Liver cell Failure

Liver cell failure:Y

1- acute: Develop within less than 8 weeks in patients without preexisting liver disease and is fatal

2- chronic: Complicate all forms of liver diseases e.g cirrhosis.

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Presentation

1. Jaundice: Hepatocelluar jaundice.
2. Hypoproteinaemia: due to decreased formation of plasma proteins. Contributes in generalized edema formation and ascites.
3. Vitamin deficiency: Vit. A, K, B12, folic acid.
4. Coagulation defect: due deficiency of fibrinogen, factors V, VII, IX, X.
5. Anemia: due to repeated hemorrhage, hypersplenism, B12 and folic acid deficiency.
6. Hypoglycemia: due to defects in carbohydrate metabolism.
7. Hormone disturbances: Increased serum aldosterone leads: to salt & water retention. Increased estrogen leads to:
   • Gynaecomastia.
   • Hypogonadism (testicular atrophy and loss of libido in males).
   • Menstrual disturbances in females.
   • Palmer erythema (local vasodilation).
   • Spider angiomas of skin: Each angioma is a central, pulsating, dilated arteriole from which small vessels radiate

8. Ascites:

• Accumulation of transudate inside the peritoneal cavity.
• Becomes clinically detectable when it reaches at least 500 ml.
• Due to salt & water retention, portal hypertension and hypoproteinaemia.

9. Hepatic encephalopathy: Neurological disturbances (apathy, disorientation, asterixis i.e. flapping tremors and coma) due to toxic amonia which are formed in intestine and not detoxified in liver so pass directly to brain.

10. Foetor hepaticus: A characteristic bad (musty) odor smelled from the body and mouth of the patients due to formation of mercaptans by the action of gastrointestinal bacteria on the sulfur-containing amino acid methionine.