What is liver failure and what are its symptoms. What is liver failure and what are its symptoms

Chronic liver failure is a pathological condition that accompanies chronic liver disease, characterized by the destruction of liver tissue for more than 6 months with progressive liver dysfunction.

Terminology

Chronic liver diseases such as alcoholic cirrhosis or chronic viral hepatitis - independent diseases that have own reasons, mechanisms of development, methods of diagnosis and treatment. In contrast, chronic liver dysfunction is a universal pathological process that reflects the gradual death of liver cells (hepatocytes) due to the underlying disease.

Unlike acute liver failure, which occurs up to 28 weeks from the onset of the disease, chronic hepatocellular failure can be present for many months and years, progressing from an asymptomatic phase to a pronounced syndrome. The symptoms included in this syndrome largely determine the clinic of cirrhosis - final stage chronic pathology liver. For this reason, chronic liver failure and cirrhosis are often considered synonymous.

Causes of chronic hepatocellular insufficiency

Alcohol abuse (alcoholic cirrhosis - K70.3, alcoholic liver disease - K70) - 60-70% of cases;
Impaired patency of the biliary tract due to congenital anomalies (atresia, bile duct cysts), hereditary pathologies (cystic fibrosis - E84), autoimmune (primary biliary cirrhosis - K74.3) and other (secondary biliary cirrhosis - K74.4) diseases - 5-10 % of cases;
Chronic hepatitis B or C (B18) - 10% of cases;
Hemochromatosis or hereditary disorder of iron metabolism (E83.1) - 5-10% of cases;
Non-alcoholic fatty liver disease (K76.0) - 10% of cases.

less often to chronic disorder liver function leads to autoimmune hepatitis (K75.4), drug-induced hepatitis (K71) (when taking methotrexate, isoniazid, amiodarone), genetic (alpha-1-antitrypsin deficiency (E88.0), tyrosinemia (E70.2), Wilson's disease ( E83.0), galactosemia (E74.2).

The mechanism of development of chronic liver failure

In medicine, “deficiency” is a term used to refer to a condition in which an organ is unable to perform its full function. Acute and chronic liver failure, respectively, occur when the liver is unable to cope with all the tasks assigned to it, due to the death of a large number of hepatocytes. But, if during an acute process a one-time death of 90% of liver cells occurs, then in chronic diseases the number of dead tissues increases gradually, over many months or several years.

This process is directly proportional to the degree of decrease in liver function and the stage of the disease. Take chronic alcoholic hepatitis as an example. A person daily consumes a certain amount of ethyl alcohol. At the same time, up to several tens of thousands of liver cells die, participating in the metabolism, providing the synthesis of proteins that cleanse the blood of external and internal toxins, intermediate metabolic products. After a few years, alcoholism can lead to the death of 30-40% of liver cells, which will lead to an equivalent decrease in organ function. However, this is only one side of the coin.

The liver has a huge margin of safety. In most patients, symptoms of chronic liver failure appear when more than 70-80% of hepatocytes die. Despite this, the death of liver tissues triggers a number of mechanisms, including pathological regeneration, proliferation, an influx of immune cells in the area of necrosis that support chronic inflammation, which together lead to cirrhosis - the growth of coarse connective tissues. This process completely changes the normal microscopic structure of the organ. As a result, there is a violation of blood circulation at the organ level.

Circulatory disorders are the leading factor leading to portal hypertension or an increase in blood pressure in the vascular bed located “before” the liver. Excess blood is pumped in a roundabout way into the inferior vena cava, leading to varicose veins in the esophagus and/or rectum. In combination with a violation of blood clotting processes, this leads to uncontrolled bleeding from dilated esophageal or hemorrhoidal veins with a fatal outcome.

Thus, chronic liver failure and cirrhosis are two components of the same pathological process eventually leading to the inevitable death of the patient.

Classification of chronic liver failure

V clinical practice classification of chronic liver failure by stages is used.

Stages of chronic liver failure (pathology code according to ICD-10 - K72.1)

The stage of liver function compensation;
Stage of decompensation with severe deficiency of liver function and clinical manifestations;
Terminal stage with the development of complications;
Hepatic coma (mortality rate over 80%).

Classification of the severity of chronic liver pathology according to Child-Pugh

The classification of chronic liver failure by stages has one serious drawback - there are no clearly defined criteria for the pathology of a particular patient to belong to one stage or another. For this reason, in medical practice, the Child-Pugh classification is used, which makes it possible to establish the severity of the disease according to clinical and laboratory parameters. Depending on the score, all patients with chronic liver failure or cirrhosis are divided into three classes: A, B, and C.

A-class: from 5 to 6 points;

B-class: from 7 to 9 points;

C-class: from 10 to 15 points.

Class A patients have a mild degree of chronic liver failure and a good prognosis (100% survival within the next year). B-class patients - average degree severity with a survival rate of 81% at 1 year, 57% at 2 years. C-class patients - a serious condition with a high risk of death (45% survival within 1 year, 35% within 2 years).

Chronic liver failure in children

The rapid development of chronic liver failure in the first months and years of life in children is due to congenital atresia of the biliary tract and hereditary metabolic disorders. In older children, chronic viral and autoimmune hepatitis most often lead to chronic liver dysfunction. In 5-15% of cases, the cause of the pathology cannot be established. The outcome of chronic liver pathology in children and adults is one - cirrhosis. Methods of treatment and diagnosis of chronic liver failure in children also do not differ from those in adults.

Symptoms and signs of chronic liver failure

“Head of a jellyfish” - expansion of the saphenous veins around the navel;
Ascites (accumulation of liquid transudate in the abdominal cavity);
Lack of appetite, weakness, decreased performance, increased fatigue;
Nausea, vomiting, sweetish pungent odor when breathing;
Enlargement of the liver and spleen, pain in the hypochondrium on the left and right;
Gynecomastia - an increase in the mammary glands due to excess estrogen;
Jaundice, pruritus, redness of the skin of the palms (palmar erythema);
Bleeding gums, lengthening the duration of bleeding;
swelling in the legs;
Vascular asterisks on the skin;
Significant weight loss.

In stage 3 chronic liver failure, symptoms of hepatic encephalopathy are added to the clinic, arising from toxic action ammonia, bilirubin and other toxins nerve cells. Patients complain of memory loss, amnesia, headaches, irritability, decreased intelligence, insomnia at night - drowsiness during the day. At stage 4, a hepatic coma develops due to cerebral edema. Convulsions, lethargy, loss of consciousness, lack of reflexes are observed.

