Liver failure - a set of symptoms, which are characterized by violation of one or more liver function due to damage to the parenchyma.The liver is unable to maintain a constant internal environment in the body due inability to provide for the needs of metabolism in the internal environment.
Hepatic impairment includes two forms: chronic and acute.But still it is possible to allocate 4 degrees of liver failure: coma, dystrophic (terminal), asthma (pronounced), compensated (initial).It is possible the development of fulminant hepatic failure, in which the relatively high probability of death.
disease can trigger the development of encephalopathy - symptom of various CNS disorders.It is rarely a complication in which the death up to 90%.
pathogenetic mechanisms of liver failure highlights:
- endogenous hepatic insufficiency (liver cell), which runs by hitting the liver parenchyma;
- exogenous (portocaval, porto).Toxins, ammonia, phenol, absorbed in the intestine and then en
- Mixed includes the above mechanisms.
Liver failure causes
development of acute liver failure is most often caused by the presence of various diseases of the liver or acute viral hepatitis.Formation of hepatic encephalopathy in acute form of the disease may be relatively rare, but not later than the 8th week of the onset of the first symptoms.
most common causes of liver failure is the education of its defeat medicines and lightning form of viral hepatitis A, B, C, D, E, G. And as a result of poisoning with carbon dioxide, aflatoxin, mycotoxins, industrial toxins, alcohol abuse, drugs admission, septicemia.Viruses herpes zoster and simple, infectious mononucleosis, herpes and cytomegalovirus also often provoke the development of the disease.
Chronic liver failure is formed in the presence of chronic liver disease (cirrhosis, cancer).Most often develop severe liver failure in people with hepatitis A at the age of 40 years who have previously been diagnosed with liver disease (often drug addicts).The greatest threat is the hepatitis E is for pregnant women, since 20% of cases develop liver failure.
Infectious diseases (tuberculosis, yellow fever), adenovirus, herpes simplex virus, cytomegalovirus, Epstein-Barr virus, much less can lead to liver failure.
In case of overdose drug Paracetamol may be liver failure.The lower dosage of the drug, the less the liver disease, and the prognosis is more favorable.Analgesic drugs, sedatives, diuretics rarely provoke the development of hepatic insufficiency.However, some fungi (Amanita phalloides, etc.) Can lead to the development of this condition.
toxoid poisoning can lead to liver failure on day 4-8 and death reaches 25% of cases.Also yellow phosphorus poisoning, aflatoxin, carbon tetrachloride and other toxins may be the cause of disease.
hypoperfusion of the liver, which develops due to Budd-Chiari syndrome, venookklyuzionnoy disease, chronic heart failure, may result in the development of liver failure.As well as the development of the disease contribute to the massive infiltration of tumor cells during metastasis or lymphoma (adenocarcinoma of the pancreas, small cell lung cancer), Wilson's disease and other metabolic liver disease that can manifest with symptoms of liver failure.
more rare cause of liver failure are: heat shock formed as a result of hyperthermia, resection of liver cirrhosis, trauma (blunt), surgery (transyugulyarnoe intrahepatic portosystemic or portocaval bypass surgery), Reye's syndrome, acute fatty liver of pregnant women, autoimmunehepatitis, galactosemia, tyrosinemia, erythropoietic protoporphyria.
development of the disease can not be ruled out due to electrolyte disorders (hypokalemia), conditions that are accompanied by an increased content of the protein in the intestine (a diet with plenty of protein, gastrointestinal bleeding).
fulminant hepatic failure is largely the outcome of hereditary diseases (Wilson's disease), autoimmune and viral hepatitis, as well as from the reception of medicines (paracetamol) poisoning and toxic substances (such as toxins pale toadstool).
due to acute metabolic stress, electrolyte metabolism disorders, infections, bleeding from varicose veins in patients with chronic liver disease and portosystemic shunts, hepatic encephalopathy may occur.Also causes the formation of hepatic encephalopathy may be: paraabdominotsetez, hepatocellular carcinoma, elevated levels of protein in the diet (if you have severe liver disease), progression of chronic liver disease, alcohol abuse, receiving medicines (paracetamol, diuretics, sedatives, opiates, codeine)spontaneous peritonitis in the presence of ascites, infectious diseases of the chest and of the urinary tract, esophageal-gastrointestinal bleeding.
formation of hepatic encephalopathy in hepatic failure is probably due to a violation of the blood electrolyte and acid-base balance (azotemia, hypochloremia, hyponatremia, metabolic acidosis, hypokalemia, metabolic and respiratory alkalosis).Also in liver failure are observed hemodynamic and homeostasis: hyper- and hypothermia, the change of hydrostatic and oncotic pressure, collateral blood flow and portal hypertension, dehydration, hypovolemia, bacteremia, hypoxia.
