1.
Acute hepatitis : hepatocyte의 infection, toxin 또는 metabolic injury가 원인
2.
Hepatic failure
(1) Cellular level : Loss of metabolic & synthetic function
(2) Gross level : Portal HTN, Ascites formation, Portal-systemic shunt 발생
3.
Liver synthetic function
(1) Vit K-dependent clotting factor (II, VII, IX, X)
(2) Protein C & S
(3) Other elements of clotting & thrombolytic processes
→ Uncontrolled bleeding is one of the life-threatening feature of liver disease
4.
Portal HTN
(1) Cirrhotic liver 때문에 생긴 portal vein의 hydrostatic pressure 증가
(2) Esophageal & gastric varix, portal-systemic shunting 유발
5.
Ascites
(1) Due to Portal HTN, hypoalbuminemia, poor renal management (Na+, Water)
(2) Respiratory compromise, SBP 유발
6.
Encephalopathy
(1) Hallmark of liver failure
(2) Large intestinal protein load : high protein meal, GI bleeding
(3) Ammonia level이 mental status와 확실히 correlation 하는 것은 아니지만 reasonable하게
영향을 끼치는 factor
(4) Fulminant liver failure
① Cerebral edema & Increased ICP
② 이러한 End-stage state에서 loss of autoregulation of cerebral blood flow, ammonia-related
edema, systemic inflammatory response 발생
→ Deadly complication
7.
Jaundice
(1) Can be present in any stage of liver disease
(2) Pre-hepatic jaundice
: Liver의 능력을 넘어서 overproduction, hemolysis, inborn errors of bilirubin metabolism
(3) Hepatic jaundice : by viral infection, toxic causes
(4) Post-hepatic jaundice : Conjugated bilirubin 증가, Excretion의 막힘
(ex: pancreatic tumor, CBD stone)