The minimum required set of laboratory tests

Determination of prothrombin time and its derivatives - prothrombin index (PTI) and international normalized ratio (INR): allow you to determine the degree of impaired blood clotting and indirectly assess the degree of impaired liver function;
Blood test for alanine aminotransferase (ALT) and aspartate aminotransferase (AST): markers of liver necrosis;
Plasma bilirubin: allows you to determine the degree of impaired excretory function. Fast growth the concentration of bilirubin in the patient's blood is an unfavorable prognostic factor;
Plasma ammonia: significantly increased in liver failure and associated with a high risk of severe hepatic encephalopathy;
Blood plasma glucose: reflects the degree of carbohydrate metabolism disorder;
Blood gas composition: reveals a lack of oxygen in the blood, which may indicate the presence of respiratory distress syndrome or pneumonia, complicating the course of the underlying disease;
Creatinine: an increase in creatinine levels indicates the presence of complications in the form of hepatorenal syndrome (hepatorenal insufficiency);
Blood test for copper content and / or ceruloplasmin: used to diagnose Wilson-Konovalov disease (identifying the cause of liver failure);
ELISA for viral hepatitis A, B, C, D and E (detection of the cause of liver failure);
Blood test for antinuclear antibodies: allows you to identify autoimmune causes liver failure;
Blood test for human immunodeficiency virus.

A liver biopsy can determine the cause of liver failure. The procedure is contraindicated in severe blood clotting disorders.

Instrumental research methods are used to diagnose complications or the underlying disease. For example, using ultrasound, you can determine the degree of portal hypertension, assess the amount of fluid in the abdominal cavity. In addition, ultrasound diagnostics allows assessing the stage of liver cirrhosis using fibroscanning (Fibroscan, liver elastometry).

Endoscopy allows you to assess the condition of the veins of the esophagus and determine the likelihood of bleeding from them. MRI/CT is used in cases of suspected cerebral edema and can detect thrombosis of the liver vessels, but these methods are not widely used.

Treatment of chronic liver failure

Drug therapy

The possibilities of drug therapy are limited. Of primary importance is early diagnosis and prevention of complications. At alcoholic hepatitis the use of ethyl alcohol, even in minimal doses, is strictly prohibited.

The only treatment that can save the life of a patient with severe chronic liver failure is liver transplantation.

Indications for liver transplantation

Chronic liver failure caused by:

autoimmune hepatitis;
Alcoholic cirrhosis;
Primary biliary cirrhosis;
Sclerosing cholangitis;
Wilson-Konovalov disease;
Hemochromatosis;
cystic fibrosis;
Tyrosinemia;
Galactosemia.

The more severe the patient's condition, the higher the chance of death. For objective evaluation indications for liver transplantation and predicting the outcome of the disease without radical therapy use the modern scale of the end-stage liver disease (MELD) model. In children under 12 years of age, use the PELD scale (Pediatric End-Stage Liver Disease Scale). It evaluates biochemical parameters and general criteria: total bilirubin, albumin, patient's age, prothrombin time, severity of edema. The higher the PELD or MELD score, the higher the chance of death.

Patients with a high risk to life have priority in transplantation. Median survival after liver transplant up to 90% during the first year after transplant, up to 70% - within five years.

Complications of chronic liver failure

hepatic encephalopathy;
Hepatic coma;
Spontaneous bacterial inflammation of the peritoneum (peritonitis);
Pneumonia;
portal hypertension;
Fluid retention in the abdominal cavity (ascites);
Esophageal bleeding;
intestinal bleeding;
Impaired kidney function.

Prognosis for chronic liver failure

The prognosis depends on the underlying disease, the age of the patient, the stage of chronic liver failure and the presence of complications. In the terminal stage, in the presence of hepatic coma and other complications, mortality reaches 80-90%. In patients in the compensated stage, the prognosis is neutral - with adequate treatment, it is possible to slow down or stop the progression of chronic liver failure. For example, when alcohol disease liver, the best effect is given by the refusal to drink alcohol. Unfortunately, most patients seek medical care in the decompensated stage with severe symptoms of impaired hepatic function / cirrhosis.

The right lifestyle for chronic liver failure

Refrain from drinking alcohol;
Chronic liver dysfunction reduces immunity. Avoid crowded places of large groups of people during the seasonal SARS epidemic, get vaccinated against influenza, pneumonia, viral hepatitis A and B on time;
Do not take medicines without first consulting a doctor, especially paracetamol, non-steroidal anti-inflammatory drugs and antibiotics. Any drug from this group can provoke a complication or cause acute liver failure against the background of chronic liver disease.

Diet for chronic liver failure

Proper nutrition is of great importance in chronic liver diseases, as it can significantly reduce the load on the diseased organ. Recommended table number 5 according to Pevzner. The patient needs a balanced diet consisting of fruits, vegetables, grains, proteins, carbohydrates and a minimum amount of fat/salt. An increased amount of energy entering the body is required due to high-calorie, easily digestible foods.

During an exacerbation or decompensation of chronic liver failure, a protein-free salt-free diet is necessary. Rough hard foods that can damage the walls of the esophagus and provoke bleeding should be avoided. With ascites or edema, you need to monitor the water balance and, if necessary, limit the amount of fluid consumed.

Prevention of chronic liver failure

In order to significantly reduce the risk of chronic liver failure, it is enough to adhere to simple rules: give up alcohol abuse, lead an active and healthy lifestyle life, eat right and watch your weight.

Vaccination against viral hepatitis A and B, as well as control of transfused blood, use of disposable syringes and needles in medical institutions and beauty salons significantly reduce the risk of infection, and, consequently, the development of complications of these diseases, incl. liver failure.

A disease that is characterized by a violation of the integrity of the liver tissues due to their acute or chronic damage is called liver failure. This disease is considered complex, due to the fact that after liver damage, a violation occurs metabolic processes. If appropriate measures are not taken to cure the disease, then under certain conditions, liver failure can quickly and rapidly develop and lead to death.

Classification

The disease is classified according to two criteria: the nature of the course and stages.

According to the nature of the course, two stages of the disease are distinguished:

Acute;
Chronic.

Acute liver failure occurs due to the loss of the ability of the liver to perform its functions. The disease manifests itself predominantly within a few days and is characterized by severe form course of symptoms. Often the acute appearance is fatal, so it is very important to know the symptoms in order to recognize the disease at an early stage.

Acute liver failure is subdivided into big and small. Big is a classic form of manifestation of the disease, which is quite clearly traced by clinical and laboratory studies. Malaya acute liver failure occurs more often in children against the background of serious diseases (poisoning, intestinal infections, etc.). This subspecies is very difficult to diagnose due to the absence of symptoms of the disease. A small species can develop both rapidly and over several years.

Chronic liver failure develops through the slow course of the disease. Due to gradual liver dysfunction with progressive course chronic illness parenchyma, a chronic form of the disease is formed. Diseases such as or are the result of chronic liver failure. Both manifestations end in hepatic coma followed by death.

Additionally, there are two types of liver failure:

endogenous;
exogenous.

For endogenous species the manifestation of complications during death or dystrophic changes in the liver tissues is characteristic. This species is characteristic of cirrhosis of the liver and chronic hepatitis.

exogenous species It is formed as a result of self-poisoning of the body, the cause of which are metabolic products and substances that are produced by the intestinal microflora. It occurs due to the entry of these substances into the blood through the walls of the intestine, when they stop in the liver. The reason for the stop can be a blockage of the veins, therefore, as a result, self-destruction of the liver is observed.

