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liver (hepatic) failure/insufficiency
Etiology:
- hepatic cirrhosis is the classic example
Pathology:
- inability of the liver to produce sufficient proteins for normal homeostatic metabolic processes, including:
a) osmotic pressure (albumin)
b) coagulation
c) drug metabolism
Laboratory:
1) serum transaminases may be normal
2) serum cholesterol is generally low
3) INR is elevated
4) serum albumin is generally low
5) platelet count: thrombocytopenia
6) prothrombin time & aPTT may be prolonged
7) factor VIII activity may be elevated
Special laboratory:
- abdominal ultrasound of liver & spleen
Management:
- decrease protein intake to < 1 g/kg/day only if hepatic encephalopathy is present
- fresh frozen plasma corrects coagulopathy
a) short 1/2life of factor VII limits duration of effect
b) also administer vitamin K [1]
- liver transplantation, see cirrhosis
Specific
acute liver failure (ALF)
cirrhosis
hepatic encephalopathy
General
liver disease
References
- Medical Knowledge Self Assessment Program (MKSAP) 15,16,17
American College of Physicians, Philadelphia 2009,2012,2015