Acute liver failure
Acute liver failure – the pathological simptomokompleks which is developing at changes of a parenchyma of a liver and followed by violation of its functions. The acute liver failure is characterized by symptoms of hepatic encephalopathy (unmotivated weakness, drowsiness, an adinamiya, excitement), dispepsichesky frustration, emergence and increase of jaundice, hypostases, ascites, hemorrhagic diathesis; in hard cases – development of a hepatic coma. Diagnosis of an acute liver failure is based on clinical yielded, results of a research of hepatic tests, KShchS, EEG. Treatment of an acute liver failure demands performing infusional therapy, vitamin therapy, hormonal therapy, a plasma exchange, a hemodialysis, haemo sorption, a limfosorbtion, oxygen inhalations, hyperbaric oxygenation.
Acute liver failure
Acute liver failure – a heavy syndrome as a result of which gross metabolic violations, organism intoxication products of proteinaceous exchange, a hemorrhagic syndrome, violations of activity of TsNS, a hepatic coma develop. In gastroenterology and hepatology various diseases and pathological states can be complicated by an acute liver failure. A liver failure mortality of patients makes 50-80%.
Reasons of an acute liver failure
The acute liver failure is an outcome of a number of the pathological processes leading to extensive dystrophic, fibrous or necrotic changes of a parenchyma of a liver. It can develop at the heavy course of hepatitises of various etiology (virus, medicinal, autoimmune), cirrhosis, a gepatoza, an obturation of bilious channels, poisonings with hepatotrophic toxic substances and poisons (compounds of phosphorus, arsenic, inedible mushrooms, pharmacological medicines), at infusion of the blood which is not coinciding on group accessory, etc. Sometimes the acute liver failure arises as a result of violation of hepatic blood circulation which meets at burns, sepsis, massive bleeding, thrombosis of a vorotny vein etc.
Can act as direct starting factors of development of an acute liver failure alcohol intake or medicines with hepatotoxic action, an anesthesia at operations, surgical interventions (for example, portokavalny shunting, at ascites), gastrointestinal bleeding, excess of protein in food, a renal failure, ponosa. At patients with the available damage of a liver (hepatitis, cirrhosis) the acute liver failure can be provoked by interkurrentny infections, peritonitis, thrombophlebitis of a vorotny vein, etc. states.
The pathological shifts developing in an organism at an acute liver failure are caused by accumulation in blood of connections (ammonia, amino acids, phenols) having tserebrotoksichesky effect, violation of water and electrolytic and acid-base balance, disorders of blood circulation, etc. factors. At an acute liver failure detoksikatsionny function of a liver is most broken, and also participation of a liver in various exchange processes decreases (proteinaceous, carbohydrate, fatty, vitamin, electrolytic etc.).
Classification of an acute liver failure
Allocate three forms of an acute liver failure: endogenous (spontaneous), exogenous (induced) and mixed. The functional insufficiency developing at direct defeat of a parenchyma of a liver is regarded as endogenous. In a basis it is exogenous the caused liver failure disorder of blood circulation in a liver lies that leads to dumping of the blood saturated with toxins (first of all, ammonia), in the general circle of blood circulation. At the mixed liver failure both pathological mechanisms – endogenous and exogenous take place.
On expressiveness of functional violations of a liver distinguish three degrees of a gepatopatiya. At a gepatopatiya of easy degree clinical manifestations of damage of a liver are absent. By means of laboratory tests moderate functional violations come to light (increase in enzymes, a bilirubinemiya, increase in level , etc.).
Gepatopatiya of average degree is characterized by emergence of clinical symptoms: gepatomegaliya, morbidities of a liver, attacks of hepatic colic, yellowness of integuments and skler, phenomena of hemorrhagic diathesis. In blood the giperbilirubinemiya, a gipoproteinemiya, a disproteinemiya accrues.
The heavy gepatopatiya corresponds to a stage of an acute liver failure. The symptoms of hepatic encephalopathy and a hepatic coma developing against the background of gross violation of functions of a liver join the above-named manifestations.
Symptoms of an acute liver failure
The clinical stage of an acute liver failure (hepatic encephalopathy) is characterized by drowsiness which can be replaced by excitement, an adinamiya, the progressing weakness. Dispepsichesky frustration are noted: nausea, appetite loss, vomiting, ponosa. Hypostases, the phenomena of hemorrhagic diathesis, jaundice, intoxication, ascites, fever accrue.
In the prekomatozny period psychological violations develop: dizziness, delay of the speech and thinking, frustration of a dream, acoustical and visual hallucinations, confusion of consciousness, tremor of fingers, motive excitement. Bleedings from a nose, gums, varicose and expanded veins of a gullet can be noted.
As harbingers approaching a hepatic coma serve pains in a podreberye, emergence of a "hepatic" smell from a mouth, reduction of a liver in the sizes. Actually hepatic coma is characterized by consciousness loss; spasms, hypothermia, arrhythmia, emergence of pathological reflexes, polyorgan insufficiency.
Diagnosis of an acute liver failure
Recognition of an acute liver failure is carried out taking into account symptomatology, results of a research of biochemical indicators (including hepatic tests), KShchS, tool researches (electroencephalography).
Anemia, thrombocytopenia, giperbilirubinemiya (level of bilirubin can increase in 5 and more times), increase in activity serumal are laboratory signs of an acute liver failure. In a terminal stage of an acute liver failure the gipokholesterinemiya, a gipoalbuminemiya, decrease in PTI, etc. folding factors are expressed, the hypoglycemia, a gipokaliyemiya, is noted violation of the acid and main state.
Research EEG depending on a stage of an acute liver failure reveals violation (unevenness, delay or disappearance) of an alpha rhythm, domination a theta - and delta waves.
Treatment of an acute liver failure
The central place in treatment of an acute liver failure is taken by the infusional therapy directed to desintoxication, improvement of microcirculation, metabolism, correction of electrolytic violations, restoration of acid-base balance. At an acute liver failure intravenous administration of solutions of glucose, albumine, a dextran, reopoliglyukin, sorbite, a mannitol, etc. is shown. At introduction of large volume of liquid diuretics are applied to prevention of hypostasis of a brain and lungs.
Purpose of vitamins (ascorbic acid, thiamine, Riboflavinum, pyridoxine of a hydrochloride, cyanocobalamine, niacinamide) is made. At a hemorrhagic syndrome introduction of solutions of Vikasolum, aminocaproic acid, sodium etamsylate is shown; at deficiency of factors of folding and signs of the DVS-syndrome the transfusion of large volumes of plasma is carried out. Progressing of an acute liver failure demands use of glucocorticoid hormones (Prednisolonum), antibiotics (aminoglycosides, tsefalosporin).
With the dezintoksikatsionny purpose use a plasma exchange, haemo sorption, a limfosorbtion, a hemodialysis. To stimulation of immunological activity apply Ural federal district blood, to fight against a hypoxia - hyperbaric oxygenation, oxygen inhalations.
Forecast and prevention of an acute liver failure
Timely intensive therapy of an acute liver failure significantly improves the forecast. At a deep hepatic coma the irreversible changes leading of the patient to death develop.
Prevention of an acute liver failure demands adequate treatment of primary diseases of a liver, an exception of effect of hepatotoxic or tserebrotoksichesky substances, provocative factors.