Cirrhosis

Homework?

AST/ALT: measurement of hepatocytes destruction, so usually elevated but may be normal or high normal if inflammatory process in liver is supressed as result of treatment or natural remission. ETOH abusers with proven cyrrhosis may have normal ALT if they keep sober, with elevated AST.

PT: elevated (vitamin K dependent intrinsic pathway).

PTT: norm (extrinsic pathway, has nothing to do with liver)

Funny thing to know: vitamin K is not effective for patients with significantly decreased liver functions, ad it has nowhere to work. Fresh frozen plasma is the only alternative. It is a NCLEX-RN question.

Hb:frequently low as well as RBC count, for many reasons: inflammation supresses bone marrow ptoduction, heme/iron metabolism alteration (ferritin and transferrin are synthesized in liver), malnutrition, erythropoetic factor (s) deficiency due to concurrent renal/lung disease.

Platelets: often elevated, non-specific marker of inflammation; also, functional deficiency of platelets as serum protein composition is severely altered in case of cyrrhosis.

Potassium: most commonly elevated, because:

- massive third spacing of fluid due to hypoalbuminemia, loss of serum oncotic pressure and development of edema and ascitis.

- potassium sparing diuretics

- hypoaldosteronism as a body's natural potassium sparing mechanism

- metabolic acidosis

- insulin resistancy, decreasing potassium entrance in cells

- overconsumption in protein and sodium restricted diet

- there are some more causes of that but tge above are the main ones

Funny fact to know: hypokaliemia drastically increases ammonia production, as in attempt to get potassium ions corticosteroids move metabolism of skeletal muscle to catabolic values. Potassium comes out of muscle, but so do protein catabolism products and impaired liver cannot manage this load. The favorite treatment of albumin and lasix can, therefore, provoke encephalopathy (and it often does).

It is the the whole lot more interesting and complicated than "liver clots the blood", yea 'now

KatieMI, you just made my geeky heart squeal!