Complications of Liver Failure: A Case Study

Posted on Oct 7, 2024 in Biology

Clinical Situation 4: Liver Failure Case Study

77-Year-Old Male with Aggravated Liver Failure

Background:

  • Liver failure from cirrhosis of enolic origin.
  • Upper gastrointestinal bleeding from esophageal varices 2 months ago.
  • Poorly controlled type 2 diabetes mellitus.

Evolution (Day 2 of Admission):

  • Drowsiness and confusion, disorientation in space and time, not recognizing family members.
  • Prostrate, remains in bed all day but moves independently within the bed.
  • Increased waist circumference (2.5 cm from admission) with pitting edema in lower limbs.
  • Left foot little finger injury (approximately 2 weeks old) with slow healing, redness, and fibrotic material, reported as caused by landscaping.
  • Bleeding from the intravenous puncture site requiring multiple dressing changes.
  • Quick Time: 67%.

Neurological Complications and Monitoring

Hepatic Encephalopathy:

The liver’s impaired function leads to ammonia build-up in the blood, affecting the central nervous system. Hepatic encephalopathy progresses through stages:

  • Initial Phase: Emotional lability (lethargy/euphoria), motor impairment (asterixis), altered sleep pattern, difficulty writing.
  • Mild Phase: Drowsiness, stupor, agitation, disorientation, asterixis, liver odor (fetor hepaticus).
  • Serious Phase: Sustained shock, difficulty waking up, confusion, incoherent speech, limb stiffness, asterixis.
  • Hepatic Coma: Response only to strong stimuli or unresponsiveness, absence of asterixis, flaccidity of extremities, absent deep tendon reflexes.

Prevention of Hepatic Encephalopathy:

  • Diet: High carbohydrates, low protein (less than 20g/day), fiber to prevent constipation.
  • Medication: Lactulose (oral and rectal) to accelerate intestinal transit and reduce ammonia absorption. Neomycin may be used to reduce bacterial flora if lactulose causes diarrhea.

Quick Time and Coagulation Disorder

Quick Time (Prothrombin Time):

Reflects coagulation status. Normal values: 80-100%. Lower values indicate bleeding risk.

Liver Failure and Coagulation:

Liver failure impairs protein synthesis (albumin, coagulation factors), increasing bleeding risk. Portal hypertension leads to varicose vessels (esophageal varices, hemorrhoids) due to circulatory congestion, further increasing bleeding risk.

Prioritized Complications

  1. Gastrointestinal Bleeding: History of esophageal varices, low Quick Time (67%), and current bleeding from the puncture site indicate high risk.
  2. Foot Ulcer Infection: Liver failure impairs phagocytosis, increasing infection risk. Diabetes further compromises wound healing and increases infection susceptibility.

Other Potential Complications (Insufficient Data):

  • Hypovolemia secondary to ascites and hypoalbuminemia.
  • Respiratory failure due to ascites and pleural effusion.