Acute liver failure
- Category: Gastroenterology
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Acute liver failure is a pathological condition with massive damage to liver cells and a violation of their functions. In severe form of the disease may occur a hepatic coma.
Kinds of the acute liver failure
There is a classification of the acute liver failure in medicine. It includes the following types:
- Endogenous. It is formed with direct damage to the liver parenchyma
- Exogenous. It is formed with disorganization of blood circulation, which ultimately results in the discharge of blood saturated with harmful components into the general circle of hemodynamics.
- Mixed. With this type of manifest both forms - endogenous and exogenous.
By functionality there are classified three stages of hepatic insufficiency:
- Easy stage. It is asymptomatic. During diagnosis, moderate defects in functions are determined.
- Stage of moderate severity. It is accompanied by the appearance of symptoms: hepatomegaly, hepatic pain, colic, jaundice of the skin and mucous membranes.
- Heavy stage. To all of the above signs are added those that characterize both encephalopathy and to whom, arising as a result of a gross malfunction of the functions of the organ.
Causes of the acute liver failure
The extreme degree of this condition is formed in the course of inflammatory processes that promote extensive dystrophic, fibrous or necrotic abnormalities. Insufficiency can be manifested as a consequence of severe hepatitis varieties of various etiologies, cirrhosis, hepatosis, intoxication with hepatotropic toxic components, etc. The disease can also progress in the course of blood circulation abnormalities caused by burns, blood infection, increased bleeding, etc.
Provoking factors of such shortage are alcohol, drugs with a hepatotoxic effect, anesthesia during surgery, excessive amounts of protein in food, liquid stools. Patients with a disorder of this organ have severe degree of insufficiency. These can be manifested with infection, peritonitis, thrombophlebitis of the portal vein, etc.
Symptoms of the acute liver failure
Acute liver failure is manifested by drowsiness, which alternates with excitement, adynamics, and severe weakness. Characteristic nausea, lack of appetite, vomiting, loose stools. Appearing edema, signs of hemorrhagic diathesis, icterus, poisoning the body with metabolic products, ascites, fever.
In the precomatous state, neuropsychic disorders are observed: dizziness, slowness of speech and thinking, insomnia, hallucinations, limb tremor.
Hemorrhages from the gums and nose can also occur. The approaching specific coma is indicated by pain syndrome in the hypochondrium, bad breath, decrease of liver size. The coma goes in parallel with loss of consciousness, seizures, hypothermia, heart rhythm disturbance, the appearance of certain reflexes, multi-organ failure.
Diagnostics of the acute liver failure
This disease can diagnose a general practitioner, after collecting complaints, anamnesis, conducting general clinical tests and studies. You may need a consultation of a gastroenterologist, a surgeon, an infectious disease specialist, a hepatologist, or in the case of extremely serious cases - transplantologist.
Laboratory features of the pathology are anemia, thrombocytopenia, hyperbilirubinemia, the increase of the activity of serum transaminases. At the terminal stage, pronounced hypocholesterolemia, hypoalbuminemia, etc.
In the diagnosis of coma, as the terminal stage of failure, EEG is performed, which determines the violation of alpha rhythm, the dominance of theta and delta waves.
Treatment of the acute liver failure
The main in pathology therapy is the infusion therapy aimed at eliminating intoxication, improving blood circulation, metabolism, correction of electrolyte defects, restoration of acid-base balance. Intravenous injections of solutions of glucose, albumin, haemodesis and other medications are used. Diuretics are prescribed to prevent swelling of the brain and lungs. For a person is recommended a number of vitamins: ascorbic acid, riboflavin, nicotinamide and others.
In the presence of hemorrhagic syndrome, injection of solutions of vicasol, aminocaproic acid and others is carried out; When clotting is violated, transfusion of large volumes of plasma is used. Progression of pathology requires the intake of glucocorticoid hormones and antibiotics. Also for the purpose of detoxification, hepatologists prescribe hemodialysis, plasmapheresis, hemorbtion, lymphosorption.
Rapid intensive therapy significantly improves the prognosis for recovery. With deep coma, irreversible processes occurs and leading to the death of the patient.