Liver failure:

Liver failure itself is not a disease but a consequences of many liver diseases which fails the liver.

Liver failure occurs in three clinical scenarios

1.      Acute liver failure

2.      Chronic liver failure

3.      Acute on chronic liver failure

ACUTE LIVER FAILURE:

DEFINITION:

Define as liver disease that produce hepatic encephalopathy within six months of diagnosis.

FULMINANT LIVER FAILURE:

When encephalopathy develops within 2 weeks of jaundice.

SUB-FULMINANT LIVER FAILURE:

When encephalopathy develops within 3 months of jaundice.

                                                                                                     

CAUSES:

1.acetoaminophnes [50% of cases]

2.Autoimmune  Disease

3.Hepatitis A,B,E

CLINICAL FEATURES:

·        TRANSAMINASE LEVELS are initially high but as liver distorts their level falls.

·        JAUNDICE due to retention of bilirubin.

·        HEPATIC ENCEPHALOPATHY

·        COAGULOPATHY formation of coagulation factors is decreased leading to easy bruising and bleeding.

·        INTRAVASCULAR COAGULATION it happens because liver is unable to remove activated coagulation factors.

·        PORTAL HYPERTENSION due to obstruction at pre hepatic ,post hepatic and intra hepatic levels.

·        HEPATORENAL SYNNDROME develops entirely due to liver failure and there is no problem in kidney at all but its consequences leads to kidney problem such as sodium retention ,free excretion of water etc.

CHRONIC LIVER FAILURE:

Cirrhosis is a morphological change associated with chronic liver disease

Cirrhosis leads to

·        Diffuse transformation[damage] of liver

·        Regenerative parenchymal nodules.

·        Fibrous bands

 

CAUSES:

1.Hepatitis Band C

2.Non alcoholic fatty liver disease

3.Alcoholic liver diseases

CLINICAL FEATURES:

·        JAUNDICE leads to pruritis

·        PORTAL HYPERTENTION

·        SPLENOMEGALY which leads to decrease platelets count due to sequesteration of these elements in expanded red pulp.

·        HYPERESTROGNEMIA due to impaired metabolism of estrogen in male patients and it causes palmer erythema ,spider angioma ,hypogonadism and gynecomastia.

·        HEPATOCEELULAR CARCINOMA ,chronic liver disease is a predisposing factor to hepatocellular carcinoma.

CRITERIA FOR DIAGNOSIS:

1.      LEBORATORY FINIDNIS ARE MAIN CRITERIA.

2.      PORTAL VENOUS WEDGE PRESSURE.

3.      LIVER BIOPSY.

ACUTE ON CHRONIC LIVER DISEASE:

After years of stable,well compensated chronic disease suddenly develops signs of liver failure[acute signs]