Gastroenterology

Liver failure


Liver failure - causes, symptoms and treatment

There are acute and chronic liver failure and its 3 stages: stage I – initial (compensated), stage II – expression (decompensated) and stage III terminal (dystrophic). End-stage liver failure ends hepatic coma.

Annually in the world from fulminant (fulminant) liver failure die 2 thousand people. Mortality from this symptom complex is 50-80%.

Causes of liver failure

Acute liver failure can occur when:
-severe forms of viral hepatitis,
-industrial poisoning (arsenic compounds, phosphorus, etc.),
-vegetable (edible mushrooms)
-other hepatotropic poisons,
-certain medications (extract of male fern, tetracycline,etc.),
-transfusion inogroupna blood and in some other cases.

Chronic liver nedostatochnosty with the progression of many chronic liver diseases (cirrhosis, malignant tumors, etc.).

Fulminant hepatic failure may be the outcome of viral hepatitis, autoimmune hepatitis, hereditary diseases (such as Wilson’s disease); to be a result of medication (e.g. paracetamol), exposure to toxic substances (for example, toxins pale toadstool). In 30% of cases the cause of fulminant hepatic failure is not defined.

Symptoms of liver failure

Symptoms of liver failureSymptoms depend on the type of liver injury, the severity of the current process.

Acute liver failure develops rapidly over a few hours or days, and timely treatment may be reversible. Chronic liver failure develops gradually over several weeks or months, but the accession of precipitating factors (alcohol intake, the esophageal-gastric bleeding from varicose veins of the esophagus, intercurrent infection, physical exhaustion, taking large doses of diuretics or simultaneous removal of a large amount of ascites, etc.) can quickly trigger the development of hepatic coma.

Evident hepatic insufficiency decline and perversion of appetite, aversion to tobacco smokers, intolerance to food and alcohol, nausea and weakness, decreased disability, emotional disorders, etc.

Prolonged chronic course marked dark-greenish-gray skin tone or its yellowness, signs of poor absorption of vitamins (poor vision in the dark, etc.), endocrine disorders (in women, the menstrual cycle, men libido decrease, impotence, testicular atrophy, gynecomastia benign hyperplasia of the breast and female type hair), skin lesions (vascular “spiders”, erythema of the palms – strong reddening), hemorrhage or bleeding (such as gastrointestinal), edema, ascites – accumulation of free fluid in the abdominal cavity, etc. Usually observed symptoms of the underlying disease causing liver failure. Reveals diverse changes of biochemical parameters in serum (accompanied by higher concentrations of bilirubin, gamma-globulin, the activity of aminotransferases, reduction of albumin, coagulation factors, esters of cholesterol, cholinesterase activity, etc.).

In stage 1 the symptoms may be absent. For stage II is characterized by clinical manifestations: weakness unmotivated, decreased disability, dyspepsia (nausea, vomiting, diarrhea yellow), the appearance and progression of jaundice, hemorrhagic diathesis (bleeding), ascites, sometimes swelling. In stage III are observed profound disturbance of metabolism in the body, degenerative phenomena not only in liver but also in other organs (nervous system, kidneys, etc.); chronic liver disease expressed cachexia (malnutrition). There are signs of impending hepatic coma.

Coma hepatic (hepatargy). In the development of hepatic coma isolated stage precoma threatening coma and proper one.

In prekomatoznoe period is usually marked by progressive anorexia (lack of appetite), nausea, decrease in liver size, the growth of jaundice, rapid changes in biochemical blood tests.

In the future, picking up neuro-psychiatric disorders, slow thinking, depression, and sometimes some euphoria. Characterized by mood instability, irritability, disturbed memory, upset sleep. Characterized by fine tremor (twitching of the limbs. Under the influence of active treatment patients can recover from this state, but more often in severe irreversible changes in the liver coma.

During the period of coma can be excited, which is then followed by depression (stupor) and progressive impairment of consciousness until the complete loss of it. The patient’s face was haggard, cold extremities, mouth, and skin emanates a distinctive sweet fetor hepaticus, amplified hemorrhagic phenomena (skin hemorrhages, bleeding from the nose, gums, varicose veins of the esophagus, etc.).

Prevention of liver failure

Prevention of acute liver failure is reduced to the prevention of infectious and toxic liver damage.

Prevention of chronic liver failure is a timely treatment of liver diseases that can serve as its cause.

Of great importance for successful treatment of liver failure is the struggle against alcoholism.

Treatment of liver failure

Treatment of liver failureThe prognosis of early treatment of acute liver failure is favorable.

In chronic liver failure, unfavorable, but in some cases, hepatic coma may regress (decrease) and over a number of months again recur (come back).

The prognosis of hepatic coma depends on its depth in the early stages with vigorous treatment may cure, actually at the stage of coma in most cases, the process is irreversible.

Treatment of liver failure in the clinic

Diagnosis is based on clinical and biochemical parameters. The treatment is carried out only in a hospital.

Treatment of liver failure should be started as early as possible in the initial stages of the pathological process. The treatment is carried out in several directions. For acute-onset hepatic failure and hepatic coma is very important intensive therapeutic interventions to support the patient’s life during a critical period (several days) before the onset of liver regeneration (liver cells are able to recover within 10 days, you have eliminated the cause of the disease).

Treats the underlying disease, the toxic hepatosis activities aimed at removing toxic factor.

In chronic liver failure treats the underlying disease and symptomatic therapy. Patients with fulminant liver failure require liver transplantation.

Self treatment

Symptoms of acute liver disease, you should immediately consult a doctor and in any case not try to treat yourself.