Liver Failure
A 47-ycar-old man is admitted with a 3-day history of shortness of breath, increased confusion, nausea, and weakness. He has a history of upper GI bleeding from esophageal and gastric varices and was recently hospitalized for refractory ascites. He is diagnosed with liver failure due to alcohol abuse and is severely malnourished. Significant findings on his admission profile were;
History
Complaints of decreased appetite for the past 2 months; also
complaints of nausea and weakness.
Vital Signs
Cardiopulmonary
• Dyspneic; using accessory muscles
• Cracklesatthebasesandcoarserhonchithroughoutalllung fields
• S/54; no murmurs
• Extremities cool, weak pulses
• 4+ pitting edema lower extremities
Nturologic
• Alert, but disoriented to time and place
• Irritable
Ahdomm
• Tense ascites, dull to percussion
• Hyperactive BSs in all four quadrants
Geni/rJurinary
• Urine dark, amber, and cloudy (0.3 mL/kg/h via urinary catheter)
• Large hemorrhoid protruding from rectal vault
• Liquid stool; black; guaiac positive Lahfffa/rJry Data
Arterial blood gases on 2 L 02
per nasal cannula
Urine electrolytes
Which complication of liver failure is this patient experiencing which contn'"butea to a high risk of mortality?
(A) Hepatorcnal syndrome
(B) GI bleeding
(C) Hepatic encephalopathy
(D) Ascites
Which factor/a contribute/a to malnutrition in the patient with liver failure?
(A) Decreased oral intake
(B) Altered metabolism and storage of nutrients
{C) Altered mental status
(D) All of the above