Pathophysiology of Hepatic Failure

Posted by e-Medical PPT
Hepatic insufficiency
Process characterized by restriction, suppression or failure of hepatic function which is manifested by homeostatic imbalance in the functions provided by the liver cells.
Manifestation of the failure is present when the hepatic cells are required to provide more  „metabolic work“. In basal conditions The failure could not be necessarily manifested.

Acute failure - per acute / fulminant course of hepatitis, toxic injury
Chronic failure – cirrhosis

Exogenous failure  - induced or provoked by external noxas, like alcohol, GUT bleeding, drugs, increased protein in take

Endogenous failure – as a natural consequence of internal hepatic disease /consequence of hepatitis,  biliar cirrhosis... /

Hepatorenal syndrome
functional acute renal failure which is present in patients suffering from severe hepatic diseases followed by ascites and by changes in systemic circulation

increased stimulation of RAA  -  impairment of renal regional circulation
decrease of glomerular filtration
extreme retention of Na and fluids in the body
decreased water elimination

Clinical course of renal failure copy the clinical course of hepatic failure, if liver is being „better“ the kidneys are better too, a vice versa

Portal hypertension
Long lasting increase of blood pressure in v. portae , more than 5-15 mmHg
Pre hepatic portal hypertension
Causes:obliteration of v. porte, v. lienalis (infection, trauma,
  thrombosis, tumor invasion)
Hepatic portal hypertension
Causes:cirrhosis of the liver (alcohol, biliar cirrhosis, hemo-
  chromatosis, Wilson's disease)
- myeloproliferat. diseases (liver and spleen)
- m. Hodgkin, leukemia (infiltration of  peri portal fields)
- sarcoidosis – pathogenesis unknown
- alcohol induced hepatopathy without cirrhosis
- metastasis of tumors
- cystic diseased of the liver

Post hepatic portal hypertension
block of hepatic veins or VCI (Budd - Chiari sy.)
extra hepatic causes (constrictive pericarditis, severe heart failure)..

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