Hepatic Dysfunction
Hepatic
dysfunction results from damage to the liver’s parenchymal cells, either
directly from primary liver diseases or indirectly from obstruction of bile
flow or derangements of hepatic circulation. Liver dysfunction may be acute or
chronic; chronic dys-function is far more common than acute.
Chronic
liver disease, including cirrhosis,
is the seventh most common cause of death in the United States among young and
middle-aged adults. More than 40% of those deaths are associated with alcohol.
The rate of chronic liver disease for men is twice that for women, and chronic
liver disease is more common among African Americans than Caucasians.
Disease
processes that lead to hepatocellular dysfunction may be caused by infectious
agents such as bacteria and viruses and by anoxia, metabolic disorders, toxins
and medications, nutritional deficiencies, and hypersensitivity states. The
most common cause of parenchymal damage is malnutrition, especially that
related to alcoholism.
The
parenchymal cells respond to most noxious agents by re-placing glycogen with
lipids, producing fatty infiltration with or without cell death or necrosis.
This is commonly associated with inflammatory cell infiltration and growth of
fibrous tissue. Cell regeneration can occur if the disease process is not too
toxic to the cells. The result of chronic parenchymal disease is the shrunken,
fibrotic liver seen in cirrhosis.
The
consequences of liver disease are numerous and varied. Their ultimate effects
are often incapacitating or life-threatening, and their presence is ominous.
Treatment often is difficult. Among the most common and significant symptoms of
liver dis-ease are the following:
•
Jaundice, resulting from increased bilirubin
concentration in the blood
•
Portal hypertension, ascites, and varices,
resulting from circu-latory changes within the diseased liver and producing
severe GI hemorrhages and marked sodium and fluid retention
•
Nutritional deficiencies, which result from the
inability of the damaged liver cells to metabolize certain vitamins;
responsi-ble for impaired functioning of the central and peripheral nervous
systems and for abnormal bleeding tendencies
•
Hepatic encephalopathy or coma, reflecting accumulation
of ammonia in the serum due to impaired protein metabolism by the diseased
liver
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