Hepatic come is due to the elevated plasma levels of?

DSSSB - 29 August 2019 (Shift-1)

Medical & Surgical Nursing

Easy

Appeared in: DSSSB - 29 August 2019 (Shift-1)

Explanation

Hepatic coma, or hepatic encephalopathy, is a neuropsychiatric syndrome caused by severe liver dysfunction.
The primary cause is the accumulation of neurotoxins in the blood, with ammonia being the most significant.
A failing liver cannot convert ammonia, a byproduct of protein metabolism in the gut, into urea for excretion.
This resulting hyperammonemia leads to ammonia crossing the blood-brain barrier, causing cerebral dysfunction, altered consciousness, and coma.

Option B: Elevated amylase levels are a primary diagnostic marker for acute pancreatitis, an inflammation of the pancreas, not for hepatic coma.
Option C: In severe liver disease, albumin levels are typically decreased (hypoalbuminemia), not elevated. The liver is the primary site of albumin synthesis, and its failure impairs production.
Option D: Adenosine is a nucleoside involved in cellular energy transfer (as part of ATP) and acts as a neurotransmitter. It is not the primary toxin that accumulates in liver failure to cause hepatic coma.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Pathophysiology of Hepatic Encephalopathy as background academic context rather than a clinical decision trigger.
Nurses must vigilantly monitor the neurological status of patients with liver disease for early signs of encephalopathy, such as changes in personality, sleep disturbances, confusion, or the characteristic flapping tremor known as asterixis.
Key nursing interventions for a patient with rising ammonia levels include administering prescribed medications like lactulose (to trap ammonia in the gut) and rifaximin (to reduce ammonia-producing gut bacteria), and potentially implementing a protein-restricted diet as ordered.
Patient safety is paramount. A patient with hepatic encephalopathy is at high risk for falls and injury due to confusion and altered motor control.

How to Approach the Question

First, identify the core of the question: what substance builds up to toxic levels and causes 'hepatic coma'?
Recall the main functions of the liver, particularly its role in detoxification and metabolism.
Think about what happens when the liver fails. It can no longer process waste products effectively.
Evaluate each option in the context of liver function:
Ammonia: A known neurotoxin produced from protein breakdown that the liver is responsible for clearing. A failing liver would lead to its accumulation.
Amylase: This enzyme is primarily associated with the pancreas.

Concept Tested & Keywords

QnplSUzkn-kWdJY5dr8Nza

E6 Nutrition Kumud Khanna 2e p. 278-280

E6 Textbook of Biochemistry for medical StudentsDM Vasudevan Part 1 (pp 26-370 of 370) p. 284-286

E6 Medicine Harrison 22e Part 2 p. 534-536