepatic failure in pregnancy, reye's syndrome, ASA
Pathophysiology= Etiology → Inflammatory response → Kupffer cells (macrophages) recruit neutrophils, monocytes, macrophages, cytokines → Liver engorgement (RUQ pain manifestation) → Apoptosis and direct toxic effect of the etiology will further recruit neutrophils, resulting in further tissue and cell damage → Tissue destruction/necrosis of the liver → Hepatocellular regeneration → Fibrous, scarring tissue → Distorted lobular pattern of the liver → Increased pressure in portal circulation and decreased function of hepatocytes
Risk Factors
Age >40
Chronic alcohol use
Preexisting liver disease
Malnourishment
Hx if smoking
Essential HTN
Diagnostics & Labs
↑ BUN & creatinine
↑ ALT & AST
CBC, PTT
Ultrasound, CT, MRI
Liver biopsy
Collaborative Treatments
Liver transplant
Charcoal if ingestion <4hrs, or acetylcystine for acetaminophen overdose
Ammonia reduction medications for hepatic encephalopathy
Airway protection
Stomach decompression
Monitor for infection
Frequent serum lab draws
Monitor for GI bleeding (give octreotide)
Hemodynamic monitoring
Administer platelets, FFP, vitamin k
NPO
Complications
WORST= cerebral edema and intracranial hypertension and death
Loss of ability to detoxify and metabolize potential toxins (drugs, alcohol)
Decreased clotting factors
Decreased manufacturing of albumin
Inability to regulate glucose and metabolism of bilirubin
Inability to shunt blood
Ascites
Portal HTN
Jaundice
Hepatorenal syndrome
Spontaneous bacterial peritonitis
Manifestations
Weakness, fatigue, malaise
anorexia, poor nutritional status
Jaundice
CNS disturbances, confusion, coma
bleeding, bruising
Hypotension
Fluid & electrolyte imbalances