• this results from inadequate liver function
  • occurs even though the liver has a large functional reserve and a high regenerative capacity

Causes

  • low liver mass
    • the functional reserve is depleted

NB: liver enzyme levels in blood may not be markedly raised in chronic ongoing liver damage because there may be few liver cells remaining to leak enyzmes

  • remodelling of the vascular and connective components after damage
    • this may lead to inadequate nutritional supply to the hepatocytes, thus reducing their function
  • impaired function of one specific or many of its diverse functions
    • eg failure of detoxification
      • aldosterone - a failure of its proper inactivation results in hypervolaemia since a feature of this hormone is to cause sodium and hence water rentention
        • this is a factor in the development of ascites
      • oestrogen - a failure of its proper inactivation will result in an accumulation of this hormone with atrophy of the genitals and an enlargement of the breasts in the male
      • plant pigments - failure to detoxify will lead to their accumulation in the tissues and photosenistisation may result if they are photodynamic
    • eg metabolic upset
      • the failing liver is unable to convert ammonia to urea, resulting in a rise in the level of blood ammonia
      • lowered level of plasma albumin contributes to the development of ascites

Syndromes in liver failure

Icterus

Photosensitisation

Hepatic Encephalopathy

Bleeding Tendencies

Hypoalbuminaemia