hepatic and biliary disorders
Systemic Abnormalities in Liver Disease
Renal and Electrolyte Abnormalities
Renal and electrolyte abnormalities are common, especially among patients with ascites. Hypokalemia None Hyponatremia None Advanced liver failure can alter acid-base balance, usually causing Metabolic Alkalosis . Blood Renal failurein liver disease may reflect Rare disorders that directly affect both the kidneys and the liver (eg, carbon tetrachloride toxicity) Circulatory failure with decreased renal perfusion, with or without frank acute tubular necrosis Functional renal failure, often called hepatorenal syndrome This syndrome consists of Progressive oliguria and azotemia in the absence of structural damage to the kidneys Hepatorenal syndrome usually occurs in patients with alcoholic hepatitis or advanced cirrhosis with Ascites . Pathogenesis is thought to be due to extreme vasodilation of the splanchnic arterial circulation, leading to decreased central arterial volume and subsequent renal vessel vasoconstriction. Neural or humoral reductions in renocortical blood flow follow, resulting in a diminished glomerular filtration rate. Low urinary sodium concentration and benign sediment usually distinguish it from Once established, renal failure due to untreated hepatorenal syndrome is usually rapidly progressive and fatal (type 1 hepatorenal syndrome), although some cases are less severe, with stable milder renal insufficiency (type 2). Combination therapy with vasoconstrictors (typically,midodrine,octreotide, orterlipressin) and volume expanders (typically,albumin) can be effective.Norepinephrineinfusion can be used in refractory cases and titrated to urine output and mean arterial pressures. If hepatorenal syndrome does not respond to medical therapy, patients should be referred for Liver Transplantation . 