According to the severity, four stages are distinguished:

Initial or compensated, which is characterized by an asymptomatic course of the disease. On the initial stage the liver begins to actively respond to toxins.
Decompensated. The first signs of the disease appear. At this stage, a blood test indicates the development of the disease.
Dystrophic or terminal. The pre-final stage, upon the onset of which the patient has serious violations of the functioning of the liver. Against the background of which there is also a violation of the work of the whole organism from the central nervous system to metabolism.
Stage of hepatic coma. It is characterized by a deepening of liver damage, which ultimately leads to death. The last stage is characterized by the complexity of treatment, since the liver passes into the stage of death.

Causes of the disease

The disease "liver failure" is diagnosed in both men and women, moreover, it has no age restrictions, so you can get sick both in childhood as well as in the elderly. The causes of liver failure are varied and unpredictable. It is important to know them in order to be able to determine the diagnosis prematurely and speed up treatment. So, the reasons that can provoke liver failure in humans are as follows:

Liver disease, which include: malignant tumors and other neoplasms, cirrhosis, acute and chronic hepatitis, echinococcus, etc. Any of these signs can serve as an impetus for the development of a fatal disease. Cirrhosis and hepatitis can be both the cause of the disease and its consequences.
Blockage of the bile ducts, as a result of which an increase in the pressure of biliary hypertension is predicted. Failure of hypertension disrupts blood circulation in the liver, which causes the development of dystrophic abnormalities in the cells of this organ.
Diseases of the heart, blood vessels, infectious infections of the body, insufficiency endocrine glands, autoimmune diseases. Any violation in the body can cause the development of a serious disease, so it is much easier to eliminate signs of abnormalities at an early stage than to try to cure serious diseases.
Taking medications(especially long time) can leave its mark on the liver. As you know, any medicine affects the liver, so it is very important to maintain the correct dosages of drugs and not violate the frequency of administration.
Poisoning by various substances organic and inorganic: poisonous mushrooms, alcohol, tobacco, chemicals etc.
Extreme Influences. The cause of a fatal disease can be even a minor burn on the skin, to which the appropriate medical measures. In addition: trauma, blood loss, allergies, septic shock and other factors can be the root cause of liver failure.
Deviation in kidney function, urolithiasis, congenital anomalies and much more, are the causes of such diseases as renal and hepatic malaise.

The main cause of renal and hepatic disease is the lack of balance between constriction and expansion of blood vessels. The reason for the lack of balance can be commonplace reason alcohol abuse, as well as poisoning, both food and respiratory. The disease of renal-hepatic insufficiency is no less serious than damage to the liver alone, since an increase in mortality from this type of disease is observed every year.

Based on all the causes, a complex of symptoms of the disease manifests itself. What are these symptoms and their main features, we will consider in more detail.

Symptoms of the disease

The symptoms of liver failure are very diverse, but they are the first factors, after the discovery of which it is necessary to hurry to the doctor. Initial stages ailments are manifested in the form of a general malaise of the body, the appearance of mania and other motor disturbances. During flexion / extension of the fingers, a tremor symptom may be observed, that is, lateral signs or trembling, which often occurs with sudden movements.

Liver failure and its symptoms are always accompanied by the development of neuritis. The patient has a rise in temperature to the level of 40 degrees with an exacerbation of the disease, as well as swelling of the legs. An unpleasant but specific odor arises from the mouth, indicating the beginning of the formation of trimethylamine and dimethyl sulfide. Disorder arises endocrine system, there is an increase in hair loss, up to baldness, libido decreases, atrophy of the uterus and mammary glands occurs in women, stratification and crumbling of nails. In women, liver failure early age can adversely affect fertility, that is, provoke development.

In addition, during the entire period of the disease, the patient has an increase in headaches, feverish manifestations, dizziness up to fainting and an aggressive state. Let us consider in more detail what symptoms are inherent in three stages diseases.

Stages of chronic liver failure

Often, chronic liver failure is characterized by four stages, which have their own symptoms.

Compensated stage it often manifests asymptomatically, but the following negative processes are observed inside the body: an increase in pressure in the hepatic system, overflow of the venous plexuses on the abdomen,. At the initial stage, you can notice an indistinct appearance on the patient's body and reddening of the palms. The patient refuses to eat food, because of disgust. There is a slight weight loss.
Decompensated stage due to increased symptoms of the disease. The first signs of the disease begin to appear: aggression, disorientation in the area, slurred speech, trembling of the limbs. Relatives can observe a significant change in a person's behavior.
Dystrophic stage caused by stupor. The patient becomes inadequate, it is very difficult to wake him up, and in moments of wakefulness, apathy is periodically replaced by excitement. There are swelling of the face, legs, accumulation of fluid in the abdominal cavity. Also, the patient may appear in the morning or evening periods of bleeding from the nose or gastrointestinal tract.
At the final stage the patient has a hepatic coma, as a result of which the patient is unconscious, while there is no reaction to external pain stimuli. The patient's vision is reduced, strabismus develops, cerebral edema and fluid accumulation occur. Chronic liver failure develops in each individual case in different ways, often over decades.

Acute symptoms

Acute liver failure occurs predominantly rapidly with a pronounced picture of symptoms. This species has the following symptoms:

sudden onset of weakness
nausea, vomiting and other signs similar to poisoning;
increase in body temperature;
an increase in jaundice, while you can observe a change in skin color to yellow. The eyeballs of the patient also become yellow;
smell from the mouth;
a decrease in the size of the liver, which manifests itself in the form of pain symptoms;
lethargy, anxiety and speech impairment.

Acute liver failure is characterized by a change in the composition of the blood: an increase in bilirubin occurs, which indicates decay and its decrease, as well as a decrease in the prothrombin index.

It is very important to deliver the patient to the clinic on time in order to be able to take medication. Otherwise, acute liver failure can be fatal in the shortest possible time.

Symptoms of kidney disease

The symptoms of renal and hepatic disease are almost identical to the above, only the only difference is the damage to the kidneys, which indicates their pain and the manifestation of the following signs:

The presence of pain first in the liver, and then in the kidneys.
Temperature increase.
Signs of jaundice.
In the urine, erythrocytes, protein and bile components are found.
Hemorrhagic diathesis is formed, the cause of which is intoxication of the body.

The main danger of a renal-hepatic disease is the involvement of other organs and systems in the process of pathology: the gastrointestinal tract, central nervous system, respiratory organs, etc. In a chronic form, the functioning of the liver tissues stops, as a result of which toxins begin to be excreted through the gastrointestinal tract and lungs. This is an abnormal condition, so the body is under severe stress.

Before starting treatment, it is important to correctly diagnose the disease. See the next section for what you need to diagnose.

