Acute vs chronic liver failure
- Decompensated cirrhosis = new ascites, hepatic encephalopathy, gastrointestinal hemorrhage, or hepatorenal syndrome in someone with established cirrhosis
- think the SDEC patients who need ascitic drains
- Acute on chronic liver failure = decompensated cirrhosis AND multiorgan failure, i.e. resp failure, encephalopathy,
precipitants
- sepsis as always
- non-septic inflammation - alcoholic hepatitis
- lipopolysaccharide translocation from gut - because of all the portosystemic anastomosis shunts It's All A Bit Weird
pathophys
systemic vasodilation → reflex vasoconstriction in renal vasculature
any further vasodilation can lead to instability