Acute hepatocellular failure in a patient ofcirrhosis of liver is precipitated by –
**Core Concept**
Acute hepatocellular failure in a patient with cirrhosis of the liver is a life-threatening condition where the liver rapidly loses its function. This can be precipitated by various factors that further compromise the liver's already compromised state.
**Why the Correct Answer is Right**
The correct answer is an infection, specifically **spontaneous bacterial peritonitis (SBP)**. SBP is a serious complication of cirrhosis, where bacteria invade the ascitic fluid in the absence of any apparent source of infection. The liver's compromised function, particularly the impaired Kupffer cell activity and reduced bacterial clearance, makes it difficult for the body to handle the bacterial load. The endotoxins and pro-inflammatory cytokines released by the bacteria further exacerbate liver injury, leading to acute hepatocellular failure.
**Why Each Wrong Option is Incorrect**
* **Option A:** While NSAIDs can exacerbate liver injury, they are not a direct precipitant of acute hepatocellular failure in cirrhotic patients.
* **Option B:** Hypovolemia can worsen liver function, but it is not a direct cause of acute hepatocellular failure in cirrhosis.
* **Option C:** While hypoxia can worsen liver injury, it is not a specific precipitant of acute hepatocellular failure in cirrhotic patients.
**Clinical Pearl / High-Yield Fact**
In patients with cirrhosis, the presence of a high white blood cell count in the ascitic fluid is a sensitive indicator of spontaneous bacterial peritonitis, and prompt antibiotic therapy can prevent progression to acute hepatocellular failure.
**Correct Answer:** C.