Diagnostics

If all of the above symptoms are found, then you should immediately contact the hospital or call an ambulance. The clinic will require diagnostics to be able to correct setting diagnosis. First of all, the diagnosis begins with a survey and examination of the patient. Often this is not enough to make a correct diagnosis, so the doctor will prescribe clinical measures.

Clinical activities include blood donation to identify biochemical data for bilirubin, alkaline photophase, LDH, AST and ALT. According to these indicators, the doctor reveals not only the presence of signs of the disease, but also at what stage the liver disease is. The higher the scores, the corresponding more active process breakdown of liver cells.

An important place in the treatment process is given to infusion therapy, through which it is provided proper nutrition and detoxification of the body. It is also necessary to improve liver microcirculation, normalize or restore the balance of acid-base balance.

The patient is prescribed laxatives and enemas to cleanse the gastrointestinal tract of toxins and get rid of constipation. A dropper with a solution of glucose, vitamins B6, B12, and lipoic acid is administered daily.

If the disease has passed into the stage of hepatic coma, then resort to intensive medical effects. The purpose of these measures is to keep the patient alive so that hepatic function can return to normal. A solution of sodium or potassium bicarbonate is introduced, and humidified oxygen is inhaled through a nasal catheter. If the pressure decreases, then albumin is administered intravenously.

The patient must be on inpatient treatment and under the care of nurses. In addition to medical procedures, the following conditions are met:

daily monitoring of a blood test to determine the composition of albumin;
urinary monitoring;
pressure ulcer prevention;
weighing daily.

Preparations of hypoammonemic effects can reduce the level of ammonia in the body.

If the patient has a connection kidney failure, then additional hemodialysis will be required in order to remove ammonia and other toxins from the blood, which in normal conditions rendered harmless by the liver. With edema or ascites, paracentesis is necessary, which will help remove excess fluid from the body.

In addition to all of the above, to normalize the liver, you will need to maintain proper nutrition, or rather, diet.

Diet

A diet in the treatment of liver disease is a mandatory procedure, since the liver receives a significant blow precisely from malnutrition. The diet includes the following procedures:

Reducing the level of protein and fat to 30 grams per day, and carbohydrates to 300.
It is preferable to eat plant foods, which include: fruits, vegetables, honey, compotes, jelly.
Eat food only in liquid or semi-liquid composition. At the same time, you need to eat little by little, but every 2 hours.
Eliminate salt from your diet altogether.
If there are no edema, then about 1.5 liters of fluid should be drunk per day.

Diet plays an important role in the treatment of liver failure, so a complex effect will allow you to get rid of the symptoms of the disease and return to your previous healthy life.

Currently, liver failure should be understood as a clinical syndrome resulting from a breakdown in the compensatory capabilities of the liver. At the same time, the liver is not able to meet the needs of the body in metabolism and maintain the constancy of the internal environment.

There is no known type of metabolism that is not controlled by the liver. In this regard, many emergency conditions manifested and complicated by liver failure. Even 40 years ago, liver failure was not diagnosed and was taken for intoxication, pulmonary insufficiency, cardiovascular insufficiency or other pathological conditions. This circumstance was due to the fact that clinically this pathology does not have pronounced symptoms peculiar only to her.

Causes of liver failure

The causes of liver failure may be the following conditions:

Liver diseases (acute and chronic hepatitis, portal and ciliary cirrhosis of the liver, malignant neoplasms, echinococcus and others);
Obstruction bile ducts, leading to an increase in the pressure of biliary hypertension, which disrupts the lymph and blood circulation in the liver and leads to the development dystrophic changes in hepatocytes (liver cells);
Diseases of other organs and systems - heart, blood vessels, endocrine glands, infectious and autoimmune diseases;
Poisoning with hepatotoxic substances (drugs, poisonous mushrooms, dichloroethane, alcohol surrogates, antibiotics, chlorpromazine, sulfonamides.);
Extreme effects on the body (extensive injuries, burns, traumatic shock, massive blood loss, massive blood transfusions, allergization, septic shock).

Clinical and experimental studies show that, whatever the reason, the morphological changes in the liver tissue are always the same. Since liver cells are very sensitive to lack of oxygen, pathological changes occur very quickly.

Symptoms of liver failure

In the clinical picture of liver failure, there are two main points that affect its manifestations.

This cholestasis syndrome- occurs due to intrahepatic biliary disorders or extrahepatic blockage of the bile ducts. In this case, jaundice is due large quantity bound bilirubin (one of the indicators biochemical analysis blood).

Syndrome of hepatocellular insufficiency. This syndrome occurs when the liver cells fail to perform their function. A number of changes occur in them and the cells are destroyed, as a result of which a large number of intracellular components enter the bloodstream. It is by them that the severity of the pathological process in the liver is judged.

The first process causes the appearance of one of the most striking and noticeable symptoms of liver disease - this is jaundice. It can have a different color intensity from green to orange and depends on the level of obstruction of the biliary tract. Jaundice may not be with a pronounced long-term process, when acute stage slowly progresses to chronic.

The second syndrome provides most of the clinical picture. Necrosis of hepatic tissue leading to cell death serious condition patient, expressed fever. Due to edema an increase in the size of the affected liver, appears discolored stool. From the cardiovascular system occurs change in circulation. Tachycardia appears, blood pressure rises. In the future it may happen sharp drop blood pressure, due to a decrease in the volume of circulating blood, the liquid part of which will go into the tissue.

In an acute process, when going fast the rate of cell death, a number of accompanying syndromes arise, since the liver is very closely interconnected with all organs and systems. She has a lot of functions that she performs in Everyday life. The lungs are the first to suffer due to a violation of the protein-synthetic function. The liquid part of the blood begins to sweat through the walls of the capillaries into the lumen of the alveoli (lung tissue elements), thereby causing a gradual pulmonary edema.

The nervous system begins to suffer due to a violation of the cleansing function of the liver, manifested by loss of consciousness, lethargy, drowsiness, nausea and vomiting, and there may also be an opposite reaction in the form of hyperexcitability, tremors of the limbs or convulsions. The relationship between the liver and kidneys leads to a gradual decrease in the filtration capacity of the kidneys, and the next contamination of the body with products that should normally be excreted in the urine.

A chronic process that occurs as a result of continued exposure to a pathological factor leads to the formation of more distant and uncorrected symptoms. Arises portal hypertension syndrome. This is a syndrome characterized by increased pressure in venous system liver, due to impaired blood circulation in the altered liver tissue. Ascites occurs - accumulation of fluid in the abdominal cavity. All superficial venous plexuses increase, forming characteristic symptom"jellyfish" on the patient's stomach. On the chest, in the area of the shoulders and nipples, spider veins. The patient develops anemia due to a violation of the synthetic function of the liver.

All of these symptoms progress until complete liver replacement develops. connective tissue and cirrhosis develops.

Diagnosis of liver failure

There are several stages in this process.