Encephalopathy, according to the theory, developed under the influence of toxic substances (tyrosine, phenylalanine, phenol, ammonia), which penetrate the blood-brain barrier, where they accumulate in the brain, disrupt the function of cells of the central nervous system.
Liver failure symptoms
in case of violation of the central nervous system in patients with liver failure will manifest symptoms of encephalopathy.Of uncommon manifestations of a mania and restlessness.For the disease characterized by tremor (lateral finger movements occur in sudden flexion-extension movement of the wrist and metacarpophalangeal joint).Symmetric be neurological disorders.In patients who are in a coma, will manifest symptoms of the brain stem in a few days or hours before death.
Patients with hepatic insufficiency can be identified enhanced jaundice and neuritis.Possibly, fever and ascites, and peripheral edema.Liver appears peculiar smell from the mouth, which is caused by the formation of dimethyl sulfide and trimethylamine.Perhaps manifestation of endocrine disorders (the "phenomenon of white nail", telangiectasia, atrophy of the uterus and mammary glands, hair loss, gynecomastia, infertility, tekstikulyarnaya atrophy, decreased libido).
Compensated stage liver failure manifested enhanced jaundice, fever, hemorrhage, weakness, sleep disturbances, mood and behavior.
Severe decompensated stage liver failure manifested increased symptoms of the previous step (sweating, drowsiness, "flapping tremor", slurred and slow speech, fainting, dizziness, disorientation, possible aggression, inappropriate behavior and liver breath).
End-stage liver failure manifested miscommunication while maintaining an adequate reaction to the pain, confusion, screaming, restlessness, agitation, difficult awakening stupor.
hepatic encephalopathy is accompanied by loss of consciousness, in the beginning there is spontaneous movement and response to pain, which then disappear completely.There divergent strabismus, pupillary reaction is absent, has slowed the rhythm of the EEG, stiffness and cramps.With the deepening coma amplitude will decrease.Hepatic encephalopathy manifested clinically reversible disorders of cognitive function, consciousness, discoordination movements, tremor, monotone speech, drowsiness.
0 stage of hepatic encephalopathy manifested minimally symptomatic: no tremor, incoordination minimum, cognitive functions, concentration, attention, memory impairment.
1 stage of hepatic encephalopathy is accompanied by sleep disturbance and breach of its rhythm, counting breach addition, decreased attention, delayed ability to perform tasks (intelligent), irritability and euphoria.
in 2 stages of hepatic encephalopathy can observe small disorientation in space and time, a violation of the account deduction, ataxia, dizziness, asterixis, slurred speech, inappropriate behavior, apathy and lethargy.
Stage 3 is shown stupor, disorientation considerable time and space, amnesia, dysarthria, temper tantrums.
into 4 stages of hepatic encephalopathy develops coma in which the reaction to pain stimulus is completely absent.
Acute liver failure
Occurs when the liver suddenly loses the ability to perform its functions.Often, there is a slowly progressive liver failure, however, the acute form of the disease is formed for a few days and has severe complications or fatal ends.
Acute liver failure is formed as a result of:
- an overdose of drugs (Efferalgan, Tylenol, Panadol, anticonvulsants, painkillers, antibiotics);
- abuse of folk remedies (supplements, poisoning marsh mint, skullcap, kava, ephedra);
- herpes virus, Epstein-Barr virus, cytomegalovirus, hepatitis virus A, B, E and other viral diseases;
- poisoning by various toxins can neutralize compound of liver cells (poisonous mushrooms);
- the presence of autoimmune diseases;
- venous diseases of the liver;
- metabolic disorders;
Symptoms of acute liver failure include nausea and vomiting, yellowing of the sclera eyes, mucous membranes and skin, malaise, pain in the upper right abdomen, confusion, inability to concentrate, drowsiness and lethargy.
