The liver in systemic critical illness

Abstract

Liver dysfunction may manifest during systemic illness as a consequence of circulatory compromise - inadequate perfusion, passive congestion, intrahepatic redistribution of blood flow - or as a consequence of hepatocellular or fixed tissue macrophage (Kupffer cell) cytotoxicity. It is probable that hepatic dysfunction exacerbates the hemodynamic sequelae and multisystem dysfunction which results from infection. Certainly, underlying hepatocellular disease such as that caused by steatosis, viral hepatitis which results in changes to the cytoarchitecture will predispose to hepatocellular dysfunction in systemic illness. Some discrete functions of the liver can be measured. However, several key aspects related to immune function are poorly characterized. Liver dysfunction is often inferred from extrahepatic organ dysfunction the severity of which can be quantified and used to characterize the severity of liver dysfunction.