My Hepatic Notes

I'll add the rest later, this is just the beginning...

Liver Anatomy

Blood Supply

Hepatic Artery (25% of blood supply)
Portal Vein - direct from GI system
Sinusoids - capillary beds where arterial & venous blood mix
Kupffer's Cells - cleans the blood
Hepatic Vein - purified blood leaves the liver and flows into the inferior vena cava

Liver Function

Cleaning - bacteria removal & detoxification/excretion of ETOH & drugs
Storage - fat soluable vitamins (A, D, E, K), water soluable vitamins (B12), iron, copper, and glycogen for energy
Manufacturing - Bile (Bile salts & conjugated bilirubin), Albumin (oncotic pressure), and most coagulation factors

Liver Failure

Categories

Hepatocellular - viral hepatitis, ETOH, drugs
Cholestatic - destructive (gallstones)

Classifications

Acute - fullminant liver failure (within 8 weeks)
Chronic - ETOH & Viral
Acute on Chronic - Chronic failure w/ acute decline

S/S Liver Failure

Neuro - ranges from monotonous speech and drowsiness to coma

Hepatic Encephalopathy - liver's inability to break down ammonia (by-product of protein breakdown)
Asterixis - nonrhythmic flexion of hands and fingers when arms are extended

CV - dilated peripheral blood vessels

Increased cardiac output
Flushed extremities
Tachycardia
Bounding pulses
Hypotension

Hematologic - deficiency of coagulation factors

Petechiae
Occult Bleeding
Impaired Vitamin K absorption
Prolonged PT & INR
Anemia - blood loss, impaired RBC formation and increased destruction
Increased infections - resulting from poorly functioning Kupffers cells
Fluid Retention - decreased albumin

GI

Portal HTN - normal 5-10 mm Hg (HTN >10 mm Hg)

Collateral vessels form throughout the body leading to varices (esp esophagus, rectum, abdomen)

Can rupture - EMERGENCY!!!!

bright red blood from GI tract
Hypotention
Tachycardia
Cold, clammy skin
Bloody or black, tarry stools (melena)

Ascites - accumulation of fluid in peritoneal cavity caused by portal HTN, Sodium retention, and low albumin

Tight, shiny skin
Dyspnea
Percussion may yield a fluid wave

Fever - may indicate bacterial peritonitis

Clay-colored stools - caused by inability to conjugate bilirubin in GI tract
Fatty Stools - steatorrhea
Fetor hepaticus - sweet, fecal odor on breath

GU - excess bilirubin excreted by kidneys - urine turns a reddish-brown color

Low urine output
High BUN
High Serum Creatinine
Acute renal failure (hepatorenal syndrome)

Endocrine - endogenous steroids and sex hormones are not metabolized.

Men - breast enlargement, testicular atrophy, loss of body hair, decreased libido
Women - increased facial hair, smaller breasts, amenorrhea, decreased libido

Skin
Jaundice - yellow skin tone from unconjugated bilirubin
Pruritis - itching caused by accumulation of bile salts under the skin
Spider angiomas - vascular spider veins
Xanthomas - white fatty deposits around eyes