Pathophysiology

Haemostasis is a fine balance between procoagulant and anticoagulant mechanisms. Because of its central role in the production of these factors, haemostasis is often disturbed in liver disease. Clotting tests become abnormal in liver damage and are useful monitors of liver function. The liver functions as a reticuloendothelial organ, clearing activated coagulation factors from the circulation. Impairment of this function leads to the scene for DIC which is usually low grade but may be fulminant. Fibrinolysis may be decreased in chronic liver disease but is high in liver transplant patients. Dysfibrinogenaemia due to increased sialic acid content of the fibrinogen molecule is described. In obstructive jaundice, impaired bile flow leads to malabsorption of vit K, a fat soluble vitamin. A degree of intrahepatic obstruction secondary to hepatocyte swelling and fibrosis may also have this effect. Thrombocytopenia may be due to portal hypertension, splenic pooling, alcohol, viral infection, drugs or DIC. Altered platelet function with a prolonged bleeding time may occur.

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