Dialysate is the fluid used during dialysis that draws waste and excess fluid from the blood. It has a similar composition to plasma with electrolytes like sodium, chloride, calcium, potassium, and either acetate or bicarbonate. Dialysate prevents the removal of essential electrolytes and excess water from the blood during dialysis. There are two main types - acetate dialysate, which can cause side effects from acetate accumulation, and bicarbonate dialysate, which uses a two-component mixing process and has a shorter stability than acetate dialysate. The dialysate delivery system controls the dialysate temperature, composition, pressure and flow rate through the dialyzer during the dialysis
Hemodialysis is a medical procedure that removes waste and excess fluid from the blood of patients with kidney failure. It uses a hemodialysis machine and an artificial kidney called a dialyzer to filter the blood outside of the body. Blood flows through the dialyzer where diffusion and ultrafiltration remove waste and regulate electrolytes, and is then returned to the patient. Hemodialysis is usually done three times a week for four hours each session through an arteriovenous fistula, graft, or catheter. Potential complications include hypotension, muscle cramps, nausea, and disequilibrium syndrome.
This document discusses electrolyte imbalances, including causes, signs and symptoms, and treatment approaches. It covers the major electrolytes: sodium, potassium, calcium, magnesium, and their roles in the body. Key points include how electrolytes are involved in neuromuscular function, acid-base balance, and fluid distribution. Electrolyte imbalances like hyponatremia, hyperkalemia, hypocalcemia and hypomagnesemia are described in terms of their definitions, causes, and clinical manifestations that clinicians should look for as well as treatment goals.
This document discusses liver function tests (LFTs), which assess the liver's metabolic, synthetic, excretory and detoxification functions. LFTs include tests of bilirubin, bile salts, aminotransferases, alkaline phosphatase, lactate dehydrogenase, ammonia, cholesterol and coagulation factors. Elevations in aminotransferases generally indicate liver injury, while alkaline phosphatase and gamma-glutamyl transferase indicate cholestasis or bile duct injury. Interpretation of LFTs can help diagnose liver diseases and assess disease severity. Limitations include lack of specificity and inability to fully assess liver function.
Kidney transplantation is the most effective therapy for end-stage renal disease. The transplanted organ can come from a live or deceased donor. Immunosuppressive medications are used to prevent rejection and include corticosteroids, calcineurin inhibitors, mTOR inhibitors, and antimetabolites. Common post-transplant complications include acute rejection, infections like cytomegalovirus, and chronic allograft dysfunction.
This document provides information on chronic kidney disease (CKD), including its definition, stages, causes, clinical features, diagnostic tests, and treatment. It notes that CKD is progressive loss of kidney function that is categorized into 5 stages based on glomerular filtration rate. The main causes are glomerular diseases, vascular issues like hypertension, and infections/toxins. Signs and symptoms become more severe as the disease progresses. Treatment focuses on managing symptoms, slowing disease progression, and renal replacement therapies like hemodialysis and peritoneal dialysis for late stages.
An SGOT (AST) blood test measures levels of an enzyme called AST or SGOT that is found in red blood cells, liver cells, and heart muscle cells, which is released when those cells are damaged. This test may be ordered to check for liver damage, help identify liver disease like hepatitis or cirrhosis, check on treatment for liver disease, monitor medications that can affect the liver, or for those who consume excessive alcohol. Results are available within 3-5 business days without any fasting or preparation required other than bringing your LabFinder order and insurance card.
Introduction to serum electrolyte, sodium homeostasis & its related disordersenamifat
This document provides an introduction to serum electrolytes, with a focus on sodium homeostasis and related disorders. It defines electrolytes as ions that dissociate in solution and conduct electricity. Sodium is the major cation in extracellular fluid and helps maintain fluid balance, blood pressure, and neuromuscular function. The kidney precisely regulates sodium levels through reabsorption and excretion in response to hormones like aldosterone and ANP. Abnormal sodium levels can cause hypernatremia or hyponatremia, depending on whether the body has too much or too little water relative to sodium.
Dialysate is the fluid used during dialysis that draws waste and excess fluid from the blood. It has a similar composition to plasma with electrolytes like sodium, chloride, calcium, potassium, and either acetate or bicarbonate. Dialysate prevents the removal of essential electrolytes and excess water from the blood during dialysis. There are two main types - acetate dialysate, which can cause side effects from acetate accumulation, and bicarbonate dialysate, which uses a two-component mixing process and has a shorter stability than acetate dialysate. The dialysate delivery system controls the dialysate temperature, composition, pressure and flow rate through the dialyzer during the dialysis
Hemodialysis is a medical procedure that removes waste and excess fluid from the blood of patients with kidney failure. It uses a hemodialysis machine and an artificial kidney called a dialyzer to filter the blood outside of the body. Blood flows through the dialyzer where diffusion and ultrafiltration remove waste and regulate electrolytes, and is then returned to the patient. Hemodialysis is usually done three times a week for four hours each session through an arteriovenous fistula, graft, or catheter. Potential complications include hypotension, muscle cramps, nausea, and disequilibrium syndrome.
This document discusses electrolyte imbalances, including causes, signs and symptoms, and treatment approaches. It covers the major electrolytes: sodium, potassium, calcium, magnesium, and their roles in the body. Key points include how electrolytes are involved in neuromuscular function, acid-base balance, and fluid distribution. Electrolyte imbalances like hyponatremia, hyperkalemia, hypocalcemia and hypomagnesemia are described in terms of their definitions, causes, and clinical manifestations that clinicians should look for as well as treatment goals.
This document discusses liver function tests (LFTs), which assess the liver's metabolic, synthetic, excretory and detoxification functions. LFTs include tests of bilirubin, bile salts, aminotransferases, alkaline phosphatase, lactate dehydrogenase, ammonia, cholesterol and coagulation factors. Elevations in aminotransferases generally indicate liver injury, while alkaline phosphatase and gamma-glutamyl transferase indicate cholestasis or bile duct injury. Interpretation of LFTs can help diagnose liver diseases and assess disease severity. Limitations include lack of specificity and inability to fully assess liver function.
Kidney transplantation is the most effective therapy for end-stage renal disease. The transplanted organ can come from a live or deceased donor. Immunosuppressive medications are used to prevent rejection and include corticosteroids, calcineurin inhibitors, mTOR inhibitors, and antimetabolites. Common post-transplant complications include acute rejection, infections like cytomegalovirus, and chronic allograft dysfunction.
