77. Chronic liver disease with coagulopathy

ชาย 61ปี มี Obstructive jaundice กำลัง W/U, ข้อใหล่ขวาปวดบวม 2 วัน No trauma คิดถึงอะไร

ผู้ป่วยได้รับการ Aspirate [ Arthrocentesis] พบว่าเป็นเลือด [ Hemarthrosis]



Coagulopathy in chronic liver disease: The liver synthesizes all of the known coagulation factors except factor VIII. Coagulation factors are part of a chemical cascade that causes blood to clot. Liver disease decreases the production of many of these clotting factors, which in turn inhibits the body's ability to stop bleeding, internally or externally. In addition, the liver also produces alpha2-antiplasmin, which removes another blood thinning factor -- plasminogen activator. Disease in the biliary tract leads to malabsorption of Vitamin K -- also involved with clotting. Lastly, liver disease may result in a back-up of fluid into the spleen and decreased platelets (also used in clotting)
Laboratory Findings:
- ProlongProthrombin time (PT) more than prolongation of partial thromboplastin time (PTT)
- Fibrinogen levels are usually normal. - Platelet counts are normal, unless spleen is also enlarged, or the person recently drank alcohol. - Liver function tests abnormal, depending on the type of liver disease (in end-stage liver disease, liver tests may become "normalized" because so much of the liver is now non-functioning.)
Treatment: Fresh frozen plasma
Correct Vitamin K Deficiency if it exists