Diagnosis of liver failure. Chronic liver failure, features of the clinical course. Principles of treatment of chronic liver failure

Liver failure is a complex of symptoms that are characterized by a violation of one or more liver functions due to damage to the parenchyma. The liver is unable to maintain constancy internal environment in the body due to the inability to meet the needs of metabolism in the internal environment.

Liver failure includes two forms: chronic and acute. But you can still distinguish 4 degrees of liver failure: coma, dystrophic (terminal), decompensated (pronounced), compensated (initial). It is not excluded the development of fulminant liver failure, in which the probability of death is quite high.

The disease can provoke the development of encephalopathy - a symptom complex of various disorders of the central nervous system. This is a rare complication, in which the lethal outcome reaches 90%.

The pathogenetic mechanism of liver failure distinguishes:

- endogenous liver failure (hepatocellular), which occurs by affecting the liver parenchyma;

- exogenous (portocaval, portosystemic). Toxins, ammonia, phenol, are absorbed into the intestine, after which they enter the general circulation through porto-caval anastomoses from portal vein;

- mixed includes the above mechanisms.

Liver failure causes

The development of acute liver failure most often occurs due to the presence of various diseases liver or acute viral hepatitis. The formation of hepatic encephalopathy in the acute form of the disease can occur quite rarely, but no later than the 8th week from the onset of the first symptoms.

Most common causes the formation of liver failure is its defeat by drugs and a fulminant form of viral hepatitis A, B, C, D, E, G. And also due to poisoning carbon dioxide, aflatoxin, mycotoxin, industrial toxins, alcohol abuse, medicines, septicemia. Herpes zoster and zoster viruses infectious mononucleosis, herpes and cytomegaloviruses also often provoke the development of this disease.

Chronic liver failure is formed in the presence of progression of chronic liver disease (, malignant neoplasms). Most often, severe liver failure develops in people over the age of 40 who have previously been diagnosed with liver disease (more often these are drug addicts). Hepatitis E poses the greatest threat to pregnant women, as liver failure develops in 20% of cases.

Stage 3 is manifested by sopor, significant disorientation in space and time, amnesia, dysarthria, fits of anger.

At the 4th stage of hepatic encephalopathy, a coma develops in which the reaction to a painful stimulus is completely absent.

Acute liver failure

Occurs when the liver suddenly loses its ability to perform its functions. Slowly progressing liver failure is often observed, however, the acute form of the disease develops over several days and has severe complications or ends lethal outcome.

Acute liver failure is formed due to:

- overdoses of drugs (Efferalgan, Tylenol, Panadol, anticonvulsants, painkillers, antibiotics);

- abuse folk remedies (biological additives, poisoning with pennyroyal, skullcap, kava, ephedra);

- herpes virus Epstein-Barr virus, cytomegalovirus, viral hepatitis A, B, E and other viral diseases;

- poisoning with various toxins that can neutralize the connection of liver cells (poisonous mushrooms);

— availability autoimmune diseases;

- diseases of the veins of the liver;

— metabolic disorders;

— oncological diseases.

Signs of acute liver failure: nausea and vomiting, yellowing of the sclera of the eyes, mucous membranes and skin, malaise, pain in the upper right abdomen, confusion, inability to concentrate, drowsiness and lethargy.

Chronic liver failure

Chronic liver failure occurs due to gradually developing liver dysfunction due to the progressive course of chronic parenchymal disease. As a rule, symptoms of the underlying disease appear. There are dyspeptic phenomena (, vomiting,), fever, jaundice, encephalopathy.

Severe liver failure occurs due to the presence of gallstone disease, tuberculosis, helminthiases, cancer, cirrhosis, viral or autoimmune hepatitis, alcohol dependence. In rare cases, chronic liver failure is formed due to a genetic metabolic disorder - glycogenosis, galactosemia, etc.

Signs of chronic liver failure: nausea, anorexia, vomiting and diarrhea. Symptoms of impaired digestion occur due to the use of smoked meats, fried and fatty foods. Perhaps the appearance of undulating fever, jaundice, skin lesions (hepatic palms, dry and weeping, hemorrhages). Early signs of the development of the disease are ascites and peripheral edema.

Chronic liver failure manifests itself endocrine disorders: atrophy of the uterus and mammary glands, alopecia, gynecomastia, testicular atrophy, infertility. Manifest neuropsychiatric disorders in the form of: irritability, aggressiveness, inappropriate behavior, loss of orientation, stupor, periodic soporous state, anxiety, insomnia and drowsiness, memory loss,.

Treatment of liver failure

The goal of treatment is to treat the underlying disease that contributed to the development of liver failure, as well as the prevention and treatment of hepatic encephalopathy. Also, therapy will depend entirely on the degree of liver failure.

In the treatment of acute liver failure, it is necessary to observe following conditions:

- individual nursing position;

— monitoring of urination, blood sugar and vital functions every hour;

— to control 2 times a day serum potassium;

- daily blood test to determine the level of albumin, creatine, be sure to evaluate the coagulogram;

— saline administered intravenously is contraindicated;

- Prevention of bedsores.

In chronic liver failure it is necessary:

- conduct active monitoring of the general condition, taking into account the intensification of symptoms of encephalopathy;

- Weigh daily

- daily measure daily diuresis (the ratio of the amount of fluid excreted to consumed);

- daily blood test for the determination of creatine, electrolyte;

- once every two weeks, the level of albumin, bilirubin, activity of alkaline phosphatase, AlAT, AsAt is measured;

- regular performance of a coagulogram, measuring the level of prothrombin;

- in the case of the last stage of cirrhosis, it is necessary to consider the possibility of liver transplantation.

Treatment of chronic liver failure is carried out according to the following scheme:

- in the daily diet, the patient is limited to taking table salt and protein (no more than 40g / day);

- Ciprofloxacin (1.0 g 2 r. / day) is administered intravenously, without waiting for the determination of sensitivity to antibacterial drugs and the result of bacteriological examination;

- Ornithine in the first stage is administered 7 times intravenously ( daily dose- 20 g), dissolving in 500 ml of sodium chloride or glucose.

- at the second stage of treatment, Hepa-Merz is prescribed for two weeks three times a day (18 g per day);

- within 10 days, 5-10 ml is administered twice a day Hofitol;

- Normaze (Dufaoak, Lactulose) in the initial daily dosage is administered 9 ml with a gradual increase until the development of a small diarrhea. This helps to reduce the absorption of ammonia;

- for constipation, enemas are needed with magnesium sulfate (20 g per 100 ml of water);

- Vikasol (vitamin K) intravenously 3 times a day, 1 mg;

- in case of blood loss, it is necessary to inject fresh frozen plasma intravenously up to 4 doses, and in case of prolonged bleeding, repeat after 8 hours;

- you need to take a complex of vitamins with an additional introduction folic acid. Maintaining magnesium, phosphorus and calcium contributes to the maintenance of adequate mineral metabolism;

- Kvametel (Famotidine) must be administered intravenously 3 r / day, diluted in 20 ml of saline, 20 mg each;

- To increase the calorie content of food, enteral nutrition through a tube is necessary.

For the treatment of bleeding, arterial punctures should not be performed and fresh frozen plasma should be administered intravenously, as well as Famotidine 3 times a day.

In order to cure the infection, antibiotic therapy is needed. For the correct selection of medication, you need to do a blood and urine culture. If there is a catheter in the vein, it is necessary to collect material from it. Ciprofloxacin is administered intravenously 2 times a day, 1.0 g each. During catheterization of the bladder, the development of oliguria or anuria is not excluded, in this case it is necessary to irrigate with a uroseptic 2 times a day.

There are specialized hepatological centers where patients with stage 3-4 hepatic encephalopathy undergo hemodialysis through a large-porous polyacrylonitrile membrane. Due to this, low molecular weight substances (ammonia and other water-soluble toxins) are removed.

With the development of fulminant hepatitis with hepatic encephalopathy, a liver transplant is performed if:

- patients over 60 years of age;

- normal liver function preceding this disease;

- if it is possible to maintain the post-transfusion regimen for a long time in full after liver transplantation.

For the treatment of hepatic encephalopathy, diet therapy is primarily prescribed to reduce the level of ammonia in the blood and protein in the diet. The increased content of protein contributes to the deterioration of the general condition. AT daily diet include herbal products.

In order to cleanse the intestines, it is necessary to take laxatives or carry out regular enemas. It should be borne in mind that the intestines must be emptied 2 times a day.

Antibacterial therapy is carried out under strict control of the functionality of the liver. 1 g Neomycin 2 times a day, 25 mg Metronidazole 3 times a day, 0.5 g Ampicillin up to 4 times a day.

Haloperidol is prescribed as sedative if the patient has significant motor disturbances. Benzodiazepines should not be given if the central nervous system is affected.

Liver failure is a complex of clinical symptoms resulting from a violation of the compensatory capabilities and functions of an organ, as a result of which the liver cannot maintain homeostasis in the body and provide normal exchange substances. There are a lot of reasons for the development of liver failure, but regardless of them, the same changes always occur in liver cells (hepatocytes). Hepatocytes are extremely sensitive to a lack of oxygen, therefore, under certain conditions, liver failure can develop very quickly and be fatal.