This document provides information on chronic kidney disease (CKD), including its definition, stages, causes, clinical features, diagnostic tests, and treatment. It notes that CKD is progressive loss of kidney function that is categorized into 5 stages based on glomerular filtration rate. The main causes are glomerular diseases, vascular issues like hypertension, and infections/toxins. Signs and symptoms become more severe as the disease progresses. Treatment focuses on managing symptoms, slowing disease progression, and renal replacement therapies like hemodialysis and peritoneal dialysis for late stages.
An SGOT (AST) blood test measures levels of an enzyme called AST or SGOT that is found in red blood cells, liver cells, and heart muscle cells, which is released when those cells are damaged. This test may be ordered to check for liver damage, help identify liver disease like hepatitis or cirrhosis, check on treatment for liver disease, monitor medications that can affect the liver, or for those who consume excessive alcohol. Results are available within 3-5 business days without any fasting or preparation required other than bringing your LabFinder order and insurance card.
Introduction to serum electrolyte, sodium homeostasis & its related disordersenamifat
This document provides an introduction to serum electrolytes, with a focus on sodium homeostasis and related disorders. It defines electrolytes as ions that dissociate in solution and conduct electricity. Sodium is the major cation in extracellular fluid and helps maintain fluid balance, blood pressure, and neuromuscular function. The kidney precisely regulates sodium levels through reabsorption and excretion in response to hormones like aldosterone and ANP. Abnormal sodium levels can cause hypernatremia or hyponatremia, depending on whether the body has too much or too little water relative to sodium.
Liver function test (LFT) includes a group of blood tests commonly performed to evaluate the function of the liver. This test measures the level of liver enzymes, proteins, and bilirubin in the blood.
For more details, visit:
https://www.1mg.com/labs/test/liver-function-test-2562
This document discusses hemodialysis techniques. It defines hemodialysis as the extracorporeal removal of waste products from the blood of patients with poorly functioning kidneys, replacing some deficient materials. It describes the main principles of diffusion, osmosis, filtration, and convection that underlie hemodialysis. It also discusses various hemodialysis techniques including conventional hemodialysis, online hemodiafiltration, SLEDD, CRRT, and hemoadsorption.
Peritoneal dialysis is a treatment for kidney failure that uses the lining of your abdomen, or belly, to filter your blood inside your body. Health care providers call this lining the peritoneum. A more convenient method of dialysis in home itself.
This document provides an overview of liver failure, including its causes, types, and pathophysiology. It discusses the major causes of acute and chronic liver failure. Acute liver failure can result from drug or toxin damage, viral hepatitis, or the end stage of chronic liver disease leading to cirrhosis. Chronic liver failure is usually the end result of chronic hepatitis or liver disease progressing to cirrhosis. The document describes the pathophysiology behind several clinical manifestations of liver failure, including hepatic encephalopathy, hepatorenal syndrome, and hepatopulmonary syndrome. It also discusses the mechanisms leading to ascites in liver failure patients.
This document provides guidelines for evaluating potential renal transplant recipients and living kidney donors. For recipients, a thorough history, clinical exam, lab tests, imaging and biopsies are recommended to assess suitability and detect contraindications. Original kidney disease must be evaluated for risk of recurrence. For donors, standard criteria include age over 21, no infections, diseases, or malignancies. Donors require medical, lab and imaging exams as well as informed consent regarding risks. High risk donors like those with obesity, hypertension or hematuria may require further testing or be deemed unsuitable to donate.
Fluid balance is an aspect of the homeostasis of body in which the amount of water in the body needs to be controlled, via osmoregulation and behavior, such that the concentrations of electrolytes (salts in solution) in the various body fluids are kept within healthy ranges.
The core principle of fluid balance is that the amount of water lost from the body must equal the amount of water taken in; for example, in humans, the output (via respiration, perspiration, urination, defecation, and expectoration) must equal the input (via eating and drinking, or by parenteral intake).
The document discusses electrolytes and body fluids. It states that the body contains inorganic and organic chemicals, with inorganic chemicals including water, salts, acids and bases. Electrolytes such as sodium, potassium, chloride and bicarbonate ions are important for maintaining fluid balance and acid-base homeostasis. Imbalances in electrolyte concentrations can lead to diseases. The document also describes intracellular and extracellular fluids and how different electrolytes are distributed between these compartments.
Cirrhosis is a chronic, progressive disease of the liver caused by extensive liver cell damage and regeneration. It results in the formation of fibrous scar tissue and loss of normal liver architecture. Common causes include alcohol abuse and viral hepatitis. Complications arise due to liver dysfunction and portal hypertension, such as jaundice, ascites, variceal bleeding, and hepatic encephalopathy. Treatment focuses on managing complications, dietary changes, and medication to reduce ammonia levels and symptoms.
Electrolytes are minerals which are present in the blood and body tissues and are essential for metabolism, for proper nerve and muscle functioning, for maintenance of proper water balance, and proper blood pH (acid-base balance). The serum electrolyte test includes a group of tests to measure the following electrolytes: Sodium (Na+), Potassium (K+) and Chloride (Cl-).
Reference: https://www.1mg.com/labs/test/serum-electrolyte-1761
This document discusses dialyzers, which are used in renal dialysis to remove waste and excess fluid from the blood of patients with kidney failure. It describes the key components of a dialyzer, including the semipermeable membrane and four ports, as well as specifications like surface area, clearance rates, and sterilization methods. Various types of dialyzers are covered, such as coil dialyzers, parallel plate dialyzers, and hollow fiber dialyzers. Membrane materials including cellulose, synthetic, and cellulosynthetic are also outlined. An ideal dialyzer is said to efficiently clear toxins while avoiding protein and cell losses.
One unit of whole blood can be separated into various blood components through centrifugation and other processing steps. This allows each component to be stored optimally and transfused only as needed by patients. Red blood cells can be stored for 21 days in CPD or 42 days when added to ADSOL. Platelets are stored at room temperature while plasma products like FFP and cryoprecipitate must be frozen and thawed as needed. Whole blood is rarely used today due to non-functional platelets and labile coagulation factors after collection.
This document provides an overview of liver anatomy, functions, and diseases. It describes the liver's structure including liver cells, bile drainage system, and blood supply. The liver's key functions are metabolism, protein synthesis, storage, detoxification, and bile production. Investigation of liver diseases includes blood tests, imaging, and biopsy. Common liver diseases discussed are jaundice, cholestasis, liver failure, and cirrhosis. Cirrhosis is the end-stage of chronic liver disease and can result from infections, toxins, autoimmune conditions, and other etiologies.
