Liver: failure

Introduction

• Cause : loss of 70% or more of functional hepatic mass due to chronic disease, or acute overwhelming insults, eg toxins, infection.
• Signs : anorexia, depression, vomiting, diarrhea, jaundice, hepatic encephalopathy.
• Diagnosis : histopathology, blood biochemistry and liver function tests; determination of inciting cause.
• Treatment : supportive, eg fluid therapy; depends on cause.
• Prognosis : depends on cause - liver has powerful regenerative capacity.

Diagnosis

Clinical signs

• Icterus.
• Hepatomegaly (or small liver if chronic).
• Pain on palpation of liver.

• Ascites.
• Hypersalivation and/or neurological signs, (hepatic encephalopathy).
• Bilirubinuria.
• Extrahepatic signs suggestive of cause.

• Bleeding diathesis, eg petechial hemorrhages in skin and mucous membranes.
• Gastrointestinal bleeding, eg melena, hematemesis.

Diagnosis

Differential diagnosis

• Causes of acute hepatic disease    .
• Causes of chronic hepatic disease    .

• Causes of secondary increases in hepatic enzymes:
  • Hyperthyroidism    .
  • Anemia    .
  • Right sided heart failure    .
• Other causes of jaundice, eg hemolysis    .
• Other causes of ascites:
  • Neoplasia.
  • Protein-losing enteropathy    , or nephropathy    .
  • Heart failure    .
  • Other abdominal fluids, eg chyloabdomen, hemoabdomen, pus.