Chronic liver failure. Liver failure

Liver failure syndrome - a symptom complex characterized by a violation of one or more functions of the liver due to acute or chronic damage to its parenchyma. There are acute and chronic liver failure and its 3 stages: stage I - initial (compensated), stage II - pronounced (decompensated) and stage III - terminal (dystrophic). End-stage liver failure ends with hepatic coma.

Etiology, pathogenesis. Acute liver failure can occur in severe forms of viral hepatitis, industrial poisoning (compounds of arsenic, phosphorus, etc.), vegetable (inedible mushrooms) and other hepatotropic poisons, some drugs (male fern extract, tetracycline, etc.), transfusion of other group blood and in a number of other cases. Chronic liver failure occurs with the progression of many chronic liver diseases (cirrhosis, malignant tumors, etc.).

Symptoms

The nature of liver failure is mainly determined by two pathological processes: cholestasis syndrome and necrosis of the liver tissue.

In the first case, due to obstruction of the bile ducts and, consequently, the cessation of the normal excretion of bile, jaundice occurs. It is the most characteristic and visible manifestation of liver disease and can be acute or chronic. The severity of jaundice can vary from bright pigmentation to an almost imperceptible appearance.

In the second case, more dangerous processes are launched. Hepatic cell failure leads not only to fever, but also to various disorders of the cardiovascular system (changes in blood circulation, tachycardia, hypertension and hypotension) and the work of the gastrointestinal tract (discolored stools).

In addition, acute and chronic liver necrosis are separately accompanied by their own diseases and disorders. Acute necrosis causes partial lung dysfunction (pulmonary edema), which occurs due to blood entering the alveoli; as well as disorders of the kidneys and nervous system (dullness of consciousness, nausea, lethargy or hyperexcitability).

Chronic necrosis is characterized by portal hypertension and ascites (fluid leaking into the abdominal cavity). Moreover, in patients with these syndromes, superficial, pronounced venous plexuses and spider veins and anemia are observed.

Source vseopecheni.ru

signs

In the clinical picture of liver failure, syndromes of hepatocellular insufficiency and hepatic encephalopathy should be distinguished.

Hepatocellular insufficiency is characterized by an increase in jaundice, hemorrhagic, edematous-ascitic, dyspeptic syndromes, abdominal pain, fever, a decrease in the size of the liver, and weight loss. A hepatic odor from the mouth appears, due to the release of methyl mercaptan due to a violation of demethylation processes in the liver.

Laboratory signs of hepatocellular insufficiency are a progressive decrease in the protein-synthetic function of the liver, an increase in the concentration of bilirubin, phenols and ammonia in the blood serum. There is a decrease in the previously increased activity of aminotransferases in dynamics, a decrease in cholesterol and cholinesterase.

Hepatic encephalopathy is characterized by a mental disorder (emotional instability, anxiety, apathy, possible delirious states accompanied by agitation, aggression; impaired orientation, sleep, etc.) and neuromuscular disorders (speech disorders, "clapping" tremor of the fingers, impaired writing, increased reflexes, ataxia).

Source lekmed.ru

The reasons

The causes of liver failure may be the following conditions:

Liver diseases (acute and chronic hepatitis, portal and ciliary cirrhosis of the liver, malignant neoplasms, echinococcus and others);

Obstruction of the bile ducts, leading to an increase in the pressure of bile hypertension, which disrupts the lymph and blood circulation in the liver and leads to the development of degenerative changes in hepatocytes (liver cells);

Diseases of other organs and systems - heart, blood vessels, endocrine glands, infectious and autoimmune diseases;

Poisoning with hepatotoxic substances (drugs, poisonous mushrooms, dichloroethane, alcohol surrogates, antibiotics, chlorpromazine, sulfonamides.);

Extreme effects on the body (major injuries, burns, traumatic shock, massive blood loss, massive blood transfusions, allergization, septic shock).

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

Source medicalj.ru

Diagnostics

When collecting an anamnesis in patients with suspected liver failure, the facts of alcohol abuse, past viral hepatitis, existing metabolic diseases, chronic liver diseases, malignant tumors, and taking medications are ascertained.