The document discusses cardiac monitoring and electrocardiography (ECG). It defines a cardiac monitor as a device that displays electrical and pressure waveforms of the cardiovascular system. Cardiac monitors are used to continuously monitor heart rate, blood pressure, respiratory rate, and other vital signs in critically ill patients. They allow for prompt detection of arrhythmias and other cardiac conditions. A 12-lead ECG provides a graphical recording of the heart's electrical activity over time and is useful for diagnosing arrhythmias and detecting other cardiac abnormalities.
The document discusses the formation and composition of blood. It begins by introducing the cardiovascular and lymphatic systems that make up the circulatory system. It then covers the components, functions, and production of blood. The key components of blood are plasma and formed elements like red blood cells, white blood cells, and platelets. Blood functions to transport nutrients and gases, protect the body, and regulate pH and temperature. Blood cells are produced through hematopoiesis in the bone marrow from stem cells.
It is the removal of solutes and water from body across a semipermeable membrane (dialyzer)
care during and after the dialysis is very important to prevent the entry of pathogens in to the body.
This document discusses kidney failure treatment options including hemodialysis, peritoneal dialysis, and transplantation. Hemodialysis and peritoneal dialysis are dialysis techniques that use filters or the peritoneal membrane to remove waste and excess fluid from the blood. Kidney transplantation is usually the best long-term treatment but demand for donors exceeds supply.
Peritoneal dialysis is a treatment for kidney failure that uses the peritoneum and peritoneal membrane to filter waste from the blood. It involves infusing dialysate into the peritoneal cavity, allowing it to dwell for a period of time to exchange wastes, and then draining the used dialysate. There are several types of peritoneal dialysis including continuous ambulatory peritoneal dialysis, automated peritoneal dialysis, and intermittent peritoneal dialysis. Nursing management involves assessing the patient pre and post dialysis, following sterile technique during the procedure, monitoring for complications, and educating the patient and family.
Blood and blood products must be stored between 2-6°C to prevent bacterial growth or cell damage from freezing. They use anticoagulants like EDTA, sodium citrate, and heparin to prevent clotting during storage and transport. When transporting blood between locations in a large hospital, it must be kept in a insulated carrier to maintain the temperature below 10°C. Blood should be transfused within 30 minutes of removal from refrigerated storage.
The document summarizes the key components and functioning of a hemodialysis machine. It describes how the machine works by circulating blood outside the body through a dialyzer to remove waste and excess water. The blood flows through the dialyzer in one direction while dialysate flows counter-currently to maximize concentration gradients and removal of toxins like urea and creatinine from the blood. The machine monitors various parameters like blood pressure and temperature during the dialysis process to ensure patient safety.
This document discusses renal function tests and their use in assessing kidney function. It covers tests that measure glomerular filtration rate like creatinine clearance and urea clearance. Creatinine clearance is considered the best measure of glomerular filtration as creatinine is filtered at the glomerulus and neither reabsorbed nor secreted. Stages of kidney disease are defined based on glomerular filtration rate. Tubular function tests like urine concentration are also discussed. Biochemical changes in blood that occur with impaired kidney function are outlined.
This document discusses acute liver failure in children. It defines acute liver failure as biochemical evidence of acute liver injury lasting less than 8 weeks with no evidence of chronic liver disease and a coagulopathy. The causes in neonates and young infants include infections, metabolic diseases, and other etiologies. In older children, the causes include infections, immune mediated diseases, metabolic diseases, vascular diseases, and drug induced liver disease. Management involves supportive care, specific treatments based on etiology, and potentially liver transplantation. The prognosis depends on the severity and underlying cause of liver failure.
Liver function test (LFT) includes a group of blood tests commonly performed to evaluate the function of the liver. This test measures the level of liver enzymes, proteins, and bilirubin in the blood.
For more details, visit:
https://www.1mg.com/labs/test/liver-function-test-2562
This document discusses hemodialysis techniques. It defines hemodialysis as the extracorporeal removal of waste products from the blood of patients with poorly functioning kidneys, replacing some deficient materials. It describes the main principles of diffusion, osmosis, filtration, and convection that underlie hemodialysis. It also discusses various hemodialysis techniques including conventional hemodialysis, online hemodiafiltration, SLEDD, CRRT, and hemoadsorption.
Peritoneal dialysis is a treatment for kidney failure that uses the lining of your abdomen, or belly, to filter your blood inside your body. Health care providers call this lining the peritoneum. A more convenient method of dialysis in home itself.
This document provides an overview of liver failure, including its causes, types, and pathophysiology. It discusses the major causes of acute and chronic liver failure. Acute liver failure can result from drug or toxin damage, viral hepatitis, or the end stage of chronic liver disease leading to cirrhosis. Chronic liver failure is usually the end result of chronic hepatitis or liver disease progressing to cirrhosis. The document describes the pathophysiology behind several clinical manifestations of liver failure, including hepatic encephalopathy, hepatorenal syndrome, and hepatopulmonary syndrome. It also discusses the mechanisms leading to ascites in liver failure patients.
This document provides guidelines for evaluating potential renal transplant recipients and living kidney donors. For recipients, a thorough history, clinical exam, lab tests, imaging and biopsies are recommended to assess suitability and detect contraindications. Original kidney disease must be evaluated for risk of recurrence. For donors, standard criteria include age over 21, no infections, diseases, or malignancies. Donors require medical, lab and imaging exams as well as informed consent regarding risks. High risk donors like those with obesity, hypertension or hematuria may require further testing or be deemed unsuitable to donate.
Fluid balance is an aspect of the homeostasis of body in which the amount of water in the body needs to be controlled, via osmoregulation and behavior, such that the concentrations of electrolytes (salts in solution) in the various body fluids are kept within healthy ranges.
The core principle of fluid balance is that the amount of water lost from the body must equal the amount of water taken in; for example, in humans, the output (via respiration, perspiration, urination, defecation, and expectoration) must equal the input (via eating and drinking, or by parenteral intake).
The document discusses electrolytes and body fluids. It states that the body contains inorganic and organic chemicals, with inorganic chemicals including water, salts, acids and bases. Electrolytes such as sodium, potassium, chloride and bicarbonate ions are important for maintaining fluid balance and acid-base homeostasis. Imbalances in electrolyte concentrations can lead to diseases. The document also describes intracellular and extracellular fluids and how different electrolytes are distributed between these compartments.
