Hepatic Insufficiency: Symptoms, Treatment, Diagnosis

The liver in the human body plays an important role. She participates in all metabolic processes, produces hepatic bile for proper digestion. Also, the liver performs the function of cleansing the body of toxins, poisons, heavy metals. Daily body passing through itself to a hundred liters of blood, purifying it.

If the liver ceases to fulfill one of the functions of the whole organism are disrupted. This condition is called hepatic insufficiency. Thus, hepatic failure accompanied by metabolic disorders, central nervous system dysfunction, intoxication. Acute lack of proper attention from the medical profession leads to hepatic coma.

What it is?

Liver failure - a syndrome complex symptoms that occur due to abnormal liver function. All metabolic processes in the body are controlled by the liver, and therefore, under certain organ failures and suffering and complications can develop its failure.

Classification

Liver failure may develop and manifest itself in three forms. Namely, it may be noted:

1. Hepatocellular failure. Yet this form is called endogenous, develops when the body poisoning with toxic substances. Because of this form of the disease begins rapid death of liver cells.
2. Exogenous form of liver failure. This dysfunction of the blood circulation in the body. That is, the liver stops functioning as it should be and the blood does not pass through the liver, and therefore is not purified of toxins, which further poisons all organs.
3. Mixed form. This disruption of hepatocytes, and failures in circulation in hepatic vessels.

Diagnostics

At present, use the following methods of diagnosis of cell-hepatic failure, allowing to create a complete picture:

1. Medical history in order to clarify the facts of the abuse of alcohol by the patient, whether it is a drug addict, sick or not viral hepatitis, whether in the body is broken metabolism, whether chronic liver disease and malignant tumors, which drugs currently takes, whether suffering from edema limbs.
2. US body that allows the most accurate assessment of his condition.
3. Biochemical blood test aimed at determining elevated levels of bilirubin, reducing the amount of protein coagulation pathologies, electrolyte imbalance, and other indicators.
4. electroencephalography technique used to detect violations in the amplitude of brain rhythms.
5. A biopsy is the method of establishing the causes of the disease and the actual indicators the body.
6. MRI reveals the extent of changes in the liver tissue.

Fulminant hepatic failure is determined based on such clinical manifestations as jaundice, a significant reduction in the size of the liver, encephalopathy and biochemical parameters determined by analysis blood.

Acute liver failure

Acute liver failure - is extremely serious condition of the body, require immediate detoxification therapy.

It develops as a result of rapid liver damage. The clinical picture of this syndrome develops very quickly (from a few hours up to 8 weeks) and as soon leads to hepatic encephalopathy and coma. It is also possible development of fulminant liver failure - fulminant hepatic failure, which often occurs when the poisoning toxins, chemicals, drugs and etc.

The causes of acute liver failure

• Poisoning surrogates alcohol.
• Poisoning poisons, toxic effects on the liver: phosphorus, chlorocarbons, and others.
• Poisoning poisonous mushrooms: death cup, stitching, Araneus, heliotrope. The mortality rate for this condition - 50%.
• Acceptance of antipyretic drugs at higher temperatures in children 4-12 years old. Particularly dangerous in this respect, acetylsalicylic acid ( "Aspirin") means containing salicylates. Less dangerous paracetamol, ibuprofen ( "Nurofen"), analgin. Disease called Reye's syndrome or acute hepatic encephalopathy. Mortality of children with 20-30%.
• viruses hepatitis A, ATE, as well as viruses of herpes group (herpes simplex, cytomegalovirus, Epstein-Barr, varicella zoster virus - varicella-zoster virus).
• Other microbes, not viruses that can cause generalized infection whole organism with liver disease. This is the most diverse bacterial infection (staph, enterococci, pneumococcal, streptococcus, salmonella, etc.), as well as rickettsiosis, mycoplasmosis, mixed fungal infection.
• Acute infection with blood liver abscess, suppurative inflammation of the intrahepatic bile ducts.
• Acute poor circulation in the liver due to embolism major branches of the hepatic artery thrombi gas oil.
• Disease of unknown origin: eg, acute steatosis pregnant.
• Rupture of hydatid cyst in the liver.
• Severe oncological diseases: hematological malignancies, Hodgkin's disease, cancer metastases to the liver of different localization.
• Poisoning by drugs, especially when they overdose. Thus, it is possible to exceed the maximum dose of paracetamol, chlorpromazine, ketoconazole, tetracyclines, Co-trimoxazole, sulfonamides, drugs to treat tuberculosis, based on men's products sex hormones.
• Operations in the abdominal organs in which disrupted liver blood flow (e.g., on a long time clamped, sewn or cut large branches of the hepatic artery).