• liver diseases (acute and chronic hepatitis, cirrhosis and tumors of the liver, echinococcosis, etc.);
• diseases associated with obstruction of the bile ducts, leading to hepatic hypertension and the development of degenerative changes in the liver cells;
• extrahepatic diseases (cardiovascular and endocrine systems, infectious and autoimmune diseases, etc.);
• poisoning with drugs, poisonous mushrooms, alcohol surrogates, chemicals;
• extreme effects on the human body (extensive burns, injuries, traumatic and septic shock, massive blood loss and blood transfusion and other similar conditions).

Symptoms of liver failure

In the clinical picture of the disease, several main syndromes are distinguished.

cholestasis syndrome

This syndrome occurs as a result of a violation of the outflow of bile through the biliary tract due to their blockage, most often by a stone or tumor. As a result of this, one of the most striking manifestations of the disease occurs - jaundice. The severity of this symptom depends on the level of obstruction of the biliary tract. The skin, sclera, and mucous membranes may take on a variety of hues, from pale yellow to orange and greenish. With a long course pathological process jaundice may or may not be present.

Cytolysis syndrome

This syndrome develops when hepatocytes are damaged, as a result of which liver cells cannot perform their function or die. As a result, a large amount of toxic substances enter the bloodstream, which the liver was supposed to neutralize. It is the cytolytic syndrome that causes the main symptoms of the disease.

If the death of hepatocytes occurs, the patient begins to worry about fever, weakness, loss and perversion of appetite, nausea, and sometimes vomiting. The liver may increase in size. Patients notice that the stool becomes light or completely discolored. The cardiovascular system suffers, tachycardia appears, blood pressure may rise.

With a long chronic course of the disease, the symptoms of liver failure increase slowly and are often masked by signs of the underlying disease. Signs of metabolic disorders, endocrine disorders (violation menstrual cycle in women, sexual dysfunction, gynecomastia in men). With further progression of the process, the nervous system suffers. Patients are lethargic, apathetic, drowsy, but sometimes the opposite reaction can be observed, expressed in the form of increased excitability, tremor of the limbs and convulsions. Violations in the work of the liver entail a violation of kidney function, as a result of which harmful substances that are normally excreted in the urine accumulate in the body, which contributes to increased symptoms of intoxication. As a result of impaired protein synthesis, anemia can develop.

portal hypertension syndrome

This syndrome occurs with prolonged progression of the process and is practically not amenable to correction. In the venous system of the liver, pressure increases, resulting in edema and ascites (accumulation of fluid in the abdominal cavity). Also, there is an overflow of the superficial venous plexuses on the patient's abdomen, this symptom is called "jellyfish head". Also, varicose veins of the esophagus occur, which can cause bleeding from them. Spider veins appear on the patient's chest and shoulders, erythema (redness) of the palms attracts attention.

At acute course liver failure symptoms increase very quickly, which can lead to the death of the patient. During chronic process there are several stages:

1. The compensated (initial) stage of liver failure is characterized by all the symptoms described above, which can be expressed in varying degrees. This stage of the disease can last for years.
2. The decompensated (pronounced) stage is characterized by an increase in the symptoms of the first stage. Symptoms of the disease increase, patients may behave inappropriately, aggressively, disoriented, speech becomes slurred, slowed down, tremor (trembling) of the limbs appears.
3. The terminal stage (dystrophic) stage is characterized by stupor, the patient can hardly be awakened, while apathy is replaced by excitement. Sometimes patients are absolutely non-contact, but the reaction to pain is preserved.
4. The last stage of liver failure is hepatic coma. Patients are in an unconscious state, there is no reaction to pain stimuli, convulsions, pathological reflexes appear.

Treatment of liver failure

Treatment for this serious illness- a very complex process that depends on the stage and form of liver failure.

1. Patients need treatment for the underlying disease that led to the development of liver failure.
2. Patients are strongly advised to follow a diet with protein restriction up to 40-60 g / day and table salt up to 5 g per day. If necessary, patients are transferred to tube feeding, fat emulsions can be used to increase the calorie content of the diet.
3. Antibacterial therapy begins immediately upon admission of the patient to the hospital, until the results of the analysis of the sensitivity of the microflora to antibiotics are obtained, broad-spectrum drugs (most often from the group of cephalosporins) are used.
4. Hypoammoniemic drugs (Ornithine, Hepa-Merz) help reduce the level of ammonia in the body.
5. Laxatives based on lactulose (Duphalac, Normaze) also help reduce the absorption of ammonia in the intestines, and also suppress intestinal flora that produces it. With constipation, patients are also given enemas with magnesium sulfate.
6. Patients may need hormonal and infusion therapy. In case of bleeding, vitamin K (Vikasol) is administered; in case of prolonged or massive bleeding, donor plasma is injected intravenously.
7. Vitamin therapy and replenishment of microelement deficiency. Vitamins of group B, ascorbic, folic, nicotinic, glutamic, lipoic acids are introduced. To maintain mineral metabolism, it is necessary to introduce calcium, magnesium and phosphorus.
8. When kidney failure is attached, patients may need hemodialysis in order to remove ammonia and other toxic substances which are normally detoxified by the liver. In stage 3–4 disease, hemodialysis may improve the prognosis for patients.
9. With severe ascites, paracentesis is performed to evacuate the fluid accumulated in the abdominal cavity.

Treatment of liver failure should be carried out only by a qualified specialist. Self-medication and treatment with folk remedies will inevitably lead to disastrous consequences.

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Symptoms of the disease

All liver diseases without appropriate treatment sooner or later lead to hepatic dystrophy, and it, in turn, leads to liver failure syndrome.

1. Jaundice

The first of the symptoms that is visible to the naked eye. The skin and mucous membranes of the mouth, nose, eyes, genitals acquire yellowish color due to the accumulation of bilirubin and biliverdin in them: from greenish to rich orange hues. Depending on the natural color of the skin, its shade changes, but in people who have a genetically isolated darkness, only yellowing of the sclera will be visible. eyeballs. Jaundice occurs due to the accumulation of bile. Compression of the biliary tract provokes the accumulation of fluid in the gallbladder, which can cause hepatic colic, and then it enters the bloodstream due to dysfunction of hepatocytes.

1. Discoloration of feces

The brown tone of digested food is not caused by the original components at all, but by stercobilin, which is a derivative of the components of bile. Since bile can no longer be excreted into the intestines, the stool becomes pale yellow or beige.

1. urine color

As the kidneys try to excrete the extra bilirubin, the urine becomes dark brown or yellowish brown, the color of the pigment being sought.

1. itchy skin

Uncontrollable itching appears, which is not relieved by any drugs, while eczema is not observed. It often starts with the feet and goes higher.

1. Gastrointestinal lesion

Violation of the functions of bile secretion negatively affects the course of the processes of assimilation of food. Nausea becomes a constant companion of the patient, and after eating without additional enzymes, vomiting appears.

Further degenerative processes in the intestines provoke a decrease or loss of appetite, as well as its distortion - the desire to eat obviously inedible foods. The situation is aggravated by diarrhea, which manifests itself at least three to four times a day.

1. Poisoning by internal toxins

The next stages of the disease imply a deterioration in the background of the death of liver cells that do not have time to recover or lyse in the normal way. The decay products of the body's own tissues, which were previously neutralized by the liver, now accumulate in healthy organs, disrupting metabolism. The body temperature rises, the patient feels weakness, pain in the joints and muscles. The temperature can rise to critical - 40C or stay within 37-38C. Acute processes give more pronounced symptoms of poisoning by metabolic products. Viral liver infections can exacerbate general intoxication organism due to increased release of the viral agent and cell destruction under the influence of viral parabiosis products.

1. Liver degeneration

A change in the structure of the liver is a natural consequence of the death of some of the cells. It is accompanied by an increase or decrease in the organ, depending on the type of ongoing processes.

An increase (hepatomegaly) is easily determined by palpation, confirmed by ultrasound of the abdominal organs. The common etiology of hepatomegaly is circulatory disorders, adhesions, blockage, necrosis of the blood vessels of the liver, cholestasis, the appearance and development of neoplasms - cancerous tumors, tubercles, purulent abscesses, etc.

A completely opposite picture is observed in cirrhosis of the liver, when functional fabric replaced by a connecting one. The liver decreases in size, hardens, the surface becomes wrinkled,

1. Accumulation of fluid in the abdomen, or ascites.

Our body is permeated with blood vessels, a dense network penetrating into all structures of the body. But few people know about the presence of a second, lymphatic system, which we inherited from the most ancient ancestors on the path of evolutionary development - the first creatures that landed on land, not yet warm-blooded, but already having separate blood and lymphatic systems. Lymph washes all the cells of the body, being part of the internal environment. In case of destruction, pinching lymphatic vessels lymph seeps through their walls and accumulates in the cavities, respectively, if the outflow of lymph in the liver is disturbed, the fluid accumulates in the abdominal cavity. The body literally swells, with an external examination, the stomach can be easily confused with pregnancy.

