Liver Failure

• 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