hepaticimpaired

Hepatic impairment, commonly referred to as liver dysfunction, describes a spectrum in which the liver’s ability to perform its essential functions is reduced. This can affect metabolism and clearance of nutrients and medications, production of clotting factors, synthesis of albumin, and detoxification of toxins.

Causes of hepatic impairment are varied and include chronic liver diseases such as cirrhosis from alcohol use or chronic viral hepatitis, nonalcoholic fatty liver disease, autoimmune hepatitis, and cholestatic disorders. Acute liver failure from drug toxicity or severe infections, as well as drug-induced liver injury, metabolic disorders, biliary obstruction, and hemochromatosis, can also lead to impairment. The underlying cause often guides management and prognosis.

Clinical presentation ranges from asymptomatic laboratory abnormalities to jaundice, fatigue, abdominal distension from ascites, peripheral edema, confusion from hepatic encephalopathy, and coagulopathy. Diagnosis relies on history, physical examination, laboratory tests showing abnormalities in liver enzymes, bilirubin, albumin, and coagulation tests, as well as imaging and sometimes liver biopsy. Scoring systems such as the Child-Pugh score and the MELD (Model for End-Stage Liver Disease) score help assess severity and prognosis by incorporating factors like bilirubin, albumin, INR, ascites, encephalopathy, and renal function.

Management focuses on treating the underlying cause, preventing and managing complications (ascites, encephalopathy, variceal bleeding, infections), providing nutritional support, avoiding hepatotoxic exposures, and immunizations where appropriate. In advanced cases, referral for liver transplantation evaluation may be indicated. Drug dosing often requires adjustments due to reduced hepatic clearance, underscoring the importance of consulting guidelines when initiating or modifying therapy. Prognosis depends on the cause, severity, and presence of decompensation.