Hepatic Physiology
The liver is the largest solid organ (1.5 kg) performing over 500 functions including metabolism, detoxification, protein synthesis, and bile production. Blood supply: Dual supply from hepatic artery (25% flow, 50%...
What matters first
The liver is the largest solid organ (1.5 kg) performing over 500 functions including metabolism, detoxification, protein synthesis, and bile production. Blood supply: Dual supply from hepatic artery (25% flow, 50%...
Acute liver failure with INR >1.5 and encephalopathy
2 Feb 2026
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Clinical board
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Urgent signals
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- Acute liver failure with INR >1.5 and encephalopathy
- Hepatorenal syndrome with creatinine >133 μmol/L
- Portal hypertension with variceal bleeding
- Severe coagulopathy with bleeding
Exam focus
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- ANZCA Primary Written
- ANZCA Primary Viva
Content status and exam context
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Topic family
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The liver is the largest solid organ (1.4-1.8 kg), receiving 25% of cardiac output through a unique dual blood supply: p... CICM First Part Written, CICM First
The liver is the largest solid organ (1.5 kg) performing over 500 functions including metabolism, detoxification, protein synthesis, and bile production. Blood supply: Dual supply from hepatic artery (25% flow, 50%...
Clinical explanation and evidence
Quick Answer
The liver is the largest solid organ (1.5 kg) performing over 500 functions including metabolism, detoxification, protein synthesis, and bile production. Blood supply: Dual supply from hepatic artery (25% flow, 50% oxygen) and portal vein (75% flow, 50% oxygen), total 1.5 L/min. Functional unit: Hepatic lobule with hexagonal arrangement, portal triads at corners (portal vein, hepatic artery, bile duct), central vein at center. Zones: Zone 1 (periportal) receives most oxygenated blood, Zone 3 (pericentral/centrilobular) most susceptible to hypoxia and toxins. Metabolic functions: Carbohydrate metabolism (glycogenesis, glycogenolysis, gluconeogenesis), protein synthesis (albumin, clotting factors, acute phase proteins), lipid metabolism (cholesterol, lipoproteins), detoxification (phase I CYP450 oxidation, phase II conjugation, phase III excretion into bile). Drug metabolism: Hepatic blood flow (flow-dependent propranolol, high extraction ratio), hepatic enzyme activity (capacity-dependent warfarin, low extraction ratio), protein binding (affects free drug concentration). Coagulation: Synthesizes all clotting factors except VIII (endothelium) and XIII (platelets); produces thrombopoietin. Bilirubin metabolism: Heme breakdown → unconjugated bilirubin (bound to albumin) → hepatocyte uptake → conjugation with glucuronide (UDP-glucuronosyltransferase) → biliary excretion. Anaesthetic implications: Altered drug metabolism (reduced clearance, increased sensitivity), coagulopathy (reduced clotting factors), hypoglycaemia, encephalopathy, portal hypertension, hepatorenal syndrome. Indigenous populations have higher rates of viral hepatitis (HBV, HCV), NAFLD, and alcohol-related liver disease. [1-10]