Manifestations and Features of chronic Liver cell failure

Here are the manifestations of chronic liver failure ,, Also known as Hepatocellular failure ( HCC) , which is caused by chronic degenerative liver diseases e.g Liver Cirrhosis .

1. General failure of health .
i.e Anorexia , loss of weight , easy fatigue , ......

2. Low grade Fever  : due to failure of the lever to clear bacteria coming from the colon .

3. Fetor hepaticus : this is fecal smell of mouth due to lack of detoxification of Mercaptans absorbed from the colon ,, it occurs also with porto-systemic shunts .

4. Hepatocellular Jaundice : due to diminished uptake & excretion of bilirubin .

5. Ascites and Edema : 

Edema of  lower limbs usually follows acsites .
Ascites usually develops grudually ,, but it may develop Acutely in cases of haematemesis , melena , infection as SBP hypotension ( hypovolemia) , portal vein thrombosis and malignancy development .

6. Skin manifestations :
a- Palmar erythema : erythema opposite the heads of metacarpal bones , thenar & hypothenar eminences with central palmar pallor .
b. Spider naevi  ,, each of them is a dilated arteriole with radiating capillaries ,, when compressing the central arteriole it causes blanching of  capillaries .Spider naevi occur on the face , neck , upper limb & upper part of chest .
c. White nails .

7. Endocrinal changes : whose cause is not yet defined .
A . Male changes 
Gynaecomastia , female distribution of suprapubic hair , decreased libido , impotence and testicular atrophy .
B. Female changes 
Amenorrhoea , Sterility &  decreased libido .

8. Cardio-Vascular manifestations :
a. Hyperkinetic circulation >> due to V.D materials esp. Nitric Oxide .
b. Cyanosis and Clubbing  (Hepato-Pulmonary syndrome ) .

9. Hematological manifestations 
Bleeding tendency , Anemia and Pancytopenia .

10. Hepatic Encephalopathy 
it is a neuropsychiatric syndrome that may complicate severe liver disease and/or extensive portosystemic shunting .

11. Hepato-Renal syndrome :
it is Acute renal failure with normal renal histology occurs in Child C liver cirrhosis .
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