Depending on the reasons for the development of different forms of acute liver failure:

1. Exogenous form - is caused by disorders of hepatic and / or extrahepatic circulation (portal system and the inferior vena cava veins), mostly in liver cirrhosis. In this case, the blood from toxic substances bypasses the liver, affecting all organs and body systems.
2. Endogenous or hepatocellular form - occurs when lesions of the liver cells as a result of exposure to hepato-toxic factors. Characterized by rapid necrosis (or dying off) hepatocytes.
3. Mixed form - when exposed as a hepato-cellular and vascular disruption factors liver.

After the development of acute liver failure all toxins that enter from the environment, or produced as a result of metabolism, have a negative effect on the cells of the whole organism. When brain damage occurs hepatic encephalopathy, followed by coma and death of the patient.

Acute liver failure involves symptoms such

• Nausea, vomiting, rapid weight loss, fever, severe weakness and fatigue at the slightest physical exertion;
• Jaundice (yellowing of the skin, mucous membranes due to an increase of bilirubin level) expressed pruritus;
• "Liver" breath (reminiscent of the smell of rotten meat);
• ascites (Fluid accumulation in the abdomen), swelling of extremities;
• Tremor, or trembling of upper extremities (involuntary flapping hands);
• Bleeding from the gastrointestinal tract, injection sites nosebleeds;
• lowering blood pressure, heart rhythm disturbances (arrhythmia different species);
• Hypoglycemia (low blood glucose).

In most cases develops hepatorenal syndrome (hepatic-renal failure). The reason may be the effects of toxic products of metabolism, not excretes properly, or a sharp drop in blood pressure.

The main symptom of acute liver failure is hepatic encephalopathy. This potentially reversible damage in neurological and psychic sphere provoked decrease detoxifying liver function and formation of vascular connections (shunts).

Treatment of acute liver failure

Acute liver failure requires emergency treatment. The patient should be hospitalized immediately to a medical facility. The therapy of the underlying disease and any violations. It is in these events:

• Infusion therapy (administration of solutions intravenously to maintain blood pressure and detoxification). It includes corticosteroids (adrenocortical hormones), glucose (energy to adequately support body), an isotonic sodium chloride solution.
• Forcing (stimulation), diuresis (furosemide).
• Reducing the ammonia formation (used lactulose).
• Antibiotic therapy (metronidazole, cephalosporins).
• Tranquilizers with mental and motor excitation (diazepam, sodium hydroxybutyrate).
• Oxygen (oxygen inhalation).

As additional methods used hemosorption, hyperbaric oxygenation, exchange transfusions and others. When administered paracetamol poisoning antidote - N-acetylcysteine. The main goal - to stabilize the state, then it is possible to eliminate the root cause of liver failure.

Chronic liver failure

It develops gradually with prolonged (chronic) exposure to hepato-toxic factors (from 2 months to several years). Characterized by the gradual development of symptoms on a background of exacerbation of chronic liver disease and biliary system.

The causes of chronic liver failure:

• Chronic hepatitis: viral, alcoholic, toxic.
• Liver cancer.
• Parasitic diseases of the liver: toxocariasis, giardiasis, Hydatid disease.
• Autoimmune diseases.
• Cirrhosis of the liver in the outcome of chronic viral hepatitis and postalkogolnogo origin or due to operation with toxins, heavy metals, receiving hepatotoxic drugs or injectable drugs.
• Parenchymal proteinosis having a basis of protein deposition in the cytoplasm of liver cells. Reason: Violation of protein metabolism, alcoholism, cholestasis, hypovitaminosis, chronic intoxication as a result of receiving the poisonous mushrooms, pesticides and so on.
• Parenchymal fatty degeneration when deposited in the cytoplasm of triglycerides. This occurs as a result of obesity, alcohol abuse, eating too much fat, sugar diabetoa, starvation.
• amyloidosis of the liver. In this case pathological amyloid protein is deposited in the liver. This occurs as a result of chronic diseases associated with intoxication.
• Parenchymal carbohydrate dystrophy when glycogen (a lot of communication connection glucose) builds up not in the cytoplasm and in the nucleus of liver cells. Reason: Violation of glycogen metabolism, diabetes, hypo-and avitaminosis.

As in the case of acute liver failure are distinguished form:

• exogenous form - lesion and necrosis of liver cells occurs gradually, a part of regenerated cells, but with continued exposure to adverse factors dying hepatocytes continues.
• endogenous form - liver circulation,
• mixed form.

