B56 Liver failure

Question 1

How much of the liver function is lsot before clinical hepatic failur occurs?

Answer 1

80-90%

Question 2

What are the 3 categories of hepatic failure?

Answer 2

Acute liver failure with massive necrosis - coagulative necrosis

• viral hepatitis
• drugs
• causes hepatic encephalopathy within 2-3 weeks
• if it lasts longer than 3 months, it is termed subacute

Chronic liver disease

• Primary parenchymal disease
• biliary disease
• Vascular disease
• All lead to eventual liver cirrhosis

Hepatic dysfunction without overt necrosis

• from acute mitochondrial injury - Reye syndrome
• Acute fatty liver in pregnancy
• Some drugs and toxins.

Question 3

Symptoms of liver failure

Answer 3

1. Jaundice
2. Cholestasis
   
   1. Fat malabsorption, vitamin deficiencies
3. Hypoalbuminemia
4. Hyperammonemia
5. Bleeding tendency
6. Toxin accumulation
   
   1. hepatorenal syndrome
   2. hepatic encephalopathy
   3. hepatopulmonary syndrome
   4. Fetor Hepatis - thiol breath
7. Ascites
8. Portal hypertension
   
   1. Hypersplenism
   2. Esophageal varicies, bleeding
9. Splenomegaly
10. Hyperestrogenemia,
    
    1. Gynecomastia and hypogonadism
11. Spider angiomas
12. Palmar erythema

Question 4

Life threatening consequences of liver failure

Answer 4

Hepatic encephalopathy

Hepatorenal syndrome

Bleeding tendency plus portal hypertension

Hepatopulmonary syndrome