1. Initial compensated. (Characterized by insomnia, behavioral and mood disorders, adynamia, fever, rashes on the body. Jaundice intensifies).
2. Expressed decompensated. (Increased symptoms of the first stage. Drowsiness. Inappropriate behavior, sometimes aggression, Disorientation. Dizziness, fainting. Slowing and slurring of speech. "Flapping tremor", sweating, liver smell from the mouth).
3. Terminal dystrophic. (Stupor, waking with difficulty. Agitation, restlessness, screaming. Confusion. Disruption of contact while maintaining an adequate response to pain.)
4. Hepatic coma. (Loss of consciousness. Spontaneous movements and reaction to pain at the beginning of the coma and subsequently disappear. Divergent strabismus. Absence of pupillary reactions. Pathological (plantar) reflexes. Convulsions. Rigidity. EEG - slowing down the rhythm, decreasing amplitude as the coma deepens).

The diagnosis of liver failure is based on the totality of all the measures that your doctor must take. For severe symptoms and an acute condition, contact an ambulance if you have had episodes of poisoning. It is necessary to accurately describe the drugs that you used or the liquids that you drank. The doctor should examine you and pay attention to external symptoms which have already been described previously.

Paraclinical measures include blood sampling for the determination of such biochemical indicators as ALT and AST, bilirubin, alkaline phosphatase, lactate dehydrogenase (LDH) - these indicators reflect the degree of activity of the process in the liver and the higher they are, the more actively the decomposition process occurs in the liver. Ultrasound of the liver can see both acute and chronic processes, describe the size of the liver, its structural and morphological changes.

Additional methods such as ECG, complete blood count, general urinalysis, functional tests and indicators of the coagulation and anticoagulation system will give an idea of the involvement of other organs and tissues in the pathological process.

Treatment of liver failure

The treatment of this process is very complex and lengthy and depends on the severity of the process. The patient's diet reduces total protein intake and table salt. Of the medications, you must immediately appoint antibacterial agents(2-3 generation cephalosporins, depending on the expected flora), hepatoprotective drugs Hepa-Merz. The appointment of Lactulose reduces the process and the amount of absorbed ammonia as a product of the breakdown of protein structures. With mild bleeding, vitamin K (Vikasol), with severe bleeding, it is necessary to prescribe fresh frozen plasma, taking into account the blood type and Rh factor. Vitamin D is required and folic acid to maintain adequate mineral metabolism in the prevailing conditions. When stopping the severity of the process, it is necessary to begin to treat the immediate cause that caused the development of insufficiency.

In viral hepatitis, it is necessary to administer interferon (Ribavirin) according to the treatment regimen for viral hepatitis. In case of obstruction of the bile duct by a stone, surgical intervention is necessary. With severe ascites syndrome, it is necessary to perform paracentesis to evacuate fluid from the abdominal cavity.

Prevention prognosis and complications of liver failure

The best way to prevent liver failure is to limit the risk of developing cirrhosis or hepatitis. Here are some tips to help prevent these conditions:

Get vaccinated against hepatitis with immunoglobulin type A or B. Eat a healthy diet and eat all food groups. Drink alcohol in moderation. Avoid drinking alcohol while you are taking antibacterial and toxic drugs. Practice good personal hygiene. Because germs are usually spread through dirty hands, be sure to wash your hands thoroughly after using the bathroom. Also, wash your hands before touching food. Be careful with blood transfusions and blood donations. Do not use other people's personal items, personal hygiene items, including toothbrushes and razors. If you are considering getting a tattoo or piercing for yourself, make sure that the organization that provides these services complies with all material handling measures. Be sure to use condoms when having sex.

Complications of liver failure and prognosis

Infection is a big problem. Spontaneous peritonitis occurs in most cases with an infectious lesion of the liver tissue. Opportunistic infection can lead to severe pneumonia.
Bleeding from esophageal varices can be a serious problem.
Hepatic coma is formed very quickly, since the breakdown products of the protein (ammonia and metabolites of its own amino acids) are not excreted from the body as a result of kidney damage and lead to an increase in the level of blood acidity, causing hypoxia of brain tissues.
The main complications that cause fatal outcome even after transplantation, are bleeding, sepsis, cerebral edema, renal failure and respiratory failure.

The prognosis depends on the cause of liver failure:

Hepatitis A has a good prognosis with a 50% to 60% survival rate. It accounts for about 20% of pediatric liver transplants. With Wilson-Konovalov disease liver failure represents an almost inevitable fatal outcome if there is no transplant. In the US in 1995, it was reported that 7% of all liver transplants were associated with chronic liver failure and that a one-year survival rate was 63%.

Therapist Zhumagaziev E.N.

Video about the causes, symptoms and treatment of liver failure

- sharp or chronic syndrome, developing in violation of one or more liver functions, accompanied by metabolic disorders, intoxication, disorders of the central nervous system and development hepatic coma. The disease occurs with symptoms of hepatocellular insufficiency (jaundice, hemorrhagic, dyspeptic, edematous-ascitic syndromes, fever, weight loss) and hepatic encephalopathy (emotional lability, apathy, speech disorders, hand tremor, ataxia). The extreme degree of liver failure is the development of hepatic coma. Liver failure is detected on the basis of biochemical parameters of blood, EEG, hepatoscintigraphy. Treatment of liver failure is aimed at eliminating intoxication, normalizing electrolyte disturbances, restoring acid-base balance.

Liver failure can develop by an endogenous, exogenous or mixed mechanism. The basis of endogenous insufficiency is the death of hepatocytes and the shutdown of more than 80% of the hepatic parenchyma from functioning, which is usually observed in acute viral hepatitis, toxic liver damage. The development of exogenous liver failure is associated with a violation of the hepatic blood flow, which leads to the intake of blood saturated toxic substances, from the portal vein immediately into the general circle, bypassing the liver. The exogenous mechanism is more common in bypass surgery for portal hypertension and liver cirrhosis. Mixed liver failure occurs in the presence of both pathogenetic mechanisms - endogenous and exogenous.

In the development of liver failure, three stages are distinguished: initial (compensated), severe (decompensated), terminal dystrophic and hepatic coma. In turn, hepatic coma also unfolds sequentially and includes the phases of precoma, threatening coma, and clinically pronounced coma.

Causes of liver failure

Drugs and toxins are the next most common etiological factors for liver failure. So, massive defeat hepatic parenchyma can cause an overdose of paracetamol, analgesics, sedatives, diuretics. The strongest toxins that cause the phenomena of liver failure are the poison of the pale toadstool (amanitoxin), the mycotoxin of fungi of the genus Aspergillus (aflatoxin), chemical compounds(carbon tetrachloride, yellow phosphorus, etc.).

In some cases, liver failure may be due to liver hypoperfusion that occurs in connection with veno-occlusive disease, chronic heart failure, Budd-Chiari syndrome, and profuse bleeding. Liver failure can develop with massive infiltration of the liver with tumor cells of lymphoma, metastasis of lung cancer, pancreatic cancer.