1. Circulatory disorders

Due to circulatory disorders in the liver, namely squeezing of blood vessels, pressure rises. The heart works for wear and tear, which leads to thickening of the walls, arrhythmia, bradycardia, etc. The walls of blood vessels cannot withstand pressure, fluid begins to effusion in the tissue, which causes swelling, and rupture of capillaries and blood vessels, which causes internal hematomas.

Vein dilation is a permanent symptom of all diseases that affect circulatory system. In the case when the abdominal organs are affected, the so-called spider veins appear on the shoulders, chest, and abdomen. They are vessels extending from the portal veins, which compensate for the lack of blood circulation.

1. Enlargement of the spleen.

If the liver is switched off from the functionality of the body, the spleen takes over part of its functions. Due to circulatory disorders, pressure in the inferior vena cava and portal veins increases. This, in turn, causes the spleen to enlarge as it stores the body's blood.

1. Hematemesis

This is a manifestation of the rupture of the veins of the esophagus. The patient vomits clotted blood, sometimes the blood may become visible only in the stool. May be acute or intermittent.

1. Pulmonary edema

Against the background of portal hypertension, the pressure in all blood vessels increases, and sooner or later the lungs are affected by hypertension against the background of liver failure. Patients complain of shortness of breath, cough. Over time, the condition worsens, burst blood vessels penetrating the alveoli. There is a cough with bubbling bright scarlet arterial blood.

Pulmonary edema can develop both quickly and very slowly, it all depends on individual features organism. This symptom is extremely dangerous, as it can cause respiratory arrest.

13. Hepatic encephalopathy

The last thing to take a toxic hit is the brain. The nervous system, due to the existence of the blood-brain barrier, is kept to the last, and failures in its work can lead to coma and even death. Classic Symptoms any encephalopathy - dizziness, lethargy, insomnia, cognitive impairment, delirium, convulsions, disorientation in time and space, loss of sensitivity, hyperreactivity, psychosis, depression, etc.

A critical accumulation of toxins, tissue decay products and other substances harmful to the body in the blood can cause encephalopathy, and if left untreated, the so-called “hepatic coma”, which will inevitably lead to death.

The reasons

For clarity, it is necessary to list the causes of liver failure:

Regardless of the etiology, development is the same and takes from two days to a week in the acute form and up to five years in the chronic form.

Pathogenesis and stages of the disease

It is really important for the diagnosis and treatment of liver diseases to know what processes take place in the depths of the body, causing certain consequences and to notice signs of liver failure in time. Pathological change acid-base balance and electrolyte imbalance (decrease in the amount of potassium, sodium, chloride ions in the blood, acidosis, alkalosis) provokes intoxication of the body, including the extreme symptom - hepatic encephalopathy.

The mechanics of development, or the pathogenesis of liver failure, is massive necrosis of liver cells. Necrosis develops as follows:

1. Hepatocytes are affected by a harmful agent. Cells begin to secrete enzymes that destroy dead hepatocytes and damage healthy ones along the way.
2. The immune system secretes bodies that attack damaged hepatocytes and completely destroy them.
3. The process extends to healthy tissues.
4. With the death of more than 70% of hepatocytes, symptoms of liver failure appear.
5. Metabolism cannot proceed normally. The liver can no longer store glycogen, synthesize urea and decompose ammonia, and it poisons the body.

The severity of symptoms depends on the percentage of functional and dead cells, as well as the rate of their death.

The disease is divided into three stages:

1. Initial. The compensated stage, which is characterized by an increased fight of the liver with an aggressive agent, whether it be a toxin, a virus, a bacterium, or mechanical injury. Lasts from several hours to several months, depending on the strength of the damage;
2. Expressed or decompensated. Characterized by a sudden transition from initial stage, temperature jump, sharp deterioration condition, onset of symptoms.
3. Terminal. Liver dystrophy, complete destruction of functional cells. Ends in hepatic coma, and within two days - death.

The classification of liver failure divides its types into two branches: acute and chronic. Their differences lie in the length in time and the severity of symptoms. It is worth dwelling on their description in more detail.

Acute liver failure

In acute liver failure, the compression stage is absent or very short. The symptoms are pronounced. The development time is from several days to several weeks, without treatment it quickly leads to coma and death.

There is a closer to acute, more rapid course of the disease - fulminant (fulminant) liver failure. With such a development of events, liver failure occurs in 6-10 hours. The causes of such phenomena are intoxication with poisons, medicinal substances, insecticides, pesticides, etc.

Depending on the type and location of violations, several of its forms are distinguished:

1. Hepatocellular (endogenous) - characterized by massive focal lesion hepatocytes caused by strong toxic effects (for example, poisons, drugs, etc.), acute hepatitis.
2. kzogennaya - provoked by nutritional deficiency as a result of pathologies of the blood supply. Violation of blood circulation in the liver or pathology of the veins that carry blood to it often occurs with cirrhosis. Blood circulates, bypassing the liver, poisoning all organs and systems of the body.
3. Mixed - combines both of the above forms and their symptoms, is characteristic of chronic and systemic liver diseases.

The course of the disease is always severe. Most often, acute deficiency is caused by the ingestion of a large dose of a toxic substance. Reception strong drugs, especially in combination with alcohol, after operations in the abdominal cavity or with hepatitis types A, B, C, D, E, F can also stimulate the development of the disease.

Chronic liver failure

Chronic liver failure develops slowly, against the background of a constant supply of hepatotoxic factors. Symptoms may not be noticeable at all or appear only in the last stages, after a long time (from 2 months to 6-10 years)

Initially, it may show signs of metabolic disorders, cholelithiasis, indigestion, which doctors do not associate with liver failure.

The causes of chronic liver failure can be alcoholism, hepatitis B and C, cancerous tumors liver, diabetes mellitus and other disorders of the endocrine system, autoimmune diseases

Forms of chronic insufficiency are identical with acute forms. Processes that inhibit the activity of the liver for several years are much more difficult to correct and treat. The most common form is cirrhosis of the liver, which manifests itself against the background of alcoholism. Daily ethanol intoxication leads to slow necrosis of functional tissues that cannot recover and their replacement.

Why is chronic liver failure so difficult to diagnose? All because of the extreme vitality of this remarkable gland. The liver has time to compensate for the damage, but some of the toxic substances circulate throughout the body for a long time, worsening the general condition of the body and causing complications of diseases that could not develop under other conditions. For example, if a person had a chance of developing arthritis due to working conditions, intoxication is guaranteed to increase that chance. He will come to the doctor and complain about the joints, although the original cause is in a completely different organ system.

Sooner or later, the moment comes when the liver, weakened by the chronic intake of toxins, is exposed to any additional hepatotoxic factors, and hepatocytes lose the opportunity to recover. Under such a combination of circumstances, encephalopathy and hepatic coma may occur.

What can lead to complications in chronic liver failure:

1. alcohol in any quantity;
2. Reception medicines in large doses;
3. Eating a large amount of fatty and protein foods;
4. stress;
5. Infections affecting all body systems;
6. Pregnancy;
7. General anesthesia for operations.

This disease requires adherence to a diet and a course of procedures to detoxify the body.

The prognosis, as in acute insufficiency, is unfavorable: only 30% of patients have time to start treatment on time, and with encephalopathy and hepatic coma, the chances of survival are reduced to 10-15%.

Diagnostics

Diagnosis of liver failure is carried out only by a hepatologist, gastroenterologist or general practitioner.

Diagnostic methods include:

1. General analysis blood - it includes the measurement of hemoglobin, leukocytes and erythrocyte sedimentation rate.
2. Liver blood tests - determination of total bilirubin, the level of transaminases ALT, GGT and AST, thymol test, determination of the De Ritis coefficient. They give an idea about the level of liver tissue damage, the state of the biliary tract.
3. Biochemical blood test - determination of the amount of glucose, urea, protein, cholesterol, free and bound iron, ammonia in the blood.
4. Urinalysis - for diagnosis, the color, amount of urobilin and protein are of interest. With liver failure, the indicators increase tenfold, and the color becomes close to the color of dark beer.
5. A blood test for antibodies to hepatitis viruses - in the presence of antibodies, there is also a virus, which will tell doctors how to deal with this disease. With a weakened immune system, antibodies may not be present. Then a PCR analysis is performed to determine the specific virus.
6. Ultrasound of the abdominal cavity is an instrumental method for determining the size, density of the liver, and the relief of its surface. Allows you to see tumors, tuberculous nodules and other neoplasms.
7. Computed tomography (CT) and magnetic resonance imaging (MRI) are the most accurate examination methods that clearly show the condition of the liver.
8. Liver biopsy - taking part of the biomaterial (liver tissue) for research. Allows you to see and evaluate the processes occurring with the liver tissue.

Treatment of acute and chronic forms

The most important thing for the successful treatment of liver failure is to recognize it in time. The following are quite logical recommendations, based on the above symptoms and causes.

