Cirrhosis: hepatic synthetic fxn

Synthetic function of liver include:

• Synthesis of plasma proteins
• Acute phase proteins
• Albumin
• Clotting factors
• Binding proteins
• Gluconeogenesis
• Cholesterol / lipoproteins
• Immunoglobulins
• Hormones
• 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:

Serum Albumin

• 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.