Rare causes of liver failure include acute fatty degeneration of the liver, autoimmune hepatitis, erythropoietic protoporphyria, galactosemia, tyrosinemia, etc. In some cases, the development of liver failure is associated with surgical interventions (porto-caval shunting, transjugular intrahepatic portosystemic shunting, liver resection) or blunt trauma liver.

Factors provoking the disruption of compensatory mechanisms and the development of liver failure can be electrolyte imbalance (hypokalemia), vomiting, diarrhea, intercurrent infections, alcohol abuse, gastrointestinal bleeding, laparocentesis, excessive consumption of protein foods, etc.

Symptoms of liver failure

Clinical picture liver failure includes syndromes of hepatocellular insufficiency, hepatic encephalopathy and hepatic coma. In the stage of hepatocellular insufficiency, jaundice, telangiectasia, edema, ascites, hemorrhagic diathesis, dyspepsia, abdominal pain, fever, and weight loss appear and progress. In chronic liver failure, endocrine disorders develop, accompanied by a decrease in libido, infertility, testicular atrophy, gynecomastia, alopecia, atrophy of the uterus and mammary glands. Violation of metabolic processes in the liver is characterized by the appearance of hepatic odor from the mouth. Laboratory tests at this stage of liver failure reveal an increase in the level of bilirubin, ammonia and phenols in the blood serum, hypocholesterolemia.

Treatment of liver failure

In liver failure, a diet with strict restriction or exclusion of protein is prescribed; at the precoma stage, tube or parenteral nutrition is provided.

Treatment of liver failure includes measures for detoxification, improvement of microcirculation, normalization of electrolyte disturbances and acid-base balance. For this purpose, large volumes of 5% glucose solution, cocarboxylase, panangin, vitamins B6, B12, Essentiale, lipoic acid. To eliminate ammonia intoxication and bind the ammonia formed in the body, a solution of glutamic acid or ornitsetil is prescribed.

To reduce the absorption of toxic substances, the intestines are cleansed with laxatives and enemas; prescribe short courses of antibiotics a wide range and lactulose, which suppress the processes of putrefaction in the intestines.

With the development of hepatocellular coma, the introduction of prednisolone is indicated; in order to combat hypoxia, it is advisable to carry out oxygen inhalations, hyperbaric oxygenation.

For complex therapy liver failure is applied hemosorption, hemodialysis, UVI blood.

Forecast and prevention of liver failure

With timely intensive treatment of liver failure, liver dysfunction is reversible, the prognosis is favorable. Hepatic encephalopathy in 80-90% passes into the terminal stage of liver failure - hepatic coma. With a deep coma, a fatal outcome most often occurs.

To prevent liver failure, timely treatment of liver diseases, the exclusion of hepatotoxic effects, drug overdoses, and alcohol poisoning are necessary.

The term “deficiency” in medicine characterizes a condition in which an organ cannot cope with its direct functions. Deficiency can be acute when many structural units fail in a short period of time (not cells, but their systems that perform joint functions). Also, this state can be chronic course when the quality and quantity of structural and functional units is reduced gradually. Liver failure syndrome is a complex of symptoms that are associated with insufficient protein synthesis, severe intoxication, and poor blood clotting. As a result of a combination of these symptoms, liver dysfunction develops.

Liver anatomy

The liver is the heaviest organ in the human abdominal cavity and performs many functions because it:

filters and inspects almost all substances that enter the intestines or are absorbed into the blood;

performs the synthesis of urea from toxic ammonia;

neutralizes substances that appear in the process of metabolism. indirect bilirubin, which is formed from hemoglobin and is a real poison for the brain. The liver ensures its binding with glucuronic acid and, becoming less toxic, it is excreted along with the bile;

store energy in case of emergency. It is glycogen bound in a special way glucose;

forms proteins, these are:

albumins - substances that attract water into the vessels and allow it to exist in a liquid state. Also, albumins are able to bind many toxic substances (heavy metal salts, bilirubin) and make them less toxic;

globulins are proteins that perform immune monitoring of the body, carry iron, which performs the process of blood clotting;

responsible for the destruction of enzymes and hormones;

deposits a certain volume of blood, in case of compensation for damage in case of blood loss and a state of shock;

synthesizes bile involved in the emulsification of fats;

vitamins B, D, A are deposited in the liver;

During fetal development, the liver performs the functions of the bone marrow and forms hemoglobin.

The above list is not complete, since there are more than 500 functions of this organ. Every minute, the liver performs up to 20,000,000 chemical reactions (synthesis of enzymes, proteins, detoxification).

The liver is the organ that has the best ability to regenerate. Even with only 25% of living cells and provided that toxic factors no longer affect the organ, it can fully restore its natural volume. However, this is achieved not due to cell division, but due to an increase in their volume. The recovery rate depends on the age of the patient, as well as the individual characteristics of the body.

Liver failure can occur for a variety of reasons. This includes, first of all, the intake of alcohol surrogates, mushrooms (especially pale grebe), the presence of viruses and the intake of aspirin (especially by children). It is these factors that in 80-100% of cases are the cause of the death of liver cells, the functions of which cease to be performed.

Forms of liver failure

According to the rate of death of liver cells, liver failure can differ in chronic and acute forms. Regarding the mechanism of development of pathology, it is customary to distinguish three forms of the condition:

Hepatocellular insufficiency

Occurs when an organ is damaged by toxic substances (poisons, alcohol surrogates, specific viruses, mushroom poisons). This type of liver failure can be chronic (poisoning develops gradually, and cells die slowly) and acute (cells die en masse in a short period of time).

Porto-caval form

In most cases, this form is chronic. The name itself speaks of the origin high pressure in the portal vein, which carries blood to the liver for cleaning. In order to prevent hypertension, blood enters the inferior vena cava through the connector veins. But with a long high blood pressure veins cannot cope with the load and ruptures occur different sizes, bleeding occurs: retroperitoneal, rectal, esophageal-gastric.

Insofar as blood is coming on alternative way bypassing the liver, it is not cleared of toxins. In addition, the portal vein of the liver provides a certain percentage of the nutrition of the organ, therefore, with a portocval form of insufficiency, liver cells will suffer from hypoxia. Hypoxia will be chronic as nutrition continues to be maintained by the hepatic artery, which brings blood to the liver directly from the aorta.

mixed form

This is one of the types of chronic liver failure, in which the discharge of unpurified blood and hepatocellular insufficiency are combined.

Acute liver failure

With the cessation of the functioning of large volumes of cells for a short period of time, a condition develops, which in medicine is called acute liver failure. The clinical picture of this pathology has a rapid development. Within a few hours to two months, severe intoxication, bleeding, impaired consciousness up to a coma, and impaired functionality of other organs can develop. After that, in 20% of cases, the symptoms begin to regress and the body begins to slowly recover, but in about 80-100% of cases, the patient dies with the development of hepatic coma.