Cirrhosis is a chronic, progressive disease of the liver caused by extensive liver cell damage and regeneration. It results in the formation of fibrous scar tissue and loss of normal liver architecture. Common causes include alcohol abuse and viral hepatitis. Complications arise due to liver dysfunction and portal hypertension, such as jaundice, ascites, variceal bleeding, and hepatic encephalopathy. Treatment focuses on managing complications, dietary changes, and medication to reduce ammonia levels and symptoms.
Electrolytes are minerals which are present in the blood and body tissues and are essential for metabolism, for proper nerve and muscle functioning, for maintenance of proper water balance, and proper blood pH (acid-base balance). The serum electrolyte test includes a group of tests to measure the following electrolytes: Sodium (Na+), Potassium (K+) and Chloride (Cl-).
Reference: https://www.1mg.com/labs/test/serum-electrolyte-1761
This document discusses dialyzers, which are used in renal dialysis to remove waste and excess fluid from the blood of patients with kidney failure. It describes the key components of a dialyzer, including the semipermeable membrane and four ports, as well as specifications like surface area, clearance rates, and sterilization methods. Various types of dialyzers are covered, such as coil dialyzers, parallel plate dialyzers, and hollow fiber dialyzers. Membrane materials including cellulose, synthetic, and cellulosynthetic are also outlined. An ideal dialyzer is said to efficiently clear toxins while avoiding protein and cell losses.
One unit of whole blood can be separated into various blood components through centrifugation and other processing steps. This allows each component to be stored optimally and transfused only as needed by patients. Red blood cells can be stored for 21 days in CPD or 42 days when added to ADSOL. Platelets are stored at room temperature while plasma products like FFP and cryoprecipitate must be frozen and thawed as needed. Whole blood is rarely used today due to non-functional platelets and labile coagulation factors after collection.
This document provides an overview of liver anatomy, functions, and diseases. It describes the liver's structure including liver cells, bile drainage system, and blood supply. The liver's key functions are metabolism, protein synthesis, storage, detoxification, and bile production. Investigation of liver diseases includes blood tests, imaging, and biopsy. Common liver diseases discussed are jaundice, cholestasis, liver failure, and cirrhosis. Cirrhosis is the end-stage of chronic liver disease and can result from infections, toxins, autoimmune conditions, and other etiologies.
The document discusses cardiac monitoring and electrocardiography (ECG). It defines a cardiac monitor as a device that displays electrical and pressure waveforms of the cardiovascular system. Cardiac monitors are used to continuously monitor heart rate, blood pressure, respiratory rate, and other vital signs in critically ill patients. They allow for prompt detection of arrhythmias and other cardiac conditions. A 12-lead ECG provides a graphical recording of the heart's electrical activity over time and is useful for diagnosing arrhythmias and detecting other cardiac abnormalities.
The document discusses the formation and composition of blood. It begins by introducing the cardiovascular and lymphatic systems that make up the circulatory system. It then covers the components, functions, and production of blood. The key components of blood are plasma and formed elements like red blood cells, white blood cells, and platelets. Blood functions to transport nutrients and gases, protect the body, and regulate pH and temperature. Blood cells are produced through hematopoiesis in the bone marrow from stem cells.
It is the removal of solutes and water from body across a semipermeable membrane (dialyzer)
care during and after the dialysis is very important to prevent the entry of pathogens in to the body.
This document discusses kidney failure treatment options including hemodialysis, peritoneal dialysis, and transplantation. Hemodialysis and peritoneal dialysis are dialysis techniques that use filters or the peritoneal membrane to remove waste and excess fluid from the blood. Kidney transplantation is usually the best long-term treatment but demand for donors exceeds supply.
Peritoneal dialysis is a treatment for kidney failure that uses the peritoneum and peritoneal membrane to filter waste from the blood. It involves infusing dialysate into the peritoneal cavity, allowing it to dwell for a period of time to exchange wastes, and then draining the used dialysate. There are several types of peritoneal dialysis including continuous ambulatory peritoneal dialysis, automated peritoneal dialysis, and intermittent peritoneal dialysis. Nursing management involves assessing the patient pre and post dialysis, following sterile technique during the procedure, monitoring for complications, and educating the patient and family.
Blood and blood products must be stored between 2-6°C to prevent bacterial growth or cell damage from freezing. They use anticoagulants like EDTA, sodium citrate, and heparin to prevent clotting during storage and transport. When transporting blood between locations in a large hospital, it must be kept in a insulated carrier to maintain the temperature below 10°C. Blood should be transfused within 30 minutes of removal from refrigerated storage.
The document summarizes the key components and functioning of a hemodialysis machine. It describes how the machine works by circulating blood outside the body through a dialyzer to remove waste and excess water. The blood flows through the dialyzer in one direction while dialysate flows counter-currently to maximize concentration gradients and removal of toxins like urea and creatinine from the blood. The machine monitors various parameters like blood pressure and temperature during the dialysis process to ensure patient safety.
This document discusses renal function tests and their use in assessing kidney function. It covers tests that measure glomerular filtration rate like creatinine clearance and urea clearance. Creatinine clearance is considered the best measure of glomerular filtration as creatinine is filtered at the glomerulus and neither reabsorbed nor secreted. Stages of kidney disease are defined based on glomerular filtration rate. Tubular function tests like urine concentration are also discussed. Biochemical changes in blood that occur with impaired kidney function are outlined.
This document discusses acute liver failure in children. It defines acute liver failure as biochemical evidence of acute liver injury lasting less than 8 weeks with no evidence of chronic liver disease and a coagulopathy. The causes in neonates and young infants include infections, metabolic diseases, and other etiologies. In older children, the causes include infections, immune mediated diseases, metabolic diseases, vascular diseases, and drug induced liver disease. Management involves supportive care, specific treatments based on etiology, and potentially liver transplantation. The prognosis depends on the severity and underlying cause of liver failure.
Acute liver failure can result from massive hepatocyte necrosis or severe impairment. It is defined by liver injury of less than 8 weeks, no chronic liver disease, and coagulopathy. Causes in children include viral infections, autoimmune disease, metabolic disorders, drugs, and unknown origins. Symptoms range from jaundice and coagulopathy to hepatic encephalopathy. Management involves supportive care, treating the underlying cause, and consideration of liver transplantation for severe cases. Prognosis depends on the cause and stage of encephalopathy, with survival rates varying from over 90% for acetaminophen overdose to less than 15% for subacute cases.
