Liver and intrahepatic bile ducts - nontumor
General concepts
Hepatic failure

Author: Komal Arora, M.D. (see Authors page)

Revised: 30 October 2017, last major update April 2012

Copyright: (c) 2002-2017,, Inc.

PubMed Search: Hepatic failure[TI] liver[TI] free full text[sb]

Cite this page: Arora, K. Hepatic failure. website. Accessed February 21st, 2018.
Definition / general
  • Usually due to progressive liver damage
  • No hepatic failure until loss of 80% of functional capacity or increased demands on liver (electrolyte disturbance, GI bleed, heart failure, infection [systemic], surgery)
  • 70 - 95% mortality
  • Usually due to chronic liver disease; causes without overt hepatocellular necrosis are Reyes syndrome, tetracycline toxicity, acute fatty liver of pregnancy
  • Symptoms: jaundice, hypoalbuminemia, elevated serum ammonia, fetor hepaticus (musty body odor due to mercaptans from GI bacteria and methionine), palmar erythema, spider angiomas, hypogonadism (men), gynecomastia (in men due to impaired estrogen metabolism and increased serum estrogen)
  • Complications: multiple organ failure (respiratory failure with pneumonia and sepsis); renal failure, coagulopathy due to reduction in functional vitamin K dependent coagulation factors II, VII, IX, X
  • Hepatic encephalopathy: altered consciousness, rigidity, hyperreflexia, asterixis (nonrhythmic, rapid extension flexion movements of head and extremities), associated with elevated serum ammonia
  • Hepatorenal syndrome: acute renal failure in patients with severe liver disease only; due to decreased renal perfusion through unknown mechanism; educed urine output, elevated serum BUN; kidney function improves with improving hepatic function; 80 - 95% mortality; borderline renal insufficiency (creatinine of 2 - 3 mg/dl) may persist for months (JAAPA 2011;24:30, Am J Gastroenterol 2005;100:460)
  • Support until hepatocellular regeneration restores adequate hepatic function or liver transplantation
Gross images

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Explanted liver with large areas of hemorrhage and necrosis

Microscopic (histologic) images

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Post isoflurane anesthesia

Explanted liver
massive necrosis and
architectural collapse