1. It is necessary to adjust the daily routine for five meals a day, fractional meals.
2. Eliminate the source of chronic intake of harmful substances.
3. Follow a diet (in medicine it is called “table number 5” for people with a diseased liver.
4. Prevent the entry of toxic substances into the body. Implied complete failure from alcohol, medicines (except those prescribed by the attending physician), it is advisable to completely abandon bad habits.
5. Carry out procedures aimed at the speedy removal of toxins from the body.

Naturally, the relief of symptoms of acute liver failure is significantly different from the treatment of chronic.

Necessary measures for acute liver failure:

1. Detoxification: the introduction of solutions of sodium chloride, ac-salt, rheosorbilact or its analogues intravenously.
2. Protein-free diet: proteins are one of the sources of nitrogen, which, when decomposed intestinal bacteria converted to ammonia. A diseased liver cannot convert ammonia into urea, and ammonia travels through the body along with the blood, poisoning the organs.
3. Ammonia elimination - application of glutamic acid and ornithine
4. Cauterization of ulcers - in case of hemorrhage of the esophagus, it is necessary to eliminate the bleeding, possibly surgically.
5. Drugs that help restore the liver: arginine, ornithine, hepatoprotectors (Essentiale, Hepa-Merz, etc.)
6. Sedatives, painkillers, antispasmodic drugs- to calm the patient.
7. Ensuring the patency of the biliary tract, possibly with the help of surgery.
8. Fast-acting vasodilators and blood pressure lowering drugs.

All drugs are administered intravenously.

Treatment of chronic liver failure:

1. Search and relief of the underlying disease that caused liver failure.
2. Compliance with a strict diet throughout the treatment.
3. Symptomatic correction of metabolism based on individual test results.
4. Monitoring the state of the liver using instrumental methods.
5. Cleansing the intestines with enemas, lactulose preparations and drugs that inhibit the activity of microflora.
6. Conducting courses intramuscular injection vitamins to support liver recovery
7. Reception of hepatoprotectors.
8. Remember folk methods This disease has no cure!

Radical treatments

Accelerated and costly treatments include hemodialysis, plasmapheresis, and liver transplantation. A common characteristic of plasmapheresis and hemodialysis is the purification of the blood from toxins outside the body. Hemodialysis moves blood through the machine artificial kidney, and plasmapheresis - it drives plasma through special filters, leaving all harmful impurities on them. Plasmapheresis is better suited for the treatment of liver failure.

Liver transplantation is a complex and rather dangerous operation, used only in extreme cases. In order for the liver to take root, a close relationship with a donor is desirable. The operation can end in death for both the donor and the patient. The organ is transferred directly, within a few minutes from the separation from the donor. A transplant is not completely required: a part of the liver is taken and sutured to the diseased part, with the connection of all vessels and nerve endings. In Russia, such operations are carried out in the most extreme cases.

Diet and daily routine

To begin with, it is worth clarifying that if it is impossible to eat - persistent vomiting, nausea - nutrient solutions are injected intravenously, which is the main “diet” of the patient for several days, until the doctors stabilize the condition.

The main purpose of the diet is to provide essential minerals, vitamins, maintain an optimal water-salt balance and reduce the amount of ammonia released by bacteria.
For this, there is a special diet called “liver”. It is worth noting that you should not arbitrarily change the diet when similar ailments- the attending physician will tell you what to eat in your individual case.
The picture shows recommended and undesirable products for use in diseases of the liver and gastrointestinal tract.

To begin with, it is recommended to reduce protein intake to 40 grams per day (at the rate for a healthy person from 120 grams, when calculating 2.5 grams of protein per kilogram of body weight). Note that digestible protein is taken into account, and its amount varies in different protein products. Some patients feel calm when increasing the amount of protein to 60-80 grams per day. Remember, a long-term protein deficiency is fraught with metabolic disorders, hematopoiesis, muscle functionality, so the doctor will gradually bring it back to normal. Protein should be introduced gradually, starting with vegetable protein and over time, in the absence of backlash, give meat and meat products.

It is advisable to eat foods that are good for the liver. We will tell you about them in another article.
It is necessary to ensure the maximum intake of all essential amino acids to accelerate liver regeneration. Amino acids are the building blocks of

Include bran and cereals in your diet - they will help cleanse the intestines.
To ease intoxication, you need to take lactulose, which reduces the absorption of nitrogen by intestinal bacteria.

Prevention

Prevention in this case comes down to three main principles:

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Purpose of the liver

The liver is an unpaired organ, the largest and most important endocrine gland, located in the region of the right hypochondrium. In our body, this organ performs more than 500 important functions. We list the main ones:

• bile is produced in the liver, which is necessary for the breakdown and further absorption of lipids (fats) that enter the body with food;
• this body is directly involved in protein, fat and carbohydrate metabolism;
• utilizes the breakdown products of hemoglobin, turning them into bile acids and removing them from the body with bile;
• neutralizes toxins, allergens and other harmful and toxic substances, accelerates their elimination from the body in a natural way;
• deposits stores of glycogen, vitamins and microelements;
• synthesizes bilirubin, cholesterol, lipids and other substances involved in the process of digestion;
• provides splitting and utilization of excess hormones, enzymes and other biologically active substances.

The liver is the main filter of our body.

This organ is subjected to high daily loads, which we further increase if we violate the diet, eat fatty, spicy, fried foods, overeat, abuse alcohol, or randomly take drugs with a hepatotoxic effect.

At the same time, the liver is the only organ capable of self-healing. Its cells (hepatocytes) are able to regenerate due to the growth and increase in their number, and even with extensive damage (up to 70%), the liver can fully recover to its previous volume if the causes that provoke the destruction of the parenchyma are eliminated.

The rate of liver regeneration is rather slow and largely depends on the age and individual characteristics of the patient, as well as on the severity of the underlying disease that causes the destruction of hepatocytes. You can speed up the recovery of the body if you lead healthy lifestyle life and adhere to proper nutrition, that is, reduce the load on the liver. At the same time, you should know that liver regeneration is impossible if its destruction is caused by active infectious process(for example, with viral hepatitis).

Types and forms of liver failure

Depending on the nature of the course of the disease, acute and chronic liver failure are distinguished.

Acute liver failure is manifested against the background of toxic lesions of the organ (alcoholic, drug, viral hepatitis).

The chronic form of the disease develops gradually, along with the progression of hepatic pathologies (cirrhosis, fibrosis, tumor processes).

The pathogenesis of liver failure or the mechanism of the development of the disease implies its division into several types:

• Hepatic cell failure - develops when the cells of the body are damaged by toxic substances (poisons, viruses, alcoholic surrogates). In this case, the disease can proceed in an acute form, accompanied by massive death of hepatocytes, or in a chronic form, when cells die slowly and the severity of symptoms increases gradually.
• Porto-caval form - associated with impaired hepatic blood flow. As a result, blood saturated with toxic substances bypasses the liver and from the portal vein enters immediately into the general circulation. In addition, with this form of insufficiency, liver cells suffer from hypoxia. Such disorders occur due to cirrhosis or shunt surgical operations about portal hypertension.
• mixed form. In this case, chronic liver failure is diagnosed, accompanied by the death of liver cells and the discharge of blood saturated with toxins into the general circulation.

Depending on the stage of development, liver failure is divided into the following types:

• compensated (initial stage);
• decompensated (pronounced form);
• terminal (dystrophic);
• hepatic coma.

At the initial, compensated stage, there are no symptoms of the disease, the life expectancy of patients is about 20 years.

In the stage of decompensation, the disease proceeds with pronounced symptoms and periodic relapses.

At the terminal (dystrophic) stage, the patient requires permanent care and medical supervision and the disease progresses steadily.

Causes of liver failure

At the initial stage of the disease, signs of liver failure are similar to many pathologies associated with dysfunction of internal organs. Therefore, the syndrome of renal failure is so difficult to diagnose in time. A person usually does not attach much importance to the lack of appetite, weakness, fatigue, attributing the malaise to the accumulated fatigue. But as the disease progresses, it manifests itself as intolerance individual products and alcohol, taste perversion, nausea, vomiting, digestive disorders, dysfunction of the nervous system.

In the chronic course of the disease, the complexion becomes earthy, yellowness of the skin, signs of beriberi, endocrine disorders, menstrual irregularities in women and impotence in men are noted. The manifestations of liver failure are diverse, they largely depend on the form of the disease, the characteristics of the course of the disease and are expressed as follows.