- Acute liver failure (ALF) is a life-threatening condition caused by severe hepatic injury from various causes. The management of ALF requires a multidisciplinary approach to address complications affecting the brain, lungs, kidneys, and other organs. Liver transplantation may be considered for patients who do not recover spontaneously based on criteria such as coagulopathy and encephalopathy severity.
This document discusses the management of acute liver failure in critical care. It covers the following key points:
- Acute liver failure results from severe hepatic injury and can have various causes. It is a life-threatening condition with high mortality if left untreated.
- Patients present with coagulopathy, encephalopathy, and multi-organ dysfunction. Management involves addressing neurological, respiratory, cardiovascular, renal, infectious and nutritional issues.
- Specific treatments include sedation and ventilation for cerebral edema, fluid resuscitation for hypotension, renal replacement therapy for kidney injury, and antibiotics to prevent infection in immunosuppressed patients. The only cure for severe cases is emergency liver transplantation.
Correlation liver disfunction and infection disease (dengue typhoid fever)01mataharitimoer MT
Correlation Liver Disfunction and Infection Disease (Dengue and Typhoid Fever)
Dr Erwin, SpPD, FINASIM
Disampaikan pada acara PIT VI IDI Kota Bogor | 9 Nopember 2013
Acute liver failure is defined as severe liver injury with hepatic encephalopathy and coagulopathy in a patient without pre-existing liver disease. It can be caused by acetaminophen overdose, viral hepatitis, drugs, toxins, and other etiologies. Patients present with jaundice, encephalopathy, and coagulopathy. Treatment involves supportive care in the ICU, lactulose, antibiotics, and consideration of liver transplantation for eligible patients. Complications include cerebral edema, bleeding, hypoglycemia, and multi-organ failure.
11 Turman Management Of Acute Renal Failure In PicuDang Thanh Tuan
This document provides an overview of the definition, causes, risk factors, evaluation, and management of acute renal failure (ARF) in pediatric intensive care unit patients. It discusses the importance of differentiating between pre-renal, renal, and post-renal causes of ARF. Key factors that influence outcomes like oliguria, multi-organ failure, and late initiation of dialysis are outlined. Fluid management and treatment of complications such as hypertension, electrolyte abnormalities, and anemia are also reviewed. Emerging potential new treatments for ARF are described but many have not proven effective in clinical trials.
This document discusses fulminant hepatic failure (FHF), including defining FHF, listing its causes, identifying its pathophysiology, diagnostic tests, medical management, complications, and nursing care plan. FHF is defined as severe acute liver injury with impaired function and encephalopathy in someone who previously had a normal liver. Its causes include acetaminophen, various viral hepatitises, and other drugs/conditions. Management involves treating precipitating factors, managing complications, and considering liver transplantation.
This document provides an outline for a presentation on acute liver failure (ALF). It begins with definitions of ALF and classifications of fulminant vs subfulminant hepatic failure. It then covers anatomy and blood supply of the liver, epidemiology, etiology, pathophysiology, clinical features, diagnostic evaluation, treatment, complications, and prognosis of ALF. Key points include that ALF results from massive liver cell necrosis and loss of synthetic function, common causes are acetaminophen overdose, viral hepatitis, and unknown etiology. Presentation may include jaundice, encephalopathy, and coagulopathy. Treatment involves supportive care, identifying and treating any underlying cause, and consideration of liver transplantation in severe
This document defines and describes Fulminant Hepatic Failure (FHF), also known as Acute Liver Failure (ALF). It provides definitions for different types of liver failure based on duration and presence of pre-existing liver disease. The document discusses the etiology, pathogenesis, clinical manifestations and stages of hepatic encephalopathy in FHF. It outlines the diagnostic workup and management approach for FHF, including initial stabilization, monitoring for complications, supportive care to maximize survival, and consideration of liver transplantation.
The document discusses hepatic encephalopathy, a neurological syndrome caused by liver dysfunction. It covers the pathogenesis, which involves neurotoxins like ammonia crossing the blood brain barrier and disrupting neurotransmitter levels. Symptoms range from mild confusion to coma and can be precipitated by factors that increase ammonia production or permeability of the blood brain barrier. Treatment focuses on managing precipitating factors and restricting protein intake to control ammonia levels.
This document summarizes hepatic insufficiency and liver failure. It defines acute liver failure as the rapid development of liver dysfunction leading to coagulopathy and encephalopathy in a patient without known liver disease. Acute liver failure can be categorized as fulminant (encephalopathy within 8 weeks) or subfulminant (encephalopathy after 8 weeks but before 26 weeks). Chronic liver failure usually occurs in the context of cirrhosis due to various causes such as hepatitis, alcohol, or autoimmune disease. Complications of liver failure include cerebral edema, bleeding disorders, infections, and kidney failure. Treatment options include medications to reverse toxicity, liver transplantation, treatments for complications, and screening for infections.
Liver failure occurs when the liver rapidly loses its ability to function, resulting in mental status changes and coagulation abnormalities. It can be caused by viral hepatitis, drug toxicity, toxins, vascular issues, or metabolic diseases. Acute liver failure presents as a sudden onset of severe liver injury in someone without pre-existing liver disease. It requires emergency treatment and may necessitate a liver transplant if liver function cannot be reversed. Management involves supportive care, medications to treat complications, and sometimes a liver transplant.
This document discusses liver function and the impact of liver disease on anesthesia. It covers the key roles of the liver, signs of impaired function, and how disease affects drug metabolism, cardiovascular and pulmonary systems. Risk is assessed using Child-Pugh scoring. For patients undergoing surgery, careful fluid management, blood product administration, and hemodynamic stability are emphasized to reduce risk according to their liver disease severity.
Acute renal failure and chronic renal failure are discussed. Acute renal failure can be prerenal, renal, or postrenal and is characterized by a sudden reduction in urine output. Chronic renal failure is a permanent loss of kidney function that progresses to end stage renal disease. It has multiple etiologies including glomerular diseases. Both present with electrolyte imbalances, fluid retention, and other complications. Treatment focuses on fluid management, diet modification, and dialysis or transplantation as needed.
The document discusses liver regeneration and function. It states that individual liver cells can regenerate destroyed liver tissue, while larger destroyed sections will cause surrounding tissue to expand. Complete liver function relies on unimpeded blood flow, as cirrhosis can only generate poorly perfused nodules. The document also outlines the liver's role in bile production, blood filtration, nutrient breakdown, and more. It describes various tests of liver function including bilirubin levels, clotting factors, and enzymes that indicate tissue damage.
