Liver Failure

Introduction

Liver failure results from inadequate liver function. It occurs even though the liver has a large functional reserve and a high regenerative capacity.

Causes

Low Liver Mass

With 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/Many of its Diverse Functions

1) 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

2) 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