The study of a clinical blood test reveals anemia, leukocytosis. According to the coagulogram, signs of coagulopathy are determined: a decrease in PTI, thrombocytopenia. In patients with liver failure, a dynamic study of biochemical samples is necessary: ​​transaminases, alkaline phosphatase, γ-glutamyl transpeptidase, bilirubin, albumin, sodium, potassium, creatinine, acid-base balance.

When diagnosing liver failure, ultrasound data of the abdominal organs are taken into account: with the help of echography, the size of the liver, the state of the parenchyma and vessels of the portal system are evaluated, and tumor processes in the abdominal cavity are excluded.

With the help of hepatoscintigraphy, diffuse liver lesions (hepatitis, cirrhosis, fatty hepatosis), liver tumors are diagnosed, and the rate of biliary secretion is estimated. If necessary, examination for liver failure is supplemented by MRI and MSCT of the abdominal cavity.

Electroencephalography is the main way to detect hepatic encephalopathy and predict liver failure. With the development of hepatic coma, the EEG registers a slowdown and a decrease in the amplitude of waves of rhythmic activity

Morphological data of a liver biopsy differ depending on the disease that led to liver failure.

Hepatic encephalopathy is differentiated from subdural hematoma, stroke, abscess and brain tumors, encephalitis, meningitis.

Source krasotaimedicina.ru

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 provide urgent help to the baby, he falls into a coma.

Treatment of a baby with liver failure is carried out only in the hospital. In the future, after being discharged home, the child should follow a special diet for a long time and take increased doses of vitamins B, A, C, K.

Source tiensmed.ru

stages

Classify 3 stages of liver failure:

Stage I - initial (compensated),
II stage-expressed (decompensated),
Stage III - terminal (dystrophic).

In stage 1, there are no clinical symptoms, but immunity to alcohol and other toxic effects decreases.

Stage II is characterized by clinical symptoms: a feeling of weakness, decreased ability to work, dyspeptic disorders, the appearance of jaundice, diathesis, ascites, and edema. Laboratory studies show significant abnormalities in many or all liver tests.

In stage III, there are profound metabolic disorders in the body, dystrophic phenomena not only in the liver, but also in other organs (CNS, kidneys, etc.);

End-stage liver failure ends with hepatic coma.

Source curemed.ru

Treatment Methods

The nature of treatment depends on the cause and characteristics of clinical manifestations. Usually prescribed:

Strict diet. The consumption of proteins is carefully controlled: their excess can cause brain damage, and a lack of them can lead to weight loss. Sodium intake should be low to avoid accumulation of fluid in the abdomen (ascites).

symptomatic therapy.

Correction of the pathology of the coagulation system and electrolyte disorders.

The surgical method of treatment is liver transplantation.

Source zdorovieinfo.ru

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 ensure normal metabolism in it. 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.

Causes of liver failure

• Liver diseases (acute and chronic hepatitis, cirrhosis and 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, chemicals;
• extreme effects on the human body (extensive burns, injuries, traumatic and septic shock, massive blood loss and blood transfusions 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 of the pathological process, jaundice may not be.

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 (menstrual irregularities in women, gynecomastia in men) are revealed. 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 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.

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

1. The compensated (initial) stage of liver failure is characterized by all the symptoms described above, which can be expressed to 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

The treatment of this serious disease is a very complex process, which 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, Normase) also help reduce the absorption of ammonia in the intestines, as well as suppress the 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 from the patient's blood, 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.

Which doctor to contact

Liver failure is treated by a hepatologist or gastroenterologist. Additionally, a consultation of an infectious disease specialist (with viral hepatitis), an oncologist (with liver cancer), a cardiologist (with cardiac cirrhosis of the liver), a neurologist (with the development of hepatic encephalopathy) is prescribed.

Every year, doctors note an increasing increase in the number of patients with liver diseases. This is due to the fact that the load on this body is constantly increasing. The liver is affected by environmental degradation, viral hepatitis and infections, poor quality products and a large number of medications taken.

