Liver: failure
Introduction
- Cause: loss of 70% or more of functional hepatic mass due to chronic disease, or acute overwhelming insults, eg toxins, infection.
- Signs: anorexia, depression, vomiting, diarrhea, jaundice, hepatic encephalopathy.
- Diagnosis: histopathology, blood biochemistry and liver function tests; determination of inciting cause.
- Treatment: supportive, eg fluid therapy; depends on cause.
- Prognosis: depends on cause - liver has powerful regenerative capacity.
Special risks
- Increased risk with anesthesia as many commonly used drugs are metabolized in liver.
Warn owner of risks associated with anesthesia.
Pathogenesis
Etiology
- Acute hepatic disease Liver: acute disease.
- Chronic hepatic disease Liver: chronic disease.
Pathophysiology
- Loss of hepatic function →
- Impaired fat digestion and metabolism and increased mobilization from peripheral stores → hyperlipidemia.
- Impaired carbohydrate metabolism → hypoglycemia or hyperglycemia.
- Impaired protein synthesis → catabolism of body protein → increased ammonia levels and cachexia.
- Loss of detoxifying capacity and development of arteriovenous shunts → hepatic encephalopathy.
- Altered metabolism of hormones → disrupted circulating hormonal levels, eg insulin, glucagon, growth hormone, insulin-like growth factors, corticosteroids, catecholamines → polydipsia/polyuria (due to increased corticosteroids in liver failure), fluid retention.
- Decreased synthesis of clotting proteins (plus vitamin K deficiency due to anorexia and fat maldigestion due to lack of bile acids) → coagulation disorders.
- Loss of detoxifying capacity and development of arteriovenous shunts → hepatic encephalopathy.
- Acute fulminating liver failure → release of tissue thromboplastins and other stimulators of coagulation → DIC.
- Portal hypertension +/- concurrent hypoalbuminemia → ascites.
- Jaundice develops as result of failure of the hepatocytes to remove unconjugated bilirubin from circulation.
- In the normal animal this unconjugated bilirubin is conjugated with glucoronic acid which is excreted in the bile.
- Accumulation of bilirubin in the tissue results in yellow discoloration.
Timecourse
- Depends on underlying hepatic disease.
Diagnosis
Subscribe To View
This article is available to subscribers.
Try a free trial today or contact us for more information.
Treatment
Subscribe To View
This article is available to subscribers.
Try a free trial today or contact us for more information.
Prevention
Subscribe To View
This article is available to subscribers.
Try a free trial today or contact us for more information.
Outcomes
Subscribe To View
This article is available to subscribers.
Try a free trial today or contact us for more information.