Liver cirrhosis is a chronic liver disease characterized by the replacement of liver tissue with fibrosis and the formation of regenerative nodules, leading to loss of liver function. It is commonly caused by alcoholism, viral hepatitis, and fatty liver disease. While generally irreversible, treatment focuses on preventing progression and complications like ascites, bleeding from esophageal varices, hepatic encephalopathy, and liver cancer. A diagnosis involves blood tests, imaging, and potentially a liver biopsy. Management includes medications to prevent complications and address underlying causes, with liver transplantation as a potential surgical option for end-stage disease.
This document summarizes liver failure, including its etiology, symptoms, management, and treatment options. Acute liver failure is defined as the development of encephalopathy within 8 weeks of illness onset and can be caused by drugs, viruses, and other factors. Management involves treating complications like encephalopathy, coagulopathy, and cerebral edema. Liver transplantation remains the primary treatment for fulminant hepatic failure when criteria like prolonged prothrombin time or age are met. Liver support systems are also discussed as potential therapies.
Executive Directors Chat Leveraging AI for Diversity, Equity, and InclusionTechSoup
Let’s explore the intersection of technology and equity in the final session of our DEI series. Discover how AI tools, like ChatGPT, can be used to support and enhance your nonprofit's DEI initiatives. Participants will gain insights into practical AI applications and get tips for leveraging technology to advance their DEI goals.
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
2. LEARNING OBJECTIVES
Students would improve their knowledge in
Anatomical functions of the Liver
Acute and Chronic Liver disease
Liver Cirrhosis
Alcoholic Liver disease
11. CELLS OF THE LIVER
Cells of the liver include
hepatocytes,
hepatic stellate cells - also known as perisinusoidal
lipocytes, or Ito cells - sinusoidal endothelial cells,
macrophages (Kupffer cells),
the cells of the biliary tree - cuboidal to columnar
epithelium - and
connective tissue cells of the capsule and portal tracts.
12. Inactivation of various substances
Toxins
Steroids
Other hormones
Synthesis of plasma proteins
Acute-phase proteins
Albumin
Clotting factors
Steroid-binding and other
Immunity
Kupffer cells
hormone-binding proteins
13.
The glucuronides of the bile pigments, bilirubin and biliverdin,
are responsible for the golden yellow color of bile.
The bile salts are sodium and potassium salts of bile acids,
and all those secreted into the bile are conjugated to glycine or
taurine, a derivative of cysteine.
The bile acids are synthesized from cholesterol.
24. Signs and Symptoms In Lower Limb
1. Pedal Edema
2. Easy bruising
3. Scratch marks
25. Other Features…
Fetor Hepaticus ( sweetish faecal smell of the
breath indicates severe hepatocellular failure.
Paper money skin ( thinning of the skin )
Hepatic encephalopathy (disturbed consciousness, altered sleep
personality changes, intellectual disturbances and asterixis)
Testicular atrophy and loss of libido.
Bounding pulse.
26. Hepatic Facial
Shunken eyes
Hollowed temporal fossa
Pinched up nose with malar symptoms
Parched lips
Muddy complexion of face
Icteric change f conjunctiva
Shallow and dry face
27. Clinical Features of alcoholic liver cirrhosis
Bilateral enlarged Parotids
Duputryren’s contracture
Gynaecomatia
Testicular atro p h y
Muscle wasting and loss of body hair.
28. ACUTE LIVER FAILURE( < 3 MONTHS)
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.
Acute liver failure (ALF) is a life-threatening multisystem illness resulting
from severe hepatic injury from a variety of potential aetiologies
Despite advances in the understanding of the aetiology and pathogenesis
mortality rates remain high.
In the most severe cases emergency liver transplantation is the only
option
29. Common causes of acute liver failure
•Paracetamol (39%)
•lndeterminant (17%)
•idiosyncratic drug reactions
(13%)
•lschaemic hepatitis (6%)
•Hepatitis B (7%)
•Hepatitis A (4%)
•Autoimmune Hepatitis (4%)
•Wilsons disease (3%)
•Budd-Chiari syndrome (2%)
•HELlP syndrome (1%)
•Acute fatty liver of pregnancy
(1%)
•Metastatic cancer (1%)
•Other (2%)
30. Aetiology of ALF is a primary concern in the management
because it can influence management and help to predict
outcome.
N-acetylcysteine (NAC) for paracetamol (acetaminophen)
overdose,
Delivery of the foetus for HELLP or fatty liver of
pregnancy,
Treatment with lamivudine in Hepatitis B viral infection
AETIOLOGY AND DEFINITION
31. In the developed world paracetamol overdose is the most common
cause of ALF,
However worldwide, viral aetiologies (Hepatitis A, B and E) and
seronegative hepatitis predominate.
.
32. There are multiple classifications of ALF.
The most widely used classifies ALF by the speed of onset of
encephalopathy when the patient becomes symptomatic.
These definitions have prognostic implications and can provide
clues regarding potential aetiology
c
33. Hyperacute: Fulminant (hyperacute) hepatic failure (FHF) is a
syndrome of abrupt onset (fulminant explosive), characterized
by progressively severe encephalopathy occurring within 7–14
days of the onset of jaundice. FHF is the result of massive
hepatocellular necrosis, i.e. death of the liver parenchyma, or
other severe functional impairment. : In the UK hyper-acute presentations
are almost exclusively related to paracetamol toxicity, contributing stimuli such
as ischaemic insults, viral pathogens and toxins have been
identified.
34. Acute: In acute hepatic failure encephalopathy occurs within
14–28 days of the onset of jaundice
This type of presentation is commonly seen with viral aetiologies (e.g.
Hepatitis B).
It is associated with a moderate spontaneous survival rate but a
slightly higher rate of transplantation when compared to
hyperacute presentations.
35. Subacute: Subacute hepatic failure is defined as acute failure occurring in
patients without preexisting liver disease, in whom the signs of encephalopathy
develop more than 8 weeks after the onset of illness. These patients are
generally older than those with FHF and tend not to have viral hepatitis.
Survivors may have autoimmune hepatitis.A protracted course of acute liver
failure is associated with a significantly higher mortality and the aetiology is
often more frequently non-paracetamol drug-related.This type of presentation
is difficult to distinguish from acute on chronic liver failure so a careful
36. Diagnosis
The diagnosis of ALF is made with reference to the specific criteria
listed below.
However, the clinical picture is dominated by coagulopathy and
encephalopathy.
