o Rapid regeneration will have low Phosphate levels Viral serologies o

O rapid regeneration will have low phosphate levels

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o Rapid regeneration will have low Phosphate levels Viral serologies o Determine type of hepatitis ANA/immunoglobulin o Autoimmune hepatitis Acetaminophen levels o Important baseline information Urine Drug Screens o Acknowledge type of hepato-toxic drug Imaging Studies o Liver ultrasound Hepatic vein patency and flow indicator o CT or MRI of liver Help exclude intraabdominal processes especially with ascites and if patient is obese Contrast may compromise renal function so consideration is great o CT head Cerebral edema and exclude intracranial mass or lesions that may mimic edema Let’s us know what phase they are in Shows if any mass or lesions are there causing the secondary acute liver failure Other tests o EEG With encephalopathy if seizures must be excluded o Liver biopsy Contraindicated in PT/INR is elevated The reason being is because they can’t stop the bleeding Consider transjugular biopsy o ICP monitoring
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Peritonitis/Liver Failure 8 Monitor very closely because of the edema and encephalopathy Read up on this and how you need to level your transducer and where it’s located Value in guiding management Extradural catheters are safer Intradural catheters are more accurate Management Key is recognition of acute liver failure and aggressive intervention! Admit to ICU Hallmark of Management o Support all of the presentation symptoms discussed o Monitor indications for feasibility of Liver transplant Treatment o Oral Lactulose therapy with administration of Neomycin IV (Gentamicin) enterally With mushrooms, treat with Penicillin G With acute liver failure because of the ammonia level we are going to give them oral lactulose down the NG tube because we won’t be feeding them. Lactulose can be given down NG tube depending on patient LOC o The 2 major things we will treat these people with are laculose and neomycin o Enteral neomycin for hepatic coma 4-12 g/day divided in 4-6 doses Peritoneal Aspiration o Have patient empty bladder before procedure o Sit up at bedside with feet on stool to support self o Set up peritoneal lavage tray Event though it says lavage you don’t have to wash it with anything, you can drain it with the same kit o Monitor vital signs (have BP cuff on patient at all times) Plasmapheresis (plasma exchange) o When we need to go in there and take the copper out to clean the blood o To correct coagulation and stabilize patient until liver transplant Antidotes for certain conditions o Tylenol Overdose (N-acetylcysteine – mucomyst) o Mushroom poisoning (Penicillin-G) Prostaglandin therapy: o To enhance hepatic blood flow Liver assist devices o Rarely used, but know them o Devices to provide bridge to transplantation o Extracorporeal liver assist device (ELAD) exposes whole blood to human hepatoblastoma cells to remove toxins o Bio-artifical liver (BAL) removes substances toxic to heptocytes
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  • Spring '14
  • ClaudiaG.Hebert
  • Peritoneal cavity, acute liver failure, fulminant hepatic failure, Peritonitis/Liver Failure

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