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Liver Disease and Hepatic Failure

The pathophysiologic abnormalities associated with liver disease result in hemostatic problems that range from subclinical coagulopathy, unmasked by the performance of a procedure, to brisk, active hemorrhage that can be life threatening. If the patient has liver disease as a result of alcoholism, thrombocytopenia results not only from splenic sequestration, but also from decreased production.


Hepatic failure in infants under four weeks old can be caused by viruses such as herpes simplex; adenovirus, which causes conjunctivitis and upper respiratory tract infections; or enteroviruses, which affect the gastrointestinal tract. Other causes in very common infants such as includes:

  • Neonatal iron storage disease
  • Certain metabolic disorders such as tyrosinemia and galactosemia
  • Fructose intolerance
  • Familial erythrophagocytic histiocytosis
  • Peroxisomal diseases
  • Defects in respiratory chain and fatty acid oxidation.

Older infants and children are more likely to develop fulminant hepatic failure from viral hepatitis. Other causes of liver failure in older children can includes:

  • Fatty liver
  • Acetaminophen overdose
  • Chronic alcohol abuse
  • Exposure to toxins
  • Leukemia
  • Reye’s syndrome
  • Cardiomyopathy
  • Autoimmune hepatitis.

In some cases, the cause of liver failure is unknown.


  • Fatigue
  • Anorexia
  • Pruritus
  • Gastrointestinal bleeding
  • Increasing abdominal girth


  • Jaundice
  • Hematemesis
  • Melena or bright red blood from rectum
  • Ascites
  • Spider nevi
  • Asterixis
  • Altered mental status


General concerns treatment such as including:

  • An intensive care unit and pediatric hepatology setting with facilities for liver transplantation should be available for proper diagnosis and management.
  • Maintain urine output, and correct hypoglycemia and any associated electrolyte disturbances.
  • Patients may require IV administration of calcium, phosphorous, magnesium, factor concentrate, and platelets.
  • An infusion of 10-20% of glucose usually is required.
  • Avoid fluid overload. Hemodynamic monitoring of central pressures is advised to assess volume depletion and overload.
  • Hepatitis is treated with acyclovir for herpesvirus hepatitis and with prednisone and azathioprine for autoimmune hepatitis.
  • Acetaminophen overdose is treated with hepatotoxic drugs.

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