Hepatic Failure 2

Clinical features of hepatic failure

Chronic Liver Disease

the most common route to hepatic failure

the end stage of chronic liver disease is cirrhosis

Hepatic Dysfunction
without overt necrosis

Examples
are

Hepatocytes may be viable, yet are unable to perform normal
metabolic functions

Acute fatty liver of pregnancy

Tetracycline toxicity

Reye syndrome

Hypoglycemia Hypoglycemia because the glycolysis mainly occurs in the liver.

Jaundice Yellowish discoloration of the skin and the sclera First site

Clinical features of hepatic failure

Fetor hepaticus (musty” or “sweat & sour) bad breath smell due to Formation of mercaptans by action of GI bacteria on sulfur containing amino acid methionine & with P-S shunting to Lungs

Hyperammonemia because ammonia is detoxified mainly in the liver, when
the liver shutdown the ammonia will elevate

Hypoalbuminemia peripheral edema

Hyperestrogenemia  palmar erythema (local vasodilatation) + spider angioma

hypogonadism & gynecomastia in males

Complications of hepatic failure:

Ascites

Portal hypertension elevation of portal blood pressure above 12

Coagulopathy : impaired hepatic synthesis of clotting factors 10/9/7/2
Bleeding tendency & GI hemorrhage

Hepatic encephalopathy : Rigidity + hyper-reflexia + Asterixis (flapping tremor) + coma

Hepatorenal syndrome : Development of renal failure
without primary disease of kidney

Portopulmonay hypertension : might be due to reduced nitric oxide levels

Hepatopulmonary syndrome : hypoxia, dyspnea, and cyanosis

Multiple organ failure Bleeding tendency & GI hemorrhage

**Reye syndrome causes swelling in the liver and brain, which may lead to shutdown the liver affects children and young adults recovering from a viral infection , aspirin may trigger Reye's syndrome

accumulation of excessive fluid in the peritoneum cavity may reach 5-6 liters Because of hypoaglunemia so there will be different in the osmolarity