Chronic liver failure

Description:

The chronic liver failure is a morbid condition of an organism which pathogeny is made by disbolism, blood coagulations and encephalopathy connected with the progressing falling of number of normal hepatocytes. If pathological changes and fibrosis of a liver cause portal hypertensia, then the hypovolemia and orthostatic arterial hypotension join a pathogeny of a chronic liver failure connected with ascites and portal hypertensia of disturbance of a water salt metabolism.

Symptoms of the Chronic liver failure:

— syndrome of dystrophy and atrophy, development of neuritis, emergence of anemia;

— a fever syndrome — rise in body temperature to 38 °C, even to 40 °C, followed by shift in a leukocytic formula; the true septic state, a bronchial astmakteriyemiya, including in connection with existence of shunts a true transintestinal bronchial astmakteriyemiya is not excluded;

— a jaundice syndrome — a massive necrosis, со­провождающийся increase of jaundice;

— syndrome endocrine frustration: sniyozheny libidos, atrophy of testicles, infertility, gineyokomastiya, hair loss, atrophy of milk

Glands, uterus, disturbance of a menstrual cycle, education and bystry increase in telangiectasias, palmarny erythema, "phenomenon of white nails";

— a syndrome of the broken hemodynamics — in connection with accumulation of histamine-like and other vasoactive substances the difyofuzny vazodilatation that conducts, despite increase in SV, kgipotenziya takes place; edematous асцитичес - a cue the syndrome connected with decrease in synthesis of albumine and falling of oncotic pressure, a secondary hyper aldosteronism, a delay of sodium and with development of a hypopotassemia;

— a specific hepatic smell, svyazanyony with release of methyl mercaptan because of a naruyosheniye of processes of demethylation;

— hemorrhagic diathesis because of disturbance of a blood coagulation and sharp increase in a potrebyoleniye of the available coagulation factors, priyovodyashchy to widespread fibrinferments and the IDCS against the background of which bleedings are frequent.

Reasons of the Chronic liver failure:

The chronic hepatic nedostatochyonost (хпечн) arises at прогрессировашш hroyonichesky diseases of a liver (cirrhosis, zlokachestvenyony tumors and t. Д).

Pathogeny. The liver failure objyasnyayotsya by dystrophy and a widespread necrobiosis of hepatocytes and (at chronic forms) massive

Development of fibrosis and porto-caval anastomosis through which a considerable part of blood from a portal vein comes in hollow and then — to an arterial rusyolo, passing a liver (that even more reduces its participation in desintoxication of the harmful substances which are soaking up in intestines).

Disturbance of diverse functions of a liver soyoprovozhdatsya by various pathological protsesyosa. This mozhetbyttoksichesky defeat головно­го a brain and the general intoxication in connection with decrease in anti-toxic function of a liver, a massive necrosis with receipt in blood of a large amount of gistamya-nopodobny substances and surplus accumulation амино­кислот and their "splinters". It is necessary to consider disturbance of exchange of proteins, development of a heavy metabolic acidosis, accumulation of decomposition products of protein with the suyoshchestvenny growth of amino nitrogen, change of a metayobolizm of urea, decrease in synthesis of a prothrombin and other pro-coagulants. In mechanisms of development of pecheyonochny insufficiency call the disturbances of a pishcheyovareniye connected with replacement of processes of fermentation in a large intestine with rotting processes therefore a large number of a pugrestsin, a kadaveyorin, an indole, skatole which in the presence of shunts and the broken function of a liver are not neutralized is formed, and get to blood, causing heavy intoxication.

Treatment of the Chronic liver failure:

Depending on weight of a liver failure food protein content is regulated: at hepatic encephalopathy the amount of protein is reduced to 35 — 50 g a day; at a prekoma and a coma of squirrels it is completely excluded, food is provided with introduction through a gastric tube or intravenously 5 — 20%  of solution of glucose.

Drug treatment is directed to elimination of ammoniac intoxication and an azotemia.
For this purpose appoint the high cleansing enemas and drugs suppressing the putrefactive processes in intestines and also reducing ammonia absorption.

The greatest application was found by Neomycinum sulfate (2-6 g a day inside) suppressing intestinal microflora and lactulose (порталак) which reduces рН intestinal contents, slows down formation of ammonia bacteria in a large intestine, reduces absorption it and other toxic products. Lactulose is accepted on 30 — 40 g by each 4 h to easy aperient effect. At a coma lactulose is entered via the nazogastralny probe or rektalno.

In blood apply glutaminic acid to neutralization of already soaked up ammonia, орницетол which is given preference. Ornitsetol (and - an ornithine ketogluconate) connects ammonia, is appointed to 15-20 g/days intravenously in 5% glucose solution.

With the disintoxication purpose enter intravenously kapelno 5% glucose solution with vitamins and solutions of electrolytes. Per day about 2,5-3 l of liquid  under control of a diuresis are entered.
Correction of a hypopotassemia is carried out. Glucocorticoids at hepatic encephalopathy against the background of cirrhosis are contraindicated in connection with high risk of complications and side effects (increase of an azotemia, development of gastrointestinal ulcers with bleedings).

In specialized hospitals carry out a hemodialysis, perfusion of blood through a liver of the person, a pig, transplantation of a liver.