Features of the course of the disease

1. cholestasis syndrome. It is associated with a violation of the outflow of bile from the liver and the accumulation in the blood of the breakdown product of hemoglobin - bilirubin. This substance exhibits toxic effect and causes itching and yellowness of the skin and sclera. In addition, with cholestasis, lightening of feces and darkening of urine, which takes on the shade of dark beer, are observed. There are pulling aching pain in the right hypochondrium associated with obstruction of the biliary tract.
2. Dyspeptic disorders. Nausea and vomiting may occur intermittently after eating certain foods or be permanent. This is due to the fact that the liver does not synthesize enough bile, which is necessary for the full digestion of fats. Lack of appetite, up to a perversion of taste and desire to consume incompatible or inedible products (chalk, earth), are associated with intoxication of the body and damage to the nervous system against the background of liver necrosis. A specific hepatic odor from the mouth, reddening of the palms, and weight loss additionally indicate developing insufficiency.
3. Symptoms of intoxication of the body. Constant weakness, increased irritability, head, articular and muscle pain, fever, fever, chills, profuse sweating at night - these manifestations are especially pronounced in acute renal failure. In this case, the temperature can rise sharply to high values or long time stay at around 38 ° C, which, together with strong weakness and malaise have an extremely negative impact on performance and general well-being person.
4. Hepatic encephalopathy It is manifested by a violation of the function of the nervous system, since toxic substances and decay products are not neutralized by the liver and, acting on the brain, cause a number of characteristic symptoms. Patients complain of dizziness, decreased concentration, lethargy, apathy, lethargy, confusion, daytime sleepiness and insomnia at night. As the disease progresses, anxiety increases. depressive states, excessive excitability, convulsions, loss of consciousness, hallucinations.
5. Symptoms of the heart and blood vessels. There are jumps in blood pressure, changes heart rate(arrhythmias), circulatory disorders.
6. Pulmonary symptoms. On the part of the respiratory system, there is the appearance of cough, shortness of breath, rapid or difficult breathing against the background of an increase in pulmonary edema. Pi this patient is afraid of suffocation and takes forced sitting position. Shortness of breath can increase not only during physical exertion, but also at rest.
7. portal hypertension syndrome is expressed by ascites (an increase in the volume of the abdomen due to accumulating fluid) and the appearance spider veins on the abdomen and shoulders. Another characteristic symptom is an increase in the size of the spleen and liver, which is easily determined by palpation of the abdomen.
8. muscle weakness(atrophy) develops against the background of a lack of glycogen - the main energy supplier for the muscles. Muscles become flabby, lethargic, a person gets tired quickly and hardly performs physical work.
9. Blood clotting disorder leads to gastrointestinal and nasal bleeding. This may cause bloody vomiting or blood in the stool (melena). The development of bleeding contributes to the expansion of the veins of the esophagus, which, against the background of portal hypertension, lose their permeability and mobility.

Thus, with liver failure, absolutely all organs and systems suffer. human body. Therefore, it is so important to start treatment in a timely manner and prevent serious complications. life threatening sick.

Diagnostic methods

When making a diagnosis, a number of laboratory and instrumental methods of examination are used. The patient must pass a series of tests:

• blood test (general and biochemistry);
• urinalysis (general);
• analysis of feces for occult blood;
• blood test for viral hepatitis;
• liver tests.

Of the modern instrumental diagnostic methods, ultrasound, CT or MRI are used. These methods allow assessing the size of the liver, its structure, the degree of damage to the parenchyma and blood vessels, as well as the presence of concomitant diseases associated with dysfunction of the biliary system (presence of stones in the gallbladder, compression of the bile ducts).

If necessary, a radioisotope scan of the liver is performed or a biopsy is taken (if malignant process) and send the biopsy to histological examination.
Additional Methods body examinations are used to assess the state of other organs and systems, since the whole body suffers from manifestations of liver failure. To this end, the patient is referred for a consultation with a cardiologist, neurologist, gastroenterologist, endocrinologist and other narrow specialists.

Treatment

The treatment of liver failure is a complex and lengthy process that includes not only drug therapy, but also the adjustment of the entire lifestyle and diet. The patient is given a specific diet, with restriction of salt and protein, which he must adhere to until complete recovery. Therapeutic measures include detoxification of the body, the use of medications, the action of which is aimed at improving blood circulation, normalizing electrolyte processes, and achieving acid-base balance.

With the development of acute liver failure, intensive therapy in a hospital setting. To restore the volume of circulating blood, a saline solution or other saline solutions while controlling urine output.

In hemorrhagic syndrome, hemostatic drugs are used to stop bleeding. With the ineffectiveness of their use, they resort to blood transfusion.

To reduce the symptoms of intoxication, drugs are administered, the action of which is aimed at enhancing intestinal motility and cleansing the body. In order to detoxify, an infusion of rheosorbilact or neogemadez is carried out.

In order to improve blood circulation in the liver and reduce edema, osmotic preparations (sorbitol) are administered, agents such as eufillin, thiotriazoline are used to expand the ducts, and cocarboxylase or cytochrome is prescribed to eliminate hypoxia. At the same time, with the help of glucose and albumin, they replenish energy reserves organism. To speed up the processes of regeneration and restoration of liver cells, the following drugs are used:

• hepatoprotectors (Essentiale, Essliver Forte, Liv-52);
• Arginine, Hepa-Merz (these funds help the formation of urea from ammonia);
• amino acids, vitamins of group B, PP.

To maintain the work of the brain, drugs are used to improve cerebral circulation (Actovegin, Cerebrolysin), diuretics (Mannitol, Lasix), as well as sedatives.

In chronic liver failure, the pathologies that led to damage to the liver cells should be treated first. In addition to taking basic medications, it is necessary to adjust the metabolism, based on the data of a biochemical blood test, and also follow a certain diet. To the list of essential drugs in the treatment chronic forms liver failure include:

• broad-spectrum antibiotics that do not toxic effect on the liver (Neocin);
• amino acids (glutamic acid), which bind ammonia and remove it from the body;
• lactulose preparations (Dufalak, Portalak), which inhibit pathogenic microflora and eliminate ammonia intoxication;
• potassium preparations, vitamins C, PP, group B - compensate for the lack of potassium, improve the condition of blood vessels, activate the processes of regeneration of liver cells, and exhibit antioxidant properties;
• hepatoprotectors (Heptral, Essentiale Forte) - contain amino acids and phospholipids, which are the building material for liver cells.

If necessary, the body is detoxified with infusion solutions (glucose, sodium chloride solution or Ringer's solution). With stagnation of bile prescribed choleretic agents(Allochol, Holosas), for pain in the right hypochondrium, antispasmodics (No-shpu, Drotavein) or Baralgin are used.

AT severe cases, at the stage of hepatic coma, hemodialysis and plasmapheresis procedures are necessary to clean and filter the blood from toxic substances.

Diet and nutritional habits

In the treatment of liver failure, special attention is paid to proper nutrition. The principles of dietary nutrition in this pathology are as follows:

• protein products are completely excluded from the diet or reduced to a minimum;
• emphasis is on fractional nutrition- you need to eat little by little, but often (5-6 times a day);
• in the diet it is necessary to increase the amount of fiber and eat more fresh fruits and vegetables;
• the diet should include a small amount of easily digestible carbohydrates (honey, sweet fruits and berries), as well as foods high in beneficial vitamins and microelements;
• daily calorie intake - at least 1500 kcal, while you should cook delicious food, as many patients have a lack of appetite.

After the condition improves, they gradually return to the previous diet and enter the menu first. vegetable proteins, then dairy products. With good tolerance of such a diet, dietary meat is included in the patient's diet.

It is necessary to maintain water balance, increase fluid intake, avoid heavy physical activity to normalize the psychological state, to establish correct mode work, rest and sleep.

from taking any alcoholic beverages should be abandoned completely, as well as the unsystematic use of drugs. You can take only those medicines that have been prescribed by your doctor. As the condition improves, it is recommended to move more and take long walks on fresh air.

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Causes of liver disease

The gland has the property of regeneration, and this allows you to restore the organ structure, normalize the functioning of hepatocytes. Initially, the volume of the liver increases due to the remaining cells by increasing them. The reproduction of hepatocytes occurs much more slowly, due to which the physiological structure is restored.

The causes of liver disease are quite diverse, let's focus on the most common:

• traumatic injury organs due to a blow to the stomach (accident, fall from a height). External signs may be absent. The first symptoms may appear several years after the injury, indicating the presence of cystic formations in the liver. To identify additional neoplasms, it is enough to conduct an ultrasound examination;
• medicinal effect. What are hepatotoxic drugs? The most aggressive for the liver are considered antibacterial agents, chemotherapy drugs, steroids;

Classifications of liver diseases

Various liver diseases in humans develop as a result of damage to hepatocytes, lobules, vessels or bile ducts. Consider the types of pathologies:

With liver disease, in the case of continued exposure to a provoking factor, the outcome of the disease is represented by cirrhosis, as well as liver failure, up to death.

Manifestations in men

What are the most common symptoms in patients with liver disease? Here is a list of clinical signs hepatic pathology:

• discomfort in the hypochondrium (right);
• hepatomegaly;
• severe weakness;
• decrease in working capacity;
• headache;
• loss of appetite;
• violation of cognitive functions;
• weight loss;
• yellowness of the skin, sclera;
• irritability;
• depression;
• puffiness lower extremities, ascites, due to which the abdomen increases in volume;
• dark urine, discoloration of feces;
• spider veins associated with disorders in the coagulation system;
• vascular fragility, tendency to bleeding;
• intestinal dysfunction in the form of diarrhea;
• visualization of veins on the anterior abdominal wall;
• itching of the skin;
• blurred vision;
• bitterness in the mouth;
• cardiopalmus;
• fragility of nails;
• nausea, vomiting;
• hair loss;
• yellow, brown coating on the tongue;
• bad breath;
• subfebrile condition or high fever.

