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21 Cards in this Set

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who generally has a better prognosis for fulminant liver disease?
those with acetominophen overdoses or infected with hepatitis A or B
what is the short term survival rate in a coma without liver transplantation?
20%
why do patients without a liver transplant have a good prognosis?
because their liver will regernerate anyway
what is the 1 year survival rate after liver transplant?
80-90%
why do you need a high index of suspicion with fulminant liver disease patients developing an infection?
because they may present without fever or leukocytosis because they're too sick
what will lactulose do?
treats encephalopathy because it can create an acidic pH to favor the conversion and excretion of ammonia
what will the blood gas levels be in encephalopathy?
decreased pO2 and increased pCO2
what is the first and most dramatic sign of liver failure?
encephalopathy
when will encephalopathy improve?
often only when liver function improves
what are two potentially treatable causes of coma?
hypoglycemia
cerebral edema
how should you treat coagulopathy and GI hemorrhage?
vitamin K
fresh frozen plasma if actively bleeding
how do you want to ventilate these patients?
hyperventilate to decrease ICP
how does mannitol work and what is it used for?
used to decrease ICP
changes the osmotic gradient and draws water out of the brain
what is the pathway to death? (4)
cerebral edema --> increased ICP --> brain herniation and death OR coma
why is cerebral edema tough to diagnose?
it is difficult to distinguish from hepatic encephalopathy and CT is often unreliable
what causes cerebral edema and encephalopathy? (3)
build up of toxic substances in the brain
auto-regulation of blood flow is impaired
neuronal cells swell up, leading to increased ICP
what happens to hepatic blood flow?
extrahepatic shunting of portal venous blood results in failure to detoxify substances leading to metabolic abnormalities in the CNS
what is the toxic dose of acetominophen and how do you treat it?
4g
treat with N-acetyl-p-benzoquinoneimine
what is most often incriminated in fulminant failure?
ammonia, especially in association with alcohol
what is the development of encephalopathy in patients between 8-24 weeks after the onset of jaundice?
late onset hepatic failure
what is the definition of fulminant liver failure?
onset of encephalopathy occuring within 8 weeks of the onset of jaundice in a patient with hepatic injury and no prior history of disease