If such a process develops and ends over several days, this condition is called fulminant (fulminant) liver failure. Developing against the background of an inflammatory process in the liver, it is called fulminant hepatitis. In most cases, fulminant hepatitis develops due to inflammation of a viral etiology. The impeccable leader among the causes is viral hepatitis B. The prognosis for life in the presence of fulminant liver failure is unfavorable. Such a patient can be cured only by a liver transplant from a donor, and the transplantation must be carried out even before the onset of severe bleeding and coma, and this is difficult to do. In addition, there are many complications that develop as a result of liver transplantation to cure fulminant insufficiency.

Causes of acute liver failure

The course of acute liver failure is in the form of hepatocellular failure. It can occur for the following reasons:

poisoning poisonous mushrooms: heliotrope, crosses, lines, pale toadstool. Mortality in such cases is over 50%;

taking antipyretics during development elevated temperature in children aged 4 to 12 years. Particularly dangerous is acetylsalicylic acid and products that contain salicylates. Less dangerous are Analgin, Ibuprofen, Paracetamol. The disease is called acute hepatic encephalopathy or Reye's syndrome. The death rate for children in this case is 20-30%;

other pathogenic microorganisms, which are not viruses, but can cause a generalized infection of the whole organism and the liver in particular. The most common bacterial infections are fungal infections, mycoplasmosis, rickettsiosis, salmonella, streptococcal, pneumococcal, enterococcal, staphylococcal infections;

poisoning with alcohol surrogates;

acute blood poisoning purulent inflammations intrahepatic bile ducts, with liver abscesses;

poisoning with poisons that adversely affect the liver: chlorocarbon, phosphorus;

drug poisoning, especially in case of overdose. Thus, it is possible to exceed the dose of drugs based on male hormones, drugs for the treatment of tuberculosis, sulfonamides, Cotrimoxazole, Tetracycline, Ketoconazole, Aminazine, Paracetamol;

acute circulatory disorders of the liver due to embolism of large branches of the hepatic artery with fat, gas, thrombus;

severe oncological pathologies: liver metastasis, lymphogranulomatosis, hemoblastoses;

diseases unclear etiology: for example, acute fatty hepatosis in pregnant women;

rupture of an echinococcal cyst;

surgical intervention on the abdominal organs, in which there was a violation of the blood circulation of the liver (cut or stitched a large branch of the hepatic artery, prolonged clamping of the vessel).

Symptoms of acute liver failure

Based on the symptoms and laboratory results, acute liver failure has 2 types:

minor acute failure (or hepatodepression, hepatic dysfunction);

severe liver failure (holemia, hepatargia).

Both types of the disease have different manifestations.

Hepatodepression

Symptoms of this type of liver failure are hidden behind the manifestations of the main disease (shock, meningitis, pneumonia, pneumonia, poisoning, sepsis), which caused the liver to malfunction. This:

loss of appetite;

mild nausea;

drowsiness.

Neither effusion of tissues in the cavity, nor spontaneous bleeding, nor jaundice is observed.

If the cause of hepatodepression is an intractable state of shock, in which there is either too much or too little blood in the vessels, then renal liver failure develops. This appears as:

sleep disorders;

loss of appetite;

skin itching;

cloudy urine;

decrease in urine volume.

Major liver failure (subfilminant and fulminant forms of hepatitis, hepatargia)

This state of the body is characterized by a high mortality rate. Developing against the background of viral hepatitis, such insufficiency can have a fulminant course, in which about three days pass from the onset of symptoms to the final, and most often even 24 hours. The presence of a subfulminant variant is said to be in the case when the development of symptoms takes several days or longer.

Although acute liver failure develops rapidly, several stages are distinguished in its course. In some cases, it is difficult to distinguish between them in time, since the account can go on for minutes and hours.

Suspect acute liver failure and seek emergency medical attention if you have at least one of the following symptoms:

perversion of smell and taste;

acute, severe pain in the right hypochondrium, which is not associated with eating. It can increase or decrease on its own and is not stopped by taking antispasmodics;

daytime sleepiness;

aversion to food;

vomiting that is difficult to control and does not bring relief;

constant nausea;

distraction;

odd behavior.

Symptoms that are determined only with the help of a doctor:

a decrease in the size of the liver according to the results of ultrasound and examination - in the presence of increasing or persistent jaundice;

soreness and softening of the liver on palpation;

a decrease in fibrinogen levels below 1.5 g / l and a prothrombin index level of less than 70% on a coagulogram;

increased heart rate;

an increase in body temperature in the absence of symptoms chronic cholecystitis and allergies;

the appearance of a hepatic odor from the mouth.

Precoma I (1st stage)

In this case, there is a violation of behavior, the patient becomes irritable, or is in a state of euphoria. The patient may suffer from feelings of anxiety or complete apathy. There may be a lack of orientation in the area, sleep inversion (insomnia at night and drowsiness during the day). Relatives notice in the patient, in addition to yellowing of the skin, also a change in character traits, stubbornness, aggression, which were unusual for the patient before. In this case, the patient understands that there has been a change in personality traits. The presence of a fulminant current is said to be:

flies before the eyes;

increased sweating;

handwriting change;

speech disorder;

noise in ears;

nightmares.

Precoma II (2nd stage)

This stage is characterized by the loss conscious control own behavior: a person becomes aggressive, tries to run, periodically becomes agitated, performs meaningless actions. There is a tremor of the hands, the patient makes repetitive movements, speech becomes not always legible. There is a confusion of consciousness, loss of orientation on the ground.

Coma I (3rd stage)

The person is in an unconscious state, does not respond to shouts, but periodically begins to fuss, without regaining consciousness. Spontaneous defecation and urination are noted, muscle twitches may occur. The pupils are wide and do not react to light.

Coma II (4th stage)

Consciousness is absent. The person is in the same position. There is no reaction to pain, heat and cold. The face is swollen. Arterial pressure decreases, breathing quickens. Periodically, spasms can occur throughout the body.

Other symptoms

The stages at which consciousness is disturbed are described above, however, in addition to them, liver failure is accompanied by:

jaundice. The sclera of the eyes and skin are stained yellow. Later it turns out that other fluids are also stained with bilirubin. Thus, sputum, tears acquire a yellow color, but the urine becomes dark;

liver smell from the mouth. It is caused by the accumulation of mercaptans in the blood, which are formed in the large intestine from amino acids that appeared there as a result of the vital activity of bacteria that were not neutralized by the liver;

light feces appear due to the absence of bile acids in it;

abdominal and internal bleeding - develop against the background of the fact that the liver is not able to synthesize factors that promote blood clotting. Thus, gastric (vomiting coffee grounds), intestinal (tarry stools), and uterine bleeding may appear. They can be subtle, so a daily stool test for occult blood should be done. Bleeding can develop from all organs at the same time;

bruises on yellow skin appear due to a low level of platelets in the blood.