Separately, it should be described what pain sensations are in hepatic pathology. List of possible pain symptoms that are observed in hepatic dysfunction:

• slight aching pain. It is also possible bursting, heaviness. They indicate a sluggish inflammatory process. In most cases pain syndrome observed with an increase in the body, when its capsule is overstretched;
• severe pain of a diffuse nature in the right hypochondrium indicates a severe inflammatory process with a purulent component or traumatic damage to the organ;
• severe pain in a certain place. It indicates the pathology of the gallbladder, as well as the ducts;

Pain in hepatic diseases may be completely absent, which complicates the initial diagnosis.

Depending on the stage of liver disease in men, the symptoms can be expressed in varying degrees of intensity. With the growth of endogenous intoxication, the consciousness of a person is depressed, up to hepatic coma, as a manifestation of dysfunction of the nervous system.

Diagnostic methods

People do not always pay attention to the first signs of liver disease, which is why the pathology is often diagnosed on late stage. Now let's talk about how to determine the disease.

How to find out about liver disease? When contacting a doctor, a survey of complaints is carried out, a physical examination, during which the specialist carefully examines the area of ​​\u200b\u200bthe right hypochondrium. On palpation (palpation) of the liver, its size, density, outlines, and surface are established.

The doctor also pays attention to the color of the skin, the presence of rashes, the color of the tongue, the volume of the abdomen, and others. external signs pathology.

Based on the results of an objective examination and the clinical picture, a range of diagnostic methods is determined to confirm the diagnosis.

How to identify liver disease? Laboratory and instrumental methods are used to examine the patient. Laboratory studies include:

1. blood chemistry. It is interested in the level of bilirubin, alkaline phosphatase, transaminases, total protein;
2. coagulogram (to assess the state of the coagulation system);
3. clinical blood test (required to determine the level of hemoglobin, erythrocytes, leukocytes, eosinophils);
4. Analysis of urine;
5. coprogram;
6. tests for viral hepatitis, HIV.

How to recognize signs of liver disease in men using instrumental methods?

1. ultrasound procedure. It is absolutely safe and can be done an unlimited number of times. Ultrasound is prescribed for the primary detection of a pathological focus, assessment of the dynamics of treatment, as well as for prophylactic purposes;
2. computer, magnetic resonance imaging, thanks to which it is possible to visualize the focus at the initial stage, clarify its size, consistency, assess the state of surrounding tissues and organs;
3. duodenal sounding - to assess the function of the gallbladder. Bile may also be collected for culture. Based on its results, it is possible to select effective antibacterial drugs for infectious cholecystitis, cholangitis;
4. puncture followed by histology;
5. laparocentesis - to remove ascitic fluid from the abdominal cavity;
6. vascular doppler;
7. laparoscopy. Surgery often uses endoscopic instruments for diagnostic purposes. The doctor on the screen sees the condition of the abdominal organs, assesses the prevalence of the process.

Medical tactics

Symptoms of liver damage in women can be eliminated with dietary nutrition, as well as drug therapy. Thanks to an integrated approach, it is restored digestive function, the general condition is facilitated.

Additionally, you can be treated with folk remedies that normalize the functioning of the gland.

1. daily calorie content - a maximum of 3000;
2. the number of meals - up to 6 per day;
3. small portions;
4. adequate fluid intake.

Signs of liver disease in women and men can be reduced if the following are excluded from the diet:

Treatment of liver diseases allows:

1. one egg per day;
2. rosehip decoction;
3. lean meat, fish, milk;
4. yesterday's bread;
5. many vegetables.

Medical treatment of liver diseases

To eliminate the cause of the pathology, to support and restore the liver, the following can be prescribed:

Detoxification is carried out with infusion solutions. Surgically echinococcosis can be treated, calculous cholecystitis, liver cancer. If the liver is affected by a malignant process, targeted chemotherapy can be additionally prescribed, and ablation can also be performed.

Folk methods

Oats have a healing effect on the gland. Its grains can be used for the preparation of infusions, jelly. You should refuse treatment with oats:

• in the acute stage of a viral disease;
• with severe weakness;
• with diabetes;
• in the acute phase of hepatic pathology;
• during pregnancy;
• with urine, cholelithiasis;
• in the lactation period.

Treatment with oats involves the use of unpeeled grains. Here are some recipes with oats:

1. 100 g of grains should be poured with 1 liter of water, boiled under an ajar lid for a quarter of an hour. After cooling, you need to drink 460 ml per day, dividing the entire volume into 4 doses. To improve the taste sensations, it is allowed to add honey;
2. ingredients for the following recipe: 2.5 liters of water, 20 g of oats, dry knotweed, 15 g of chopped rose hips, corn stigmas, lingonberry leaves, birch buds. The first thing to do is oats. It must be mixed with lingonberry leaves, birch buds, pour 1.8 liters of water, leave to infuse for a day. Rosehip should be poured with 700 ml of boiling water, insisted in a thermos for a day. After 24 hours, boil the oatmeal infusion, add the remaining ingredients, boil for 35 minutes, then cool. Now the medicine must be filtered, add a rosehip decoction. The therapeutic course is 7 days. Scheme of therapy: on the first day you need to drink 60 ml three times, on the second day - half a glass, then a single volume remains the same (120 ml), but the frequency of administration decreases to two per day;
3. pour 200 g of oats into a saucepan, pour a liter of water, boil for half an hour. Now you need to add boiling water to the broth until you get a total volume - a liter. Wait for cooling, filter, add lemon juice (from half a citrus), 15 g of honey. Drink 120 ml three times half an hour before meals.

Oat therapy alone cannot lead to a complete cure for liver disease. In addition, you should not start therapy yourself if the cause of the lesion of the gland is not known. Incorrectly selected drugs can not only not lead to the desired result, but also significantly worsen the course of the pathology.

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Classification

Deficiency is classified according to the nature of the course and stages.
The nature of acute and chronic insufficiency differs.
The acute form develops in the acute form of hepatitis, poisoning or subacute liver dystrophy.
The chronic form is characteristic of cirrhosis of the liver, chronic hepatitis. Both forms of insufficiency can end in hepatic coma.
The stages differ: compensated, decompensated, dystrophic and hepatic coma.

In addition, endogenous and exogenous insufficiency are separated.
Endogenous- is a complication of the death or degeneration of liver tissue and is characteristic of cirrhosis, hepatitis.
exogenous- this is self-poisoning of the body by metabolic products and substances produced by the intestinal microflora. This happens if the above substances enter the blood through the walls of the intestine and do not pass through the liver, for example, if the portal vein is clogged. This form insufficiency does not cause changes in the quality of liver tissue.

The reasons

Causes of liver failure are divided into hepatogenic and extrahepatic.
Hepatogenic: diseases and phenomena that directly affect the liver tissue.
Extrahepatic: processes that affect liver function indirectly.

Hepatogenic:

• Dystrophy ( use of drugs, sulfonamides, antibiotics, poisoning with toxic substances, alcohol, mushrooms)
• Hepatitis
• Cirrhosis.

Extrahepatic:

The endogenous form is characterized by:

• Aversion to food
• Aversion to alcohol in people who drink before)
• Aversion to nicotine in former smokers)
• Lethargy
• Weakness
• mood instability
• The complexion becomes grayish or yellowish
• Night blindness appears
• The menstrual cycle is disturbed in women, libido in men, other hormonal disorders appear
• Has a tendency to bleed
• Puffiness.

The exogenous form is characterized by:

• Mental instability of a temporary nature up to mental disorders
• bad dream
• neurological symptoms.

Acute liver failure

This condition develops when a large number of liver cells are killed in a short time, which causes organ dysfunction in people whose liver was previously healthy.
The main symptom of acute liver failure is hepatic encephalopathy.
The condition causes death in 50 to 90% of cases.

The main factors that provoke this condition:
1. viral hepatitis
2. Paracetamol poisoning
3. Poisoning by poisons that destroy liver cells ( counterfeit alcohol, mushrooms)
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5. Liver dystrophy during pregnancy, passing in an acute form.

Signs:

• General deterioration in well-being
• Yellowing of the sclera, skin
• Rotten meat smell from the mouth
• Trembling of limbs
• Puffiness.

What to do?
Urgently go to the hospital.

Diagnostics

1. Questioning the patient about his bad habits, past illnesses, medicines used by him.
2. General blood analysis
3. Coagulogram
4. Analysis of urine
5. Biochemistry of blood
6. Analysis for alpha-fetoprotein
7. abdominal ultrasound
8. Abdominal x-ray
9. Radionuclide scanning
10. Electroencephalogram
11. Biopsy of liver tissue.

In children

Despite the fact that this condition is quite rare in children of the first year and a half of life, in 50% of cases it ends in death. And saving the life of a child depends only on the competent and timely actions of parents and doctors.
In newborn babies under the age of 15 days, liver failure is often caused by the immaturity of the production of certain enzymes.
In addition, in babies, the cause of this condition may be hypoxia and an increased amount of proteins in the body.

