Chronic liver failure
Chronic liver failure – gradually developing liver dysfunction connected with the progressing course of chronic diseases of a parenchyma. The chronic liver failure is shown by symptoms of the main disease, the dispepsichesky phenomena (anorexia, vomiting, diarrhea), fever, jaundice, encephalopathy. At diagnosis of a chronic liver failure data of biochemical analyses, ultrasonography of a liver, a gepatostsintigrafiya, a biopsy of a liver, EEG are considered. Treatment of a chronic liver failure is directed to a detoxication, elimination of metabolic violations and the phenomena of polyorgan insufficiency.
Chronic liver failure
The liver failure in gastroenterology can be an outcome of many diseases of a gepatobiliarny and digestive tract. On a clinical current distinguish the acute liver failure developing in short terms from the moment of damage of a liver and the chronic liver failure accruing gradually. At all forms of a liver failure frustration metabolic, dezintoksikatsionny and other functions of a liver, TsNS leading to violation of activity takes place, up to development of a hepatic coma.
The chronic liver failure progresses for several months or years, differs in gradual and slow expansion of clinical manifestations.
Reasons of a chronic liver failure
Development of a chronic liver failure progressing of chronic damages of a liver – alcoholic, viral or autoimmune hepatitis, cirrhosis, tumors is the cornerstone, of a fatty gepatoz, helminthoses, tuberculosis.
The chronic liver failure can arise against the background of cholelithiasis when overlapping by a concrement of the general bilious channel takes place: in this case there is an accumulation of bile in intra hepatic bilious ways, damage and death of hepatocytes to replacement with their connecting fabric and development of secondary biliarny cirrhosis. In certain cases the disease can be caused by chronic heart failure or operations of portosistemny shunting. It is possible to carry genetic disorders of a metabolism to the rare reasons of a chronic liver failure – a galactosemia, glikogenoza, etc.
Thus, at a chronic liver failure is always available it is long existing and slowly developing which progressing till certain time restrains compensatory mechanisms. Sharp increase of a chronic liver failure can be provoked by an infection, alcohol intake, physical overfatigue, intoxications, reception of high doses of medicines (in particular, diuretic), one-stage removal of a large amount of liquid at ascites, gastrointestinal bleeding etc. In these cases there is a sharp decompensation of a course of a chronic liver failure to development of a hepatic coma.
Classification of a liver failure
On the main pathogenetic mechanism taking place distinguish:
- the hepatocellular (endogenous) liver failure proceeding with defeat of a parenchyma of a liver;
- portosistemny (portokavalny, exogenous) at which toxic products (ammonia, phenols) which are soaked up in intestines come from a vorotny vein on portokavalny anastomoza to the general blood-groove;
- mixed – combining both previous pathogenetic mechanisms.
On a clinical current allocate: a small liver failure (gepatodepressiya) proceeding with violations of functions of a liver, but without symptoms of encephalopathy, and a big liver failure (gepatargiya) at which the hepatocerebral syndrome, i.e. hepatic encephalopathy develops.
In expansion of a chronic liver failure allocate the compensated, dekompensirovanny and terminal stage which is coming to an end with a hepatic coma.
Symptoms of a chronic liver failure
Displays of a chronic liver failure are similar to those at a sharp form. Sometimes to the forefront there is a symptomatology of the main disease leading to development of a chronic liver failure.
The dispepsichesky phenomena – nausea, vomiting, a diarrhea, anorexia belong to the earliest displays of a chronic liver failure. Symptoms of violation of digestion are often connected with the use of greasy or fried food, smoked products. Wavy fever, jaundice, damages of skin (the gemorragiya which are becoming wet and dry eczemas, hepatic palms) can take place. Peripheral hypostases and ascites at a chronic liver failure develop early enough.
As feature of a course of a chronic liver failure serves existence of endocrine violations: infertility, decrease in a libido, atrophy of testicles, ginekomastiya, alopetion, atrophies of mammary glands and uterus.
Psychological frustration at a chronic liver failure have passing character and are shown by a depression, decrease in memory, alternation of drowsiness and sleeplessness, concern, periodic soporozny states, an oglushennost, orientation loss, inadequate behavior, aggression, irritability, etc. At not rendering timely medical care the hepatic coma can develop.
Diagnosis of a chronic liver failure
In view of duration of a current and low-specificity of displays of a chronic liver failure, especially at early stages, diagnostics happens not always timely.
Serve as early laboratory indicators of a chronic liver failure gradual increase in dynamics of level of bilirubin and , decrease in sugar of blood (hypoglycemia) and cholesterol, hypocoagulation signs according to a koagulogramma, etc. In urine the level of bilirubin and an urobilin in this connection it gains yellowish-brown color increases.
Ultrasonography of abdominal organs reveals a gepatomegaliya, allows to estimate a condition of a parenchyma and portal vessels, to find out the reason of a chronic liver failure. The gepatostsintigrafiya is applied to specification of extent of violation of functions of a liver. In complex diagnosis of a chronic liver failure MRT of a liver, MSKT of an abdominal cavity is used.
Carrying out an electroencephalography is expedient at emergence of symptoms of hepatic encephalopathy. Delay of a rhythm and reduction of amplitude of the registered waves can warn about the approaching hepatic coma.
Treatment of a chronic liver failure
At a chronic liver failure strict restriction of protein and table salt in a food allowance is shown. Treatment of a chronic liver failure antibiotic treatment (Neomycinum), a laktuloza (suppresses formation of ammonia in intestines and its absorption), glutamic acid, and pursues the aim of elimination of ammoniac intoxication in this connection to patients cleaning enemas and salt laxatives are appointed (for binding of already soaked up toxic products).
For the purpose of correction of electrolytic violations carry out intravenous infusions of salt solutions and glucose, pour freshly frozen plasma. For maintenance of functions of a liver gepatoprotektor, group B vitamins, cocarboxylase, vitamin K, folic acid are appointed. For removal of intoxication haemo sorption, a plasma exchange, a hemodialysis are shown.
When progressing a chronic liver failure the question of transplantation of a liver is raised.
Forecast and prevention of a chronic liver failure
Early diagnosis and therapy of a chronic liver failure improve quality of life and prolong life. Existence of cirrhosis, ascites, the alcoholic anamnesis burdens the forecast of a disease. At development of hepatic encephalopathy the lethality makes 80-90%.
It is possible to prevent progressing of a chronic liver failure by an exception of impact on an organism of provocative factors (excess consumption of protein, uncontrolled drug intake, abuse of alcohol and so forth). Patients with a chronic liver failure have to be under observation of the gastroenterologist or hepatologist.