Chronic liver failure
Chronic liver failure occurs because of gradually developing liver dysfunction due to chronic disease over progresiruet parenchyma.As a rule, exhibit symptoms of underlying disease.There are dyspeptic symptoms (diarrhea, vomiting, anorexia), fever, jaundice, encephalopathy.
severe liver failure occurs due to the presence of gallstone disease, tuberculosis, helminthiasis, fatty liver, cancer, cirrhosis, viral or autoimmune hepatitis, alcohol dependence.In rare cases, chronic liver failure is derived from a genetic metabolic disorders - glycogenoses, galactosemia and others.
Signs of chronic liver disease: nausea, anorexia, vomiting, and diarrhea.Symptoms of impaired digestion arises from the consumption of smoked, fried and fatty foods.Perhaps the appearance of undulating fever, jaundice, skin lesions (liver palms, dry and weeping eczema, hemorrhage).Early signs of the disease is ascites and peripheral edema.
Chronic liver failure manifested endocrine disorders: atrophy of the uterus and mammary glands, alopecia, gynecomastia, testicular atrophy, infertility.Manifest psychological disorders in the form of irritability, aggression, inappropriate behavior, disorientation, stupor, periodic soporous state, anxiety, insomnia and sleepiness, memory loss, depression.
Treatment of liver failure
goal of treatment is treatment of the underlying disease, which contributed to the development of liver failure, as well as prevention and treatment of hepatic encephalopathy.Also, treatment will depend entirely on the degree of liver failure.
the treatment of acute liver failure, observe the following conditions:
- Individual nursing unit;
- monitoring of urine, blood sugar levels and vital signs every hour;
- control 2 times a day serum potassium;
- daily blood tests to determine the level of albumin, creatine, be sure to evaluate the coagulation;
- saline administered intravenously contraindicated;
- prevention of pressure sores.
In chronic liver failure must be:
- to conduct active monitoring of the general state, taking into account the increased symptoms of encephalopathy;
- perform daily weighing;
- daily measure daily urine output (ratio of the amount allocated to the liquid consumed);
- daily blood tests to determine the creatine, electrolyte;
- once every two weeks is measured by albumin, bilirubin, alkaline phosphatase activity, ALT, AST;
- regularly perform coagulation by measuring the level of prothrombin;
- in the case of the last stage of cirrhosis of the need to consider the possibility of a liver transplant.
Treatment of chronic liver disease is carried out as follows:
- in the diet to limit patient acceptance of salt and protein (not more than 40g / day);
- intravenous ciprofloxacin (1.0 g 2 p. / Day), without waiting for the determination of sensitivity to antibiotics and the result of bacteriological research;
- Ornithine in the first phase is administered 7 times intravenously (daily dose - 20 g) was dissolved in 500 ml of sodium chloride or glucose.
- the second stage of treatment is appointed Hepa-Merz in two weeks, three times a day (18g a day);
- within 10 days of 5-10 ml twice daily is administered Hofitol;
- Normase (Dyufaoak, lactulose) in an initial daily dosage is injected 9 mL of a consistent increase in its development to a small diarrhea.This helps reduce the absorption of ammonia;
- constipation needed enema with magnesium sulfate (20 g per 100 ml of water);
- Vikasol (vitamin C) intravenously three times a day for 1 mg;
- when blood loss must be administered intravenously fresh frozen plasma to 4 doses, and in the event of prolonged bleeding again after 8 hours;
- is strictly forbidden administering saline solutions;
- requires reception complex vitamins with the additional introduction of folic acid.Doing magnesium, phosphorus and calcium contributes to the maintenance of adequate mineral metabolism;
- Kvametel (famotidine) must be administered intravenously 3 p / d by diluting 20 mL of saline solution 20 mg;
- To increase the caloric intake necessary to enteral tube feeding.
For treatment there should be no hemorrhages arterial puncture and fresh frozen plasma administered intravenously and famotidine 3 times a day.
To cure the infection required antibiotic therapy.For proper selection of medication you need to do blood cultures and urine.If you have a catheter in a vein is necessary to collect material from him.