Liver failure in children causes a lot of ailments. The child is weak, inactive, sleeps a lot, his head hurts. Digestion of food is disturbed: diarrhea, bloating, vomiting. My stomach hurts, my heart rate is erratic.
If you do not give the baby emergency assistance he falls into a coma.
Treatment of a baby with liver failure is carried out only in a hospital. In the future, after being discharged home, the child should adhere to a special diet for a long time and take increased doses of vitamins of the group B, A, C, K .

Treatment

Treatment of liver failure of any stage and in patients of any age should be carried out only in a hospital.
It is necessary to maintain the vital activity of the patient's body and at the same time fight the underlying ailment that caused this condition.
If the cause of deficiency is poisoning, toxins are removed from the body with the help of laxatives. To cleanse the body of ammonia, use intravenous injections glutamic acid twice or thrice a day for 3-4 days.
Also infuse glucose, vitamins AT 12 and AT 6 , cocarboxylase, panangin, lipoic acid.
Use of oxygen installations and oxygen pillows is obligatory.
In the chronic form of insufficiency, drugs are prescribed that alleviate the patient's condition, reduce the proportion of protein in food, enemas are shown to cleanse the intestines, as well as from time to time antibiotics, vitamins of the group AT in the form of injections vitohepat.

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 having their own causes, 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 pronounced syndrome. The symptoms included in this syndrome largely determine the clinic of cirrhosis - the final stage of chronic liver pathology. 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 development (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 disease liver (K76.0) - 10% of cases.

Less often, autoimmune hepatitis leads to chronic liver dysfunction (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 at acute process there is a one-time death of 90% of liver cells, 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 coagulation 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 one pathological process, eventually leading to the inevitable death of the patient.

Classification of chronic liver failure

In clinical practice, the classification of chronic liver failure by stages is used.

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

1. The stage of liver function compensation;
2. Stage of decompensation with severe deficiency of liver function and clinical manifestations;
3. Terminal stage with the development of complications;
4. 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 indicators. 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 mild degree chronic liver failure and a good prognosis (100% survival within the next year). Class B patients are moderate with 81% survival 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, skin itching, 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 the toxic effect of ammonia, bilirubin and other toxins on 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. A rapid increase in 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: allow you to identify autoimmune causes of liver failure;
• Blood test for human immunodeficiency virus.

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

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. Besides, ultrasound diagnostics allows you to assess 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 hepatic vascular thrombosis, but these methods are not widely used.

Treatment of chronic liver failure

Drug therapy

The possibilities of drug therapy are limited. Early diagnosis and prevention of complications are of primary importance. 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 an objective assessment of indications for liver transplantation and predicting the outcome of the disease without radical therapy, a modern scale of the model is used. terminal stage liver disease (MELD). In children under 12 years of age, the PELD scale (Pediatric End-Stage Liver Disease Scale) is used. At the same time, biochemical parameters and general criteria are evaluated: 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 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 can slow or stop the progression of chronic liver failure. For example, in alcoholic liver disease, the best effect is to avoid drinking alcohol. Unfortunately, most patients seek medical help 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;
• 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 on the background chronic disease liver.

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 minimum quantity 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, eat right and monitor 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.

At this syndrome violated metabolic processes in the body, it is poisoned by the products of protein metabolism.

Classification

In addition, endogenous and exogenous insufficiency are separated.
Endogenous- is a complication of the death or degeneration of liver tissue and is characteristic of cirrhosis, hepatitis.
exogenous- this is self-poisoning of the body by metabolic products and substances produced by the intestinal microflora. This happens if the above substances enter the blood through the walls of the intestine and do not pass through the liver, for example, if the portal vein is clogged. This form of insufficiency does not cause changes in the quality of liver tissue.

The reasons

Hepatogenic: diseases and phenomena that directly affect the liver tissue.
Extrahepatic: processes that affect liver function indirectly.

The condition causes death in 50 to 90% of cases.

The main factors that provoke this condition:
1. viral hepatitis
2. Paracetamol poisoning
3. Poisoning by poisons that destroy liver cells ( counterfeit alcohol, mushrooms)
4. Wilson-Konovalov disease
5. Liver dystrophy during pregnancy, taking place in an acute form.

Signs:

• General deterioration in well-being
• Yellowing of the sclera, skin
• Rotten meat smell from the mouth
• Trembling of limbs
• Puffiness.

Diagnostics

In children

Liver failure in children causes a lot of ailments. The child is weak, inactive, sleeps a lot, his head hurts. Digestion of food is disturbed: diarrhea, bloating, vomiting. My stomach hurts, my heart rate is erratic.
If you do not provide urgent help to the baby, he falls into a coma.
Treatment of a baby with liver failure is carried out only in a hospital. In the future, after being discharged home, the child should adhere to a special diet for a long time and take increased doses of vitamins of the group B, A, C, K .

Treatment

Diet

If the patient's condition improves, then every three days you can add 10 grams. protein until reaching the age norm. Protein should be increased by introducing cottage cheese, kefir, yogurt into the diet. You can slowly increase the fat content. At the same time, the basis of the diet is easily digestible carbohydrates ( honey, sugar, jam, jelly, jelly, fruit).

Liver failure - medical term denoting a complex of symptoms that develop as a result of the destruction of the liver parenchyma and a violation of its basic functions. This pathological condition is manifested by intoxication of the body, since the liver ceases to perform a detoxifying function and harmful substances in high concentration accumulate in blood and tissues.

Impairment of one or more liver functions leads to a disorder metabolic processes, malfunctions of the nervous system and brain. Severe forms of liver failure provoke irreversible processes that can result in the development of hepatic coma and death.

Purpose of the liver

The liver is an unpaired organ, the largest and most important endocrine gland, located in the region of the right hypochondrium. In our body, this organ performs more than 500 important functions. We list the main ones:

• bile is produced in the liver, which is necessary for the breakdown and further absorption of lipids (fats) that enter the body with food;
• this body is directly involved in protein, fat and carbohydrate metabolism;
• utilizes the breakdown products of hemoglobin, turning them into bile acids and removing them from the body with bile;
• neutralizes toxins, allergens and other harmful and toxic substances, accelerates their elimination from the body in a natural way;
• deposits stores of glycogen, vitamins and microelements;
• synthesizes bilirubin, cholesterol, lipids and other substances involved in the process of digestion;
• provides splitting and utilization of excess hormones, enzymes and other biologically active substances.

The liver is the main filter of our body.

This organ is subjected to high daily loads, which we further increase if we violate the diet, eat fatty, spicy, fried foods, overeat, abuse alcohol, or randomly take drugs with a hepatotoxic effect.

At the same time, the liver is the only organ capable of self-healing. Its cells (hepatocytes) are able to regenerate due to the growth and increase in their number, and even with extensive damage (up to 70%), the liver can fully recover to its previous volume if the causes that provoke the destruction of the parenchyma are eliminated.

The rate of liver regeneration is rather slow and largely depends on the age and individual characteristics of the patient, as well as on the severity of the underlying disease that causes the destruction of hepatocytes. You can speed up the recovery of the organ if you lead a healthy lifestyle and adhere to proper nutrition, that is, reduce the load on the liver. At the same time, you should know that liver regeneration is impossible if its destruction is caused by an active infectious process (for example, with viral hepatitis).

Types and forms of liver failure

Depending on the nature of the course of the disease, acute and chronic liver failure are distinguished.

Acute liver failure is manifested against the background of toxic lesions of the organ (alcoholic, drug, viral hepatitis).

The chronic form of the disease develops gradually, along with the progression of hepatic pathologies (fibrosis, tumor processes).

The pathogenesis of liver failure or the mechanism of the development of the disease implies its division into several types:

• Hepatic cell failure - develops when the cells of the body are damaged by toxic substances (poisons, viruses, alcoholic surrogates). In this case, the disease can proceed in an acute form, accompanied by massive death of hepatocytes, or in a chronic form, when cells die slowly and the severity of symptoms increases gradually.
• Porto-caval form - associated with impaired hepatic blood flow. As a result, blood saturated with toxic substances bypasses the liver and from the portal vein enters immediately into the general circulation. In addition, with this form of insufficiency, liver cells suffer from hypoxia. Such disorders occur due to cirrhosis or bypass surgery for portal hypertension.
• mixed form. In this case, chronic liver failure is diagnosed, accompanied by the death of liver cells and the discharge of blood saturated with toxins into the general circulation.

Depending on the stage of development, liver failure is divided into the following types:

• compensated (initial stage);
• decompensated (pronounced form);
• terminal (dystrophic);
• hepatic coma.

At the initial, compensated stage, there are no symptoms of the disease, the life expectancy of patients is about 20 years.

In the stage of decompensation, it proceeds with pronounced symptoms and periodic relapses.

At the terminal (dystrophic) stage, the patient requires constant care and medical supervision, and the disease is steadily progressing.