1. Absence of chronic liver disease
2. Acute hepatitis (elevation in AST/ALT) accompanied by
elevation in INR >1.5
3. Any degree of mental alteration (encephalopathy)
4. Illness less than 26 weeks duration
37. Investigations
Serum biochemistry
(AST) and (ALT) will be acutely elevated reflecting hepatocellular damage.
Serum bilirubin will also be elevated with levels exceeding
300 µmol/l indicating severe disease.
Serum albumin a poor marker of acute hepatic failure.
Renal failure often accompanies ALF and the patient’s initial
presentation
be that of an acute kidney injury (AKI).
hypoglycaemia,
hyponatraemia
metabolic acidosis.
38. A deranged prothrombin time is used in the
diagnosis of ALF
It is also used as a prognostic indicator for the
consideration of liver transplantation
Coagulation
39. hepatic Doppler ultrasound to exclude chronic
liver disease in the form of
varices or a nodular liver.
This technique can also assess for intra-
abdominal malignancy, which is a
contraindication to liver transplantation.
Hepatic vein patency is also assessed
to exclude Budd-Chiari syndrome.
Radiology
40. Histological data is unlikely to change the therapy
being provided
it may provide information about specific viral
aetiologies or information
that would preclude a liver transplant e.g. metastatic
malignancy or
lymphoma.
Has to be balanced against the risk of performing
such a procedure in
these coagulopathic patients
Liver Biopsy
41. Management
FHF due to paracetamol (acetaminophen) overdose,
gastric aspiration and absorption with activated charcoal is
carried out if ingestion occurred within 2 h of hospital
admission.
1. IV infusion of N-acetylcysteine (NAC) in 5% glucose
2. Oral methionine is also used if appropriate facilities for
infusion are not available.
3. Methionine must be used with care in patients with
known hepatic impairment, because it may precipitate
coma
42. NAC protects the liver against the depletion of glutathione by the reactive
metabolite N-acetylbenzoquinoneimine (NBQ).
If NAC is not used, hepatic glutathione is exhausted and the NBQ then reacts with
hepatic intracellular protein sulphydryl groups, causing hepatocellular necrosis.
NAC also acts as a cardiac inotrope, increasing peripheral blood flow and oxygen
extraction, and may potentiate vasodilatation due to endothelium-derived
relaxing factor (EDRF, nitric oxide), thus increasing hepatic and cerebral blood
flow.
Prophylactic parenteral H2-RAs reduce the incidence of gastro-oesophageal
bleeding, but regrettably have little influence on mortality
43. Over-dosage with the popular combination analgesic co-
proxamol (paracetamol + dextropropoxyphene) poses a greater
risk than does plain paracetamol, because dextropropoxyphene
causes CNS depression and inhibition of liver enzymes.
Dextropropoxyphene is a mild opioid, so naloxone is required
as an opioid antidote in addition to NAC, and ventilatory
support may be needed.
44. Management
Neurological-ALF and cerebral oedema
Metabolising ammonia, a by-product of normal protein metabolism to
a less toxic compound urea would be prevented.
Glutamine synthase
urea ====-glutamine
accumulation of glutamine within cerebral astrocytes.
The astrocytes subsequently swell secondary to this cerebral
osmotic disturbance leading to cerebral oedema and intracranial
hypertension.
45. Inflammatory mediators
Disrupted cerebral auto-regulation, resulting in
increased cerebral blood flow, are contributing
factors
Ammonia levels - prognostic marker in ALF
46. Simple neuro-protective measures
should be implemented
Elevate head to 30 degrees to improve cerebral
perfusion pressure (CPP)
The patient should be appropriately sedated to
prevent stimuli from rising intracranial pressure.
Avoid hypotension. This may require use of
vasoactive drugs
Prevent hypoxaemia
Tight glycaemic control with blood glucose target
between 4 and 10 mmol/L
47. Mannitol
hypertonic saline-- 1-2ml/kg of 5% Saline may be given, ideally via a
central line, targeting a serum sodium concentration of
between 145-155 mmol/l
48. Hepatic encephalopathy
As the clinical course of ALF progresses, hepatic
feature.
encephalopathy becomes the predominant
, hepatic encephalopathy is a clinical diagnosis and is graded
Grades of Encephalopathy
Altered mood, impaired concentration
Grade
Grade
Grade
Grade
1
2
3
4
and psychomotor function, rousable
Drowsy, inappropriate behaviour, able to talk
Very drowsy, disorientated, agitated, aggressive
Coma, may respond to painful stimuli
49.
50. grade 3 encephalopathy or above will require sedation and mechanical
ventilation for airway protection..
51. . Mechanical ventilation
Facilitates the use of sedation and analgesia
Reduce cerebral metabolic demand and cerebral blood flow
Minimising intracranial pressure rises associated with agitation and painful stimuli.
52. Respiratory
Grade 3 or 4 encephalopathy
order to protect the airway
- Indication for intubation and ventilation in
Complications of liver disease,
Intra-abdominal hypertension (IAH) secondary to bowel oedema or ascites,
pleural effusions,
acute lung injury and acute respiratory distress syndrome
compromise a patient’s respiratory function and
may lead to the requirement for ventilatory support
53. Mechanical ventilation are at risk of ventilator acquired pneumonia.
immune compromise associated with ALF. Due to the inability to mobilise
cellular components of the immune system and a diminished acute phase and
complement response.
High levels of (PEEP) should be avoided if possible because they may
increase hepatic venous pressure and ICP.
54. Cardiovascular
The majority are intravascularly
insensible losses,
vomiting and
reduced oral intake.
depleted secondary to a combination of
Reduced systemic vascular resistance is characteristic in ALF. This may result
hepatic hypoperfusion despite a sometimes elevated cardiac output.
profound hyperlactataemia
in
55. Fluid resuscitation is an important early management step.
No definitive guidance exists for the type of fluid to be utilised,.
Avoid Hartmann’s or lactated Ringer’s.
5% Dextrose solutions lack suitable volume expanding properties and result in
hyponatraemia that can worsen cerebral oedema.
Hypotension that persists despite fluid resuscitation require inotropic support.
For reduced systemic vascular resistance vasopressors such as norepinephrine, dopamine
or vasopressin can be used.
56. Renal
Acute kidney injury (AKI) is common
with paracetamol toxicity.
AKI can be secondary to
Direct nephrotoxic effects of drugs
Raised intraabdominal pressure,
Hepatorenal syndrome
in the setting of ALF, especially if associated
Acute tubular necrosis (ATN) due to profound hypovolaemia and hypotension
57. Renal replacement therapy (RRT) should be provided early
To prevent worsening acidosis and fluid overload.
