Liver failure

Description:

This morbid condition which is characterized by disturbances of different types of a metabolism in an organism and intoxication products of proteinaceous metabolism owing to insufficiency of function of a liver.

Symptoms of the Liver failure:

On a clinical current distinguish an acute and chronic liver failure. The first is observed generally at an acute hepatitis, subacute dystrophy of a liver, and also at some poisonings, for example by organophosphorous substances. The chronic liver failure develops gradually at patients with chronic hepatitis, cirrhosis. It slowly progresses and, having reached high severity, as well as acute, can lead to development of a hepatic coma.

The diagnosis is established on the basis of a clinical picture and biochemical indicators. Treatment is carried out only in a hospital. At an endogenous liver failure appoint a bed rest, a rational diet (high-calorific with the increased content of carbohydrates), vitamins. At an exogenous liver failure the prevention of development of an intestinal endointoxication is necessary (restriction of protein in a diet, high enteroclyses, prescription of antibiotics of a broad spectrum of activity, etc.). The forecast at timely treatment favorable.

Symptoms, current depend on the nature of damage of a liver, sharpness of a course of process. In 1 stage clinical symptoms are absent, however tolerance of an organism to alcohol and other toxic influences, positive takes of load hepatic tests decreases (with a galactose, sodium benzoate, bilirubin, especially vofaverdiny). Clinical symptoms are characteristic of the II stage: unmotivated weakness, decrease in working capacity, dispepsichesky frustration, emergence and progressing of jaundice, hemorrhagic diathesis, ascites, sometimes gipoproteinemichesky hypostases. Laboratory researches show considerable aberrations of many or all hepatic tests; content in blood of albumine, a prothrombin, fibrinogen, cholesterol is reduced. Content in blood of aminotransferases, especially alaninaminotranspherases is usually increased, anemia, increase in SOE is often noted. Degree of an abnormal liver function can be determined also by method of a radio isotope gepatografiya. In the III stage deep disbolism in an organism, the dystrophic phenomena not only in a liver, but also in other bodies (TsNS, kidneys etc.) are observed; at chronic diseases of a liver the cachexia is expressed. There are signs of the coming hepatic coma.

The acute liver failure develops quickly, for several hours or days, and at timely therapy can be reversible. The chronic liver failure develops gradually, for several weeks or months, but accession of provocative factors (alcohol intake, esophageal and gastric bleeding from varicose veins of a gullet, the intercurrent infection, physical overfatigue, reception of high doses diuretic or single-step removal of a large amount of ascitic liquid etc.) can quickly provoke development of a hepatic coma. The forecast, especially at a chronic liver failure, adverse, however in some cases a hepatic coma (a porto-caval form) can regress and for a row of months to recur again.

Reasons of the Liver failure:

The endogenous liver failure develops owing to dystrophy or a necrosis of cells of a liver and is observed, for example, at hepatitises, hepatoses, cirrhosis, etc. Clinically it is characterized by decrease and a perversion of appetite, disgust for tobacco at smokers, intolerance of food and alcohol, nausea, and also weakness, decrease in working capacity, emotional frustration, etc. At a long chronic current the earthy-gray shade of skin or its yellowness, signs of disturbance of exchange of vitamins (poor eyesight in the dark, etc.), endocrine frustration (women have a disturbance of a menstrual cycle, men have a decrease in sexual desire, impotence, an atrophy of testicles, a gynecomastia and female type of pilosis), damages of skin (vascular "asterisks", an erythema of palms), hemorrhages or bleedings (for example, gastrointestinal), hypostases, ascites, etc. are noted. Also symptoms of a basic disease are usually observed. Diverse changes of biochemical indicators in blood serum come to light, increase in content of bilirubin, gamma-globulin, activity of aminotransferases, decrease in content of albumine, blood-coagulation factors, ethers of cholesterol, activity of cholinesterases, etc. is noted.

Understand process of intoxication as an exogenous liver failure metabolism products (ammonia, phenol, etc.) and the microbic toxins which are soaking up in intestines and getting from a portal vein to the general blood stream, passing a liver, owing to portal hypertensia (for example, at fibrinferment of a portal vein). At the same time changes of cells of a liver can be minimum. The exogenous liver failure is shown by periodically arising mental disorders (emotional instability, irritability, sleeplessness at night and drowsiness in the afternoon, further is broken consciousness) and neurologic symptoms — a paraplegia, a dysarthtia, the choreoathetoid movements, etc. These frustration have passing character, usually they are in whole or in part reversible. At the same time clinical symptoms of portal hypertensia develop. Biochemical changes (increase in content in blood of ammonia, phenols, etc.) are connected with intake of blood of a portal vein in the general blood stream through collaterals, passing a liver.

Treatment of the Liver failure:

The patient is subject to immediate hospitalization (at a viral hepatitis, a hay fever and other infectious diseases — in infectious diseases hospitals, at toxic damages of a liver — in the centers of poisonings). At sharply arisen liver failure and a hepatic coma it is very important to support by intensive medical actions the patient's life during a critical period (several days), expecting considerable regenerative ability of a liver. Carry out treatment of a basic disease, at toxic hepatoses — the actions directed to removal of a toxic factor. At a chronic liver failure carry out treatment of a basic disease and symptomatic therapy.