Causes of liver failure

In addition, the cause of kidney failure can be such factors as acute circulatory disorders in the liver, oncological tumors, including cancer metastases from other organs to the liver, fatty liver of pregnancy, or abdominal surgery, in which the hepatic artery is accidentally damaged.

Symptoms of liver failure

At the initial stage of the disease, signs of liver failure are similar to many pathologies associated with dysfunction of internal organs. Therefore, the syndrome of renal failure is so difficult to diagnose in time. A person usually does not attach much importance to the lack of appetite, weakness, fatigue, attributing the malaise to accumulated fatigue. But as the disease progresses, it manifests itself with intolerance to certain foods and alcohol, taste perversion, nausea, vomiting, digestive disorders, and dysfunction of the nervous system.

In the chronic course of the disease, the complexion becomes earthy, yellowness of the skin, signs of beriberi, endocrine disorders, menstrual irregularities in women and impotence in men are noted. The manifestations of liver failure are diverse, they largely depend on the form of the disease, the characteristics of the course of the disease and are expressed as follows.

Features of the course of the disease

1. cholestasis syndrome. It is associated with a violation of the outflow of bile from the liver and the accumulation in the blood of the breakdown product of hemoglobin - bilirubin. This substance exhibits a toxic effect and causes itching and yellowness of the skin and sclera. In addition, with cholestasis, lightening of feces and darkening of urine, which takes on the shade of dark beer, are observed. There are pulling, aching pains in the right hypochondrium associated with obstruction of the biliary tract.
2. Dyspeptic disorders. Nausea and vomiting may occur intermittently after eating certain foods or be permanent. This is due to the fact that the liver does not synthesize enough bile, which is necessary for the full digestion of fats. Lack of appetite, up to a perversion of taste and desire to consume incompatible or inedible products (chalk, earth), are associated with intoxication of the body and damage to the nervous system against the background of liver necrosis. A specific hepatic odor from the mouth, reddening of the palms, and weight loss additionally indicate developing insufficiency.
3. Symptoms of intoxication of the body. Constant weakness, irritability, headache, joint and muscle pain, fever, fever, chills, profuse sweating at night - these manifestations are especially pronounced in acute renal failure. At the same time, the temperature can rise sharply to high values ​​​​or stay at 38 ° C for a long time, which, together with severe weakness and malaise, have an extremely negative effect on the working capacity and general well-being of a person.
4. Hepatic encephalopathy It is manifested by a violation of the function of the nervous system, since toxic substances and decay products are not neutralized by the liver and, acting on the brain, cause a number of characteristic symptoms. Patients complain of dizziness, decreased concentration, lethargy, apathy, lethargy, confusion, daytime sleepiness and insomnia at night. As the disease progresses, increased anxiety, depressive states, excessive excitability, convulsions, loss of consciousness, hallucinations occur.
5. Symptoms of the heart and blood vessels. There are jumps in blood pressure, changes in heart rhythm (arrhythmias), disorders of the general circulation.
6. Pulmonary symptoms. On the part of the respiratory system, there is the appearance of cough, shortness of breath, rapid or difficult breathing against the background of an increase in pulmonary edema. Pi this patient is afraid to suffocate and takes a forced sitting position. Shortness of breath can increase not only during physical exertion, but also at rest.
7. portal hypertension syndrome expressed as ascites (an increase in the volume of the abdomen due to accumulating fluid) and the appearance of spider veins on the surface of the abdomen and shoulders. Another characteristic symptom is an increase in the size of the spleen and liver, which is easily determined by palpation of the abdomen.
8. muscle weakness(atrophy) develops against the background of a lack of glycogen - the main energy supplier for the muscles. Muscles become flabby, lethargic, a person gets tired quickly and hardly performs physical work.
9. Blood clotting disorder leads to gastrointestinal and nasal bleeding. This may cause bloody vomiting or blood in the stool (melena). The development of bleeding contributes to the expansion of the veins of the esophagus, which, against the background of portal hypertension, lose their permeability and mobility.

Thus, with liver failure, absolutely all organs and systems of the human body suffer. Therefore, it is so important to start treatment in a timely manner and prevent serious complications that threaten the life of the patient.

Diagnostic methods

When making a diagnosis, a number of laboratory and instrumental methods of examination are used. The patient must pass a series of tests:

• (general and biochemistry);
• urinalysis (general);
• analysis of feces for occult blood;
• blood test for viral hepatitis;
• liver tests.

Of the modern instrumental diagnostic methods, ultrasound, CT or MRI are used. These methods allow assessing the size of the liver, its structure, the degree of damage to the parenchyma and blood vessels, as well as the presence of concomitant diseases associated with dysfunction of the biliary system (presence of stones in the gallbladder, compression of the bile ducts).

If necessary, a radioisotope scan of the liver is performed or a biopsy is taken (if a malignant process is suspected) and the biopsy is sent for histological examination.
Additional body methods are used to assess the state of other organs and systems, since the whole body suffers from manifestations of liver failure. To this end, the patient is referred for a consultation with a cardiologist, neurologist, gastroenterologist, endocrinologist and other narrow specialists.

Treatment

The treatment of liver failure is a complex and lengthy process that includes not only drug therapy, but also the adjustment of the entire lifestyle and diet. The patient is given a specific diet, with restriction of salt and protein, which he must adhere to until complete recovery. Therapeutic measures include detoxification of the body, the use of medications, the action of which is aimed at improving blood circulation, normalizing electrolyte processes, and achieving acid-base balance.

With the development of acute liver failure, intensive care is carried out in a hospital setting. To restore the volume of circulating blood, saline or other saline solutions are injected into the vein by drip method, while controlling urine output.

In hemorrhagic syndrome, hemostatic agents are used to stop bleeding. With the ineffectiveness of their use, they resort to blood transfusion.

To reduce the symptoms of intoxication, drugs are administered, the action of which is aimed at enhancing intestinal motility and cleansing the body. In order to detoxify, an infusion of rheosorbilact or neogemadez is carried out.

In order to improve blood circulation in the liver and reduce edema, osmotic preparations (sorbitol) are administered, agents such as eufillin, thiotriazoline are used to expand the ducts, and cocarboxylase or cytochrome is prescribed to eliminate hypoxia. At the same time, with the help of glucose and albumin, they replenish the energy reserves of the body. To speed up the processes of regeneration and restoration of liver cells, the following drugs are used:

• hepatoprotectors (Essentiale, Essliver Forte, Liv-52);
• Arginine, Hepa-Merz (these funds help the formation of urea from ammonia);
• amino acids, vitamins of group B, PP.

To maintain the work of the brain, drugs are used to improve cerebral circulation (Actovegin, Cerebrolysin), diuretics (Mannitol, Lasix), as well as sedatives.

In chronic liver failure, the pathologies that led to damage to the liver cells should be treated first. In addition to taking basic medications, it is necessary to adjust the metabolism, based on the data of a biochemical blood test, and also follow a certain diet. The list of essential drugs in the treatment of chronic forms of liver failure includes:

• broad-spectrum antibiotics that do not have a toxic effect on the liver (Neocin);
• amino acids (glutamic acid), which bind ammonia and remove it from the body;
• lactulose preparations (Dufalak, Portalak), which inhibit pathogenic microflora and eliminate ammonia intoxication;
• potassium preparations, vitamins C, PP, group B - compensate for the lack of potassium, improve the condition of blood vessels, activate the processes of regeneration of liver cells, and exhibit antioxidant properties;
• hepatoprotectors (Heptral, Essentiale Forte) - contain amino acids and phospholipids, which are the building material for liver cells.

If necessary, the body is detoxified with infusion solutions (glucose, sodium chloride solution or Ringer's solution). In case of bile stagnation, choleretic agents (Allohol, Holosas) are prescribed, for pain in the right hypochondrium, antispasmodics (No-shpu, Drotavein) or Baralgin are used.

In severe cases, at the stage of hepatic coma, hemodialysis and plasmapheresis procedures are necessary to clean and filter the blood from toxic substances.

Diet and nutritional habits

In the treatment of liver failure, special attention is paid to proper nutrition. The principles of dietary nutrition in this pathology are as follows:

• protein products are completely excluded from the diet or reduced to a minimum;
• the emphasis is on fractional nutrition - you need to eat a little, but often (5-6 times a day);
• in the diet it is necessary to increase the amount of fiber and eat more fresh fruits and vegetables;
• the diet should include a small amount of easily digestible carbohydrates (honey, sweet fruits and berries), as well as foods high in useful vitamins and minerals;
• the daily calorie content of the diet is at least 1500 kcal, while tasty meals should be prepared, since many patients have a lack of appetite.

After the condition improves, they gradually return to the previous diet and introduce vegetable proteins into the menu first, then dairy products. With good tolerance of such a diet, dietary meat is included in the patient's diet.

It is necessary to observe the water balance, increase fluid intake, avoid heavy physical exertion, normalize the psychological state, establish the correct mode of work, rest and sleep.

The intake of any drinks should be completely abandoned, as well as the unsystematic use of drugs. You can take only those medicines that have been prescribed by your doctor. As the condition improves, it is recommended to move more and take long walks in the fresh air.