Continuous veno-venous haemodialysis (CVVHD) is preferred over
Haemodialysis due to the associated haemodynamic instability
58. Hepato-renal syndrome
The progressive rise in cardiac output and reduction in SVR results in
reduced total vascular resistance and, ultimately, a decline in renal
perfusion.
The end result is reduced glomerular filtration rate (GFR) and sodium
excretion.
The pathological basis associated with the accumulation of vasoactive
substances such as endotoxin, which are usually cleared in the liver.
Hepato-renal syndrome is a condition that is often irreversible and may
rapidly fatal.
be
59. Nutrition
ALF is a catabolic
feasibly possible.
state and nutritional support should be instigated as soon as
Enteral and parenteral routes are both accepted methods of delivery.
Protein intake should not be restricted
Dietary laxatives (e.g. lactulose) should be administered to speed the evacuation
nitrogenous waste.
Due to the loss of hepatic glycogen stores with diminished gluconeogenesis and
hyperinsulinaemia, hypoglycaemia often complicates ALF.
Infusion of 10% Dextrose solutions may be required,
Target blood glucose above 3.5mmol/l is
of
60. Infection
Prone to Gram negative and Gram positive bacteria and fungi infections.
Patients being considered for liver transplantation may benefit from
prophylactic antibiotics because sepsis can prevent the proposed procedure.
61. Coagulation
The liver synthesises all the coagulation factors apart from factor VIII.
Deficient protein C and anti thrombin III and coexistent sepsis causes severe
coagulopathy.
The routine use of fresh frozen plasma (FFP) to correct coagulopathies should be
discouraged.
FFP will mask the trends in the prothrombin time that can be used as a prognostic
marker.
Thrombocytopenia should also not be routinely corrected.
62. N-acetylcysteine
N-acetylcysteine (NAC) is a proven effective therapy for paracetamol
hepatotoxicity and should be administered as soon as possible following
the overdose as guided by treatment nomograms.
NAC should be administered in all cases of ALF, especially where the
underlying aetiology is unclear.
However, survival benefits have only been shown in paracetamol related
hepatotoxicity.
63. Liver Transplantation
The only effective therapy for ALF patients
spontaneously.
who fail to recover
the Kings College Hospital Criteria is probably the most widely
the most diagnostic accuracy.
Contraindications to liver transplantation include
used with
irreversible brain damage,
Accelerating inotrope requirements,
Uncontrolled sepsis and severe respiratory failure.
64. Table 4: Kings College Hospital criteria for liver transplantation in acute liver failure
Paracetamol (acetaminophen) overdose
• pH <7.3 (irrespective ofencephalopathy)
Or all of the following:
•
•
•
Grade Ill-IV encephalopathy
Creatinine >300umol/litre
Prothrombin time>100 seconds (INR >6.5)
Non-paracetamol aetiology
• Prothrombin time >100 seconds
Or any 3 of the following:
•
•
•
•
•
Age <10 years or >40 years
Prothrombin time >SO seconds
Bilirubin >300umol/litre
Time from jaundice to encephalopathy >2 days
Non-A, non-B hepatitis, halothane or drug-induced acute liver failure
66. A consequence of CLD
Characterized by replacement of
tissue by fibrosis & regenerative
nodules
Leads to irreversible loss of liver
function & its complications
Micronodular- alcohol or
liver
Macronodular- chronic viral hepatitis
Cirrhosis
67. CLINICAL PRESENTATION
Cirrhotic patients may present in a variety of ways, from asymptomatic patients with abnormal
laboratory tests noted on routine blood tests to acute life-threatening hemorrhage in an
emergency room.
71. Based on Child-Turcotte-Pugh scoring
system
Includes- each given
Ascitis
Encephalopathy
Bilirubin
Albumon
PT/INR
score of 1-3
Class-
A- 5-6
B- 7-9
C- 10-15
total score
Staging of CLD
82. Varices- dilated submucosal veins,
esophagus or stomach
Cause- portal HT
in
Causes ~80% of UGI bleed
Risk factors for bleed-
Size of varices
Severity of liver disease
Continued alcohol intake
in CLD
UGIE- wale markings, hematocystic/red spots on
Dx- EGD/UGIE
varix
Variceal bleed
83.
84. Acute-
Resuscitation
FFP, platelets,
Prevent rebleed-
Band ligation- over repeated
sessions
Non-selective β- blockers-
Propanolol/Nadolol
TIPS- for recurrent bleed or
bleed from gastric varices
Surgery- portosystemic
shunts
Liver transplantation
vit. K
Terlipressin/octreotide
Lactulose
UGIE
Banding/sclerotherapy
Balloon
TIPS
Surgery
tamponade
Management
85.
86. Confusiondrowsinessstuporcoma
Ammonia is an identified/measurable
Precipitants-
GI bleed
Constipation
Alkalosis, hypokalemia
Sedatives
Paracentesishypovolemia
Infection
TIPS
Dx- clinical- s/s of CLD
toxin
with asterixis & altered sensorium
Hepatic encephalopathy
87. Correct underlying precipitating factor
Avoid sedatives
Restrict dietary protein intake
Lactulose- 2-3 loose stools a day
Oral antibiotic- Metronidazole,
Rifaximin, Neomycin
Management
88. Occurs in patients with advanced CLD &
ascitis
Marked by renal impairment in the absence
any renal parenchymal disease or shock
Oliguria, hyponatremia & low urinary Na
accompany raised creatinine
Albumin infusion, with vasoconstrictors
(norepinephrine, terlipressin/ornipressin,
octreotide) may help
Liver transplantation is Rx of choice
of
Hepatorenal syndrome
89. Associated with cirrhosis in ~80%
Suspect if- worsening of CLD, enlarged
hemorrhagic ascitis, weight loss
Dx-
CT/MRI with contrast- vascular SOL in cirrhotic liver
Raised AFP- α-fetoprotein
Liver biopsy
Rx-
Early-resection
liver,
Advanced- liver transplantation or local palliative treatment
Screening- US & AFP every 6 months
Hepatocellular carcinoma
91. There are no laboratory or radiographic tests of hepatic function despite the commonly
ordered liver function tests. These commonly measured markers are substances produced
by the liver and released into the bloodstream during hepatocellular injury, and are more
correctly termed liver dysfunction tests.
True liver function tests that assess the ability of the liver to eliminate substances that
undergo hepatic metabolism, such as the 14C-aminopyrine breath test, are limited by
complexity and availability.
LIVER FUNCTION TESTS