In chronic liver failure are more advanced liver compensatory possibilities, that is, liver has time to recover part of their cells, some of which continue to perform their function. However, toxins which are not utilized in the liver into the blood and chronic poisoning organism.

If you have additional hepato-toxic factors going decompensation (lost opportunities regenerating hepatocytes), thus can develop hepatic encephalopathy and coma, and more lethal Exodus.

Symptoms of chronic liver failure

For chronic liver failure is characterized by a gradual, phased increase in symptoms. And no matter how long the disease does not exist in the initial stage, sooner or later it will begin to progress.

• I.Nachalnaya stage, also known as compensated. Usually there are no symptoms and the patient no complaints. Any disturbances in the body at this stage can only be determined through laboratory tests;
• II. Expressed, or asthma. At this stage, it expressed intoxication, portal hypertension, and CNS disorders;
• III. Terminal, or dystrophic. All signs are clearly marked, at this stage, poor blood clotting, liver ceases smaller. In this case, the central nervous system is not stable, that is replaced by the inhibition activity;
• IV. Coma. This condition is expressed by loss of consciousness, reflexes thus appear only to strong stimuli. It could turn into a deep coma, in which there is no reaction, because usually there is brain edema and multiple organ failure.

To confirm the diagnosis of chronic liver disease is necessary to conduct complex diagnostic procedures. Approximate number of studies is as follows:

1. CBC - may be determined by increasing the number of white blood cells, and also decrease the number of erythrocytes, thrombocytes and hemoglobin levels decrease;
2. Biochemical analysis of blood - pay attention to the levels of bilirubin, ALT and AST, alkaline phosphatase, creatinine;
3. Coagulation - reducing blood prothrombin index;
4. Ultrasound of the abdomen - allows the doctor to assess the condition of the liver parenchyma, liver size.

chronic liver failure treatment

Treatment of liver failure is to eliminate the factors that cause the disease. In some cases, such as liver cancer, can be carried out surgical treatment. Assigned low-protein diet carbohydrate with 400-500 g / day, and fat - 80-90 g / day, excluding alcohol, caffeine, fluid restriction.

My daily routine is also changed: Now it will be necessary to move enough, but without lifting more than 2 kg and avoiding open sunlight. Persons with chronic liver disease need to get enough sleep, and about the reception of any medication, even the common cold, to consult with a doctor-hepatologist (almost all drugs pass through liver).

It is also necessary the appointment of the following medications:

• to neutralize ammonia "Glutargin", "Hepa-Merz ';
• antibiotics that are absorbed only in the intestine and destroy local flora, manufacturing proteins derived from food produce amino acids, which have a negative impact on the brain. This "Gentamicin", "Kanamycin";
• lactulose preparations that bind to toxic substances brain "Lactulose", "Dufalak", "Prelaksan", "Laktuvit";
• veroshpiron - to reduce the risk of edema and ascites;
• to reduce the pressure in the portal vein - "Nebilet", "Propranolol", "Molsidomine";
• blockade biliary passages used drugs-holespazmolitiki. "No-Spa", "Buscopan", "Flamen";
• use at elevated bleeding "Etamsylate" and "Vikasol2 in tablet form.

In chronic liver failure, and try to avoid complications as much as possible to prepare a person for a liver transplant. The indications for the latter are:

• tumors that allow at least part of his liver to save;
• congenital liver disease;
• alveococcosis liver;
• cirrhosis of the liver;
• autoimmune hepatitis

Prognosis is poor. In 50-80% of cases of hepatic encephalopathy occurs the patient's death. When the compensated chronic hepatic failure may liver recovery only in eliminating all hepato-toxic factors and of adequate therapy. Often chronic liver failure in its initial stages are asymptomatic and diagnosis can be made only on the basis of targeted surveys. This is the cause of delayed diagnosis and treatment of diseases, which greatly reduces the chances of recovery.

Diet and eating habits

In the treatment of liver failure focuses on nutrition. The principles of diet in this pathology are as follows:

• emphasis on fractional power - need to eat little and often (5 to 6 times a day);
• from the diet completely eliminate or reduce to a minimum the protein products;
• in the diet should include a small amount of carbohydrate (honey, sweet fruits and berries), as well as foods rich in beneficial vitamins and minerals;
• in the diet is necessary to increase the amount of fat and eat more fresh fruits and vegetables;
• daily caloric intake - at least 1500kkal, thus it is necessary to prepare delicious meals, since many patients have no appetite.

After improving the gradually returning to its previous diet and injected into the first menu vegetable proteins, dairy products then. With good endurance of this diet include meals patient dietary meat.