Liver Failure

Steven Podnos MD

Acute vs. Chronic

• Acute: Shock liver, Hepatitis (infection, drugs)• Chronic-alcohol, viral hepatitis most common

Chronic Liver Failure

• Effects are both Functional and due to Plumbing issues

Chronic Liver Failure-Functional problems

• Clotting factor production drops-elevated PT, increase bleeding risks

• Encephalopathy-toxins, ? Ammonia• Poor drug metabolism

Chronic Liver Failure-Plumbing

• Portal Vein drains Gut. Liver scarring increases Portal venous pressure.

• Blood shunts to : Spleen and system venous anastomosis (anal, esophageal, skin). Results in spleenomegaly and platelet sequestration (low platelets), hemorrhoids and esophageal varices

GI Bleeding with Liver Failure

• Usual causes plus Esophageal Varices• Increase in coagulopathy-platelets and clotting

factors• Rx-early endoscopy, anti acid Rx,

Somatostatin, Blakemore tubes, Shunting, Hematologic support

Long term prevention of Variceal Bleeding

• Beta Blockers• Shunt