Successfully reported this slideshow.

More Related Content

Related Books

Free with a 14 day trial from Scribd

See all

Related Audiobooks

Free with a 14 day trial from Scribd

See all

Hepatic failure

  1. 1. Liver Failure/ Hepatic Failure By, Ms. Ekta S Patel Assistant Professor
  2. 2. LIVER FAILURE Liver failure is an uncommon condition in which rapid deterioration of liver function results in coagulopathy and alteration in the mental status( encephalopathy ). Liver failure indicates that liver has sustained injury.
  3. 3. TYPES OF LIVER FAILURE FULMINANT HEPATIC FAILURE • Encephalopathy starts within 8 weeks Non fulminant hepatic failure • Encephalopathy starts between 8 to 26 weeks
  4. 4. ACUTE LIVER FAILURE Acute liver failure (ALF) is a rare condition characterized by the abrupt onset of severe liver injury.
  5. 5. ALF • Acute liver failure is loss of liver function that occurs rapidly — in days or weeks — usually in a person who has no pre- existing liver disease . • It's a medical emergency that requires hospitalization .
  6. 6. INCIDENCE • In developed country incidence is 10 cases per million people per year. • it accounts for 6% of all deaths due to liver disease. • It is more common in women than in men, and more common in white people than in other races.
  7. 7. ETIOLOGY OF ALF • VIRAL HEPATITIS DRUG INDUCED HEPATOTOX ICITY TOXIN RELATED HEPATOTOX ICITY VASCULAR CAUSES METABOLIC CAUSES
  8. 8. VIRAL HEPATITIS Virus hepatitis may lead to hepatic failure. Hepatitis A and B Accounts for most of the cases. Atypical causes of viral hepatitis and fulminant hepatic failure include the following: Cytomegalovirus, Herpes simplex virus, paramyxovirus, Epstein-Barr virus
  9. 9. DRUG INDUCED HEPATOTOXICITY • Acetaminophen is the main drug for these type of hepatotoxicity. • Acetaminophen (also known as paracetamol ) may lead to liver failure as a result of intentional or accidental overdose. • Some kind of antibiotics, antidepressants, anaesthetic agents, Salicylates are also associated with hepatotoxicity.
  10. 10. TOXIN RELATED HEAPTOTOXICITY Amanita phalloides, mushroom toxin. Cyanobacteria toxin . Organic solvents (eg, carbon tetrachloride). Yellow phosphorus.
  11. 11. AMNITA PHALLOIDES
  12. 12. VASCULAR CAUSES• Liver injury caused by insufficient blood flow Ischemic hepatitis./ Shock liver • Occlusion of hepatic veins that drains liver Budd chairi syndrome . • Blockage or narrowing of the portal vein. Portal vein thrombosis.
  13. 13. METABOLIC CAUSES Alpha1-antitrypsin . (shape and blockage ) Fructose intolerance. (Def. of aldolase B which results in inability to convert fructose 1 phosphate into dihydroxyacetone and glyceraldehyde. ) Galactosemia (Decreased liver enzyme to break down ) Reye syndrome. (fatty liver+ encephalopathy ) Wilson disease. (copper accumulation )
  14. 14. MALIGNANCIES • primary liver tumour (hepatocellular carcinoma). • Secondary tumour includes hepatic metastasis or breast, lung cancer .
  15. 15. C/M OF ALF  Hepatic encephalopathy (mental confusion, difficulty concentrating and disorientation)  Sudden jaundice .  Pain and tenderness in the upper right side of the stomach.  Nausea.  Vomiting.  Melena.
  16. 16. • Ascites (accumulation of fluid in the stomach) • Ankle Edema (accumulation of fluid in the legs, ankles and feet) • Feeling ill (Malaise). • Drowsiness. • Muscle tremors.
  17. 17. • Bleeding easily • Cerebral oedema • Coma • Brain herniation. • Hypotension. • Tachycardia. • Hematemesis.
  18. 18. DIAGNOSTIC EVALUATION • History collection. • Physical examination. • CBC. • Prothrombin time (PT) . (9.5-13.5 Seconds ) • SGOT , SGPT. • Serum billirubin level, Serum ammonia level. • ABG. • Serum Creatinine level, • Serum free copper • Ceruloplasmin level. (20-38mg/dl)(wilson diases)
