liver (hepatic) failure/insufficiency
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Etiology
- hepatic cirrhosis is the classic example
Pathology
- inability of the liver to produce sufficient proteins for normal homeostatic metabolic processes, including:
Laboratory
- serum transaminases may be normal
- serum cholesterol is generally low
- INR is elevated
- serum albumin is generally low
- platelet count: thrombocytopenia
- prothrombin time & aPTT may be prolonged
- factor VIII activity may be elevated
Diagnostic procedures
- abdominal ultrasound of liver & spleen
Management
- decrease protein intake to < 1 g/kg/day only if hepatic encephalopathy is present
- fresh frozen plasma corrects coagulopathy
- short 1/2life of factor VII limits duration of effect
- also administer vitamin K[1]
- liver transplantation, see cirrhosis