In the midst of the pathology, acute renal failure also joins the liver. It develops against the background of vasospasm, which occurs due to a decrease in the amount of fluid contained in them, and exposure to bile acids, bilirubins, other highly toxic metabolites, as well as death renal tissue. Kidney failure manifests itself in the form of edema and a decrease in the volume of urine excreted. If a person is conscious by this time, he has husky voice and complains of thirst.

Diagnosis of the disease

If the diagnosis at the latent stage is difficult, then in the future for an experienced specialist it is enough only an external examination, tests for bilirubin and ALT, determining the boundaries of the liver and checking reflexes in order to make a diagnosis of "acute liver failure". Determining the prognosis and tactics of the disease depends on such studies:

electroencephalography: a decrease in the frequency and an increase in the amplitude of the waves, the appearance of three-phase waves, in a state of deep coma, brain activity is completely absent;

coagulogram: decrease in the level of fibrinogen, prothrombin index, coagulation factors. Fibrinogen B is in the range from 1 to 4 pluses;

biochemical blood test: increase in creatine phosphokinase, decrease in the level of urea in the blood. When attached to the main pathology of renal failure - an increase in potassium, the level of creatinine in the blood;

proteinogram - shows the state of albumin and total protein.

Next, it is necessary to establish the cause of liver failure. Determine antibodies to viruses of the herpetic group, markers of viral hepatitis, determine the presence of malarial plasmodia in the blood, carry out bacteriological examination blood for the development of sepsis. In a mandatory manner, they study the anamnesis of relatives for the presence of such manifestations, find out the patient's attitude to alcohol, the last use of alcohol, mushrooms, and the presence of particular hazard in the workplace.

Therapy for acute liver failure

The diet is liquid with the exception of animal proteins, and within 1-2 days a protein-free diet with high content carbohydrates with their total volume up to one and a half liters.

This is achieved with the help of such drugs:

intravenous injections of amino acid mixtures: "Hepaferil", "N-Hera", "Aminosteril";

to replenish the protein level - transfusion of a pharmacy solution of albumin;

v without fail drip introduction: "Glutargin", "Ornitox" ("Hepa-Merz");

intravenous administration of proton pump inhibitors (Omez, Kontralok, Rantak);

mandatory inhibitors of proteolytic enzymes: "Gordox2", "Kontrykal2;

oral administration of lactulose preparations, which neutralize the toxic effect of amino acids on the brain: "Laktuvit", "Normaze", "Dufalak";

sorbents that absorb toxins are also administered orally or through a gastric tube: White coal, "Atoxil", Enterosgel";

in the presence of viral hepatitis use glucocorticoids (hormones): "Methylprednisolone", "Dexamethasone";

to improve blood clotting, freshly frozen single-group plasma, Etamzzilat, Vikasol are prescribed.

Chronic liver failure

The development of this form of liver failure can occur in one of three ways:

porto-caval form;

hepatocellular form;

mixed form.

This condition, in comparison with acute insufficiency, progresses for a long time, from several months to several years. During this time, there is a gradual death of cells, but some of them are restored, which compensates for the functions of the liver. Symptoms do not appear immediately, but only after the death of more than 60% of hepatocytes. In the presence of chronic liver failure, signs of portal hypertension necessarily appear. This fact also distinguishes the chronic form of insufficiency from the acute form.

Chronic liver failure is an irreversible process, unlike acute form. It can be cured only at the beginning of the disease, with running form further treatment is aimed at maintaining normal quality and preventing the development of hepatic coma.

Causes of chronic liver failure

The disease can lead to this condition:

cirrhosis of the liver, The final stage chronic viral hepatitis, alcoholic or toxic origin, heavy metal poisoning, injecting drugs, hepatotoxic drugs;

parenchymal fatty degeneration, in which the cytoplasm begins to accumulate triglycerides. This occurs as a result of starvation, diabetes, overeating of fats, alcohol abuse, obesity;

parenchymal protein degeneration - the deposition of protein in the cytoplasm of liver cells. Causes: chronic intoxication of the body with pesticides, mushroom poison, hypovitaminosis, cholestasis, alcoholism, impaired protein metabolism;

parenchymal carbohydrate degeneration - accumulation of glycogen in the nuclei and cytoplasms of liver cells. Causes: hypo- and beriberi, diabetes mellitus, glycogen metabolism disorders;

liver amyloidosis. Occurs due to the deposition of abnormal amyloid protein in the liver. It develops against the background of chronic diseases leading to intoxication of the body;

chronic hepatitis: toxic, alcoholic, viral;

liver cancer;

autoimmune diseases.

Symptoms of chronic liver failure

Signs of a cell death condition are:

reddening of the palms and the last phalanx in the area of the thumb and little finger;

the appearance of telangiectasias on the skin;

skin itching;

yellowness of the sclera and skin;

dark color of urine;

light feces;

feeling of heaviness in the hypochondrium on the right;

loss of appetite;

feeling of heaviness in the left hypochondrium;

periodic bleeding from the veins of the esophagus, when vomiting coffee grounds, or from the rectum when defecation with tarry stools;

an increase in the volume of the abdomen due to the accumulation of fluid in it, the expansion of the veins of the anterior abdominal wall;

weight loss;

loss of muscle tone;

pain in the joints;

personality disorders;
rapid breathing, especially seizures during sleep;

cough with frothy pink sputum;
increased blood pressure.

Treatment chronic insufficiency liver

Treatment of liver failure is to eliminate the factors that provoke the disease. There are cases, for example, in the presence of liver cancer, when surgical treatment is required. A low-protein diet is prescribed, in which daily rate fat is - 80-90 g, carbohydrates - 400-500 g, the use of caffeine, alcohol is excluded, fluid intake is limited. Requires a change in daily routine: sufficient physical activity, without lifting weights (no more than 2 kg) and avoiding direct sun rays. Patients with chronic liver failure should get enough sleep and consult their doctor about taking any medication, even if it is a cold spray, since all drugs pass through the liver.

You also need to use the following medications:

in order to neutralize ammonia: "Glutargin", "Hepa-Merz";

antibiotics, which are adsorbed only in the intestines and destroy the local flora that process proteins obtained from food, produce amino acids that negatively affect the brain. These are "Gentamicin", "Kanamycin";

lactulose preparations that bind substances toxic to the brain: Lactulose, Dufalac, Prelaxan, Lactuvit;

veroshpiron - to reduce the risk of ascites and edema;

to reduce pressure in the portal vein - "Nebilet", "Propranolol", "Molsidomine";

with blockade of the bile ducts, cholespasmolytics are used. "No-Shpa", "Buscopan", "Flamin";

at increased bleeding use "Etamzilat" and "Vikasol2" in tablet form.

In the presence of chronic liver failure, it is necessary to avoid complications and prepare the patient to the maximum for liver transplantation. Indications for transplantation are:

tumors that allow you to at least partially preserve your liver;

congenital hepatic pathologies;

alveococcosis of the liver;

cirrhosis of the liver;

autoimmune hepatitis