  19. 19. • Blood cultures: For patients with suspected infection. • Viral serology: hepatitis A virus immunoglobulin M (IgM), hepatitis B surface antigen (HBsAg). • Drug screening. • Electroencephalography(EEG) • Intracranial pressure monitoring. • Percutaneous (contraindicated in presence of coagulopathy) or transjugular liver biopsy.
  20. 20. • Autoimmune markers: Autoimmune markers (for autoimmune hepatitis diagnosis): A. Antinuclear antibody (ANA). B. Anti-smooth muscle antibody (ASMA).
  21. 21. MANAGEMENT OF ALF Treatment of acute liver failure consists of Drugs and liver transplantation. Pharmacological management includes certain antidotes to reverse the effects of ALF and various medications to reduce ICP. Antidotes neutralize toxic agents or counteract any form of poisoning.
  22. 22. PHARAMACOLOGICAL INTERVENTION Penicillin G. Activated charcoal. N-Acetylcysteine. Osmotic diuretics. Barbiturate. Benzodiazepine. Anaesthetic agents.
  23. 23. PENICILLIN G • Intravenous Penicillin G is the drug of choice for the treatment of Mushroom Poisoning from Amanita Phalloides.
  24. 24. ACTIVATED CHARCOL • Patients who have recently ingested A. Phalloides activated charcoal may bind the toxin and prevent absorption.
  25. 25. ACTIVATED CHARCOAL
  26. 26. EFFECT OF ACTIVATED CHARCOAL
  27. 27. N-Acectylcycteine • It is the drug of choice in acetaminophen overdose. •
  28. 28. OSMOTIC DIUERETICS • Intracranial hypertension in acute liver failure managed by osmotic diuretics such as Mannitol. • Mannitol decreases cerebral Edema.
  29. 29. BARBITURATE • Pentobarbital are used when severe intracranial hypertension does not respond to any measures.
  30. 30. BENZODIAZEPENE • Midazolam is used for sedation in mechanically ventilated patients.
  31. 31. ANEASTHATIC AGENTS • Propofol is a sedative hypnotic used to reduce cerebral blood flow.
  32. 32. LIVER TRANSPLANTATION When acute liver failure can't be reversed, the only treatment may be a liver transplant. During a liver transplant, a surgeon removes patient’s damaged liver and replaces it with a healthy liver . Liver transplantation is indicated for many patients with ALF.
  33. 33. COMPLICATIONS Kidney failure. Cerebral Edema. Bleeding disorders. Infections.
  34. 34. OTHER INTERVENTIONS For coagulopathy/ GIT bleeding vitamin K can be given to treat abnormal PT. Hypotension should be treated with fluids. Pulmonary complications mechanical ventilation may be required. Head of the patient should be elevated to 30 degree . Neurological status should be monitored regularly.
  35. 35. NURSING DIAGNOSIS • Increased risk of dehydration, electrolytes and metabolic disturbances related to liver damage. • Increased risk of secondary infections due to impaired immune state , related to liver dysfunction. • Increased risk of haematological complications related to liver dysfunction.
  36. 36. contd • Changes in neurological state( Encephalopathy) due to liver insufficiency. • Increased risk of haematological complications related to liver dysfunction. • Anxiety related to the symptoms of disease and fear of the unknown.
  37. 37. NURSING INTERVENTIONS • Assess, report and record signs and symptoms and reactions to the treatment. • Monitor fluids input and output closely, observe signs of dehydration, secondary infections, neurological disturbances, Edema and jaundice. • Provide adequate diet with high proteins, carbohydrates and vitamins ( carefully in encephalopathy) .
  38. 38. Contd. • Administer antibiotics, antiemetic, vitamins and other medications as prescribed, monitor for side effects. • Monitor for signs of possible bleeding. • Provide prescribed diet, rest and comfort measures. • Provide emotional support to client and his family , explain all procedure to decrease anxiety and to obtain cooperation.
  39. 39. PREVENTIVE MEASURES • Tell doctor about all medicines. Over the counter and herbal medicines interfere with the drugs. • Limit the amount of alcohol. • Do not have wild mushrooms. • Get vaccinated for hepatitis. • Avoid contact with other people blood or body fluids.

×