Hepatic coma

Description:

Hepatic coma (acute dystrophy of a liver, portosistemny encephalopathy) - the disorder of consciousness connected with deep oppression of function of a liver.

Symptoms of the Hepatic coma:

The hepatic coma at a malignant form of a disease of a viral hepatitis arises at the height of clinical symptoms of a disease on 5 — the 8th day of the icteric period. Malignant forms of a viral hepatitis usually arise at children of the first year of life. The symptom complex at the same time consists, on the one hand, of signs of an abnormal liver function, and with another — of quickly progressing disturbances of the central nervous system. The initial stage is usually designated as preky, then the period which is classified as a coma of I and a coma of II follows.

Prekoma — a state with dominance of symptoms from the central nervous system in the form of concern or an adynamia, sleep disorders, hyper - hyporeflexias. Trembling of a chin, a tremor of hands, convulsive readiness of separate muscles of a trunk are noted. Constant symptoms of a prekoma are repeated vomiting "a coffee thick", fervescence, a hemorrhagic enanthesis and mucous membranes, a toxic asthma, a hepatic smell from a mouth, decrease in a diuresis, disturbance from cardiovascular system (takhi-, bradycardia). Duration of a prekomatozny state — of 12 h to several days. After prekomy the coma of I develops.

Côme I — the state which is characterized by resistant lack of consciousness. Pupils are narrowed, the photoharmose sluggish, a tremor, spasms, a hyporeflexia, but is kept reaction to strong painful irritants. Body temperature is increased (39 — 40 °C). There are pathological reflexes (Babinsky, Gordon, etc.). There can be generalized spasms, swallowing is not broken. The hemorrhagic syndrome, tachycardia, an asthma, a hepatic smell from a mouth, abdominal distention, pastosity of fabrics, decrease in a diuresis are constantly noted. The liver is palpated at edge of a costal arch (a symptom of empty hypochondrium).
In 1 — 2 days the coma of II develops. Côme II — a state at which total absence of reaction to painful irritants is noted, mydriatic pupils without photoharmose, an areflexia, pathological breath like Kussmaul or Cheyn — Stokes, spasms, sharp decline in quality of pulse, takhi-, and then bradycardia, falling of arterial pressure, an incontience of urine and a calla. Duration of this state — from several hours to one days.

Reasons of the Hepatic coma:

The hepatic coma arises at sharply expressed liver failure at patients with hepatitis, cirrhosis and an acute hepatatrophia. Irrespective of an etiology of a hepatic coma exchange disturbances, decrease in anti-toxic function of a liver and accumulation in an organism of ammonia, phenols, tyramine and tserebrotoksichesky products, disturbance of electrolytic balance are its cornerstone. Distinguish the endogenous, mixed and exogenous hepatic coma. The endogenous coma arises at a viral hepatitis, toxic dystrophy of a liver, and also at a liver replacement of tissue a tumor or cicatricial fabric at cirrhosis.

The exogenous hepatic coma (portal and hepatic, or a coma of "the disconnected liver") meets more often than endogenous. It develops at chronic diseases of a liver (cirrhosis with a syndrome of portal hypertensia, a state after imposing of a porto-caval anastomosis).

Treatment of the Hepatic coma:

Acute management is carried out in chamber of an intensive care or in the intensive care unit. It is directed to improvement of a functional condition of a liver, reduction of intoxication, recovery of water and electrolytic balance and improvement of exchange of proteins. Immediately intravenously kapelno enter 500 ml of 5% of solution of glucose from 20 - 30 ml of solution of Pananginum or 1,5 g of potassium of chloride from 10-12 PIECES of insulin. For reduction of necrotic processes in a liver appoint high doses (on 200 - 1000 mg a day) Prednisolonum. For improvement of functional capacity of a liver appoint 10 ml of 1% of solution of niacin intramusculary or intravenously, 3 ml of 1% of solution of Riboflavinum intravenously, 4 - 5 ml of 5% of solution of a pyridoxine of a hydrochloride, 5 ml of 5% of solution of Thiamini chloridum, 500 - 1000 mkg of cyanocobalamine. For fight against acidosis intravenously kapelno enter 500 - 800 ml of 4% of solution of Natrii hydrocarbonas, in 4-8 g of glutaminic acid. For reduction of intoxication appoint Neocompensanum (400 - 800 ml intravenously kapelno), exclude from a diet of a squirrel, appoint a cleansing enema, carry out гемосорбциюо, in recent years apply a plasma exchange of drugs in an umbilical vein through a catheter. At excitement and spasms Sibazonum or Seduxenum (on 0,02 g) intramusculary or intravenously, a lumbar puncture are shown. Save life of olny liver transplantation can.