Cirrhosis: hepatic synthetic fxn
Synthetic function of liver include:
- Synthesis of plasma proteins
- Acute phase proteins
- Clotting factors
- Binding proteins
- Cholesterol / lipoproteins
- Urea and bile
*Almost all plasma proteins synthesized by liver except: Gamma-globulins (RES), factor VIII (Vascular/glomerular endothelium, and sinusoidal cells of the liver), Factor III (tissue endothelial), vWF (endothelial)
Measures of synthetic function of liver:
- Albumin is mainly synthesized by liver
- Long T1/2 (14 to 21 days) → serum albumin concentrations change slowly in response to alteration in synthesis.
- Indirect measure of synthetic capacity of liver as it could also be decreased by renal disease, burns, critical illness.
Prothrombin time (PT):
- Primary qualitative measure of synthetic function of liver.
- Shorter T1/2 (factor VII → 4-6 hours)
- PT does not become abnormal until more than 80 percent of liver synthetic capacity is lost.
- It could also be elevated in vitamin K deficiency (malnutrition, cystic fibrosis), DIC, medications (warfarin), decreased plasminogen, fibrinolysis, and DIC
Cirrhosis is a chronic disease process in which fibrotic scar tissue or regenerative nodules replaces normal hepatic tissue. (Miller P431)
- Albumin levels fall as the synthetic function of liver declines.
- PT increases due to the deficient synthesis of coagulation factors.