With such loads on the organ, a person himself also provokes a situation in which various liver diseases appear, adding to the above factors low mobility, alcohol, drugs and malnutrition. One of the most severe pathologies of the organ is liver failure. Almost 70% of all liver diseases end with this diagnosis.

Liver failure is a symptom complex in liver pathologies. With the manifestation of the syndrome, one or more liver functions may be impaired due to damage to the tissues of the organ. Every year, about 45 million people die on the planet due to this disease. Pathology with the same frequency "overtakes" both men and women. In this case, age does not matter.

PN classification

The prognosis for the development of organ failure in most cases is unfavorable. A transplant is needed. In its absence, the patient most often dies during the first year after the onset of the disease.

In the case of liver transplantation at the initial stage of the disease, the mortality rate is no more than 10%. However, with the further development of the pathology, even organ transplantation helps worse, the mortality rate increases.

Many adverse factors, which are called hepatotoxic, affect the membranes of liver cells in a negative way. Damage to hepatocytes is the initial stage in the development of pathology. In this case, the liver cells are replaced by others, non-functional, which are normally absent in the organ. Then, from such cells, the release of enzymes capable of independently "digesting" hepatocytes begins.

In the future, an autoimmune complication of liver pathologies may appear. It causes the immune system to recognize damaged cells as foreign. In this case, antibodies completely destroy them, this process is called "necrosis of liver tissue." It can also spread to neighboring hepatocytes.

If more than 70% of the liver cells are affected, then organ failure develops. In this case, liver function is lost partially or even completely.

Due to the gradual destruction of cells “native” to the liver and the duration of the ongoing process (if there is no proper treatment), anastomoses begin to form. This term, translated from Greek, means "exit", "hole". Anastamoses are an additional pathway for the passage of blood, bypassing the liver.

This reduces the chances of liver recovery. At the same time, toxins that are not processed by the liver enter the bloodstream. Harmful substances cause gradual damage to all organs and systems. Metabolic processes are disturbed, there is stagnation of bile. The brain is affected by decay products, in connection with which there are malfunctions in the functioning of the central nervous system.

Causes of the disease and risk factors

The causes that cause the development of pathology include the following diseases and conditions:

There are also extrahepatic reasons due to which a complication may develop. These include:

• large blood loss;
• transfusion of incompatible blood;
• hormonal problems;
• beriberi;
• surgical intervention performed in the peritoneal region.

To understand the mechanism of development of liver failure, consider one of the studies conducted at the University of Edinburgh, aimed at elucidating the role of paracetamol in the development of pathology.

Among medicines, this medicine for the inhabitants of Europe is the main reason due to which pathology develops. To describe the mechanism of liver destruction under the influence of increased dosages of paracetamol, experiments were carried out with the liver tissues of mice.

During the experiment, scientists found that under the influence of paracetamol, the connections between neighboring cells are destroyed.

It was called "dense" due to the fact that in a healthy organ the intercellular membranes are brought together as close as possible and there is no space between them. Under the influence of paracetamol, such a dense intercellular junction is damaged. Because of this, the structure of tissues is disturbed, cells lose the ability to function normally.

This kind of pathological processes occur in the body with viral hepatitis, cirrhotic or oncological changes. However, for a long time they were not associated with the use of paracetamol. The work is ongoing, and further studies will be carried out on human liver tissues.

It should be borne in mind that paracetamol is contained in many drugs. It must be used strictly for its intended purpose, the prescribed dosage must be strictly observed. Particular care must be taken when using the drug in children.

Signs of illness

According to the form of the course, the disease can have different forms and stages. Consider the main manifestations of pathology and their consequences for the human body.

Stages of manifestation

Organ failure develops as follows:

Syndromes

The clinical picture of the pathology consists of several syndromes:

Forms of pathology

There are two types of pathology:

It is worth saying that there is also a so-called lightning-fast form of pathology, when complete damage to an organ occurs over several days or even hours.

This is possible due to the rapid death of liver cells. The body does not cope with its work, which leads to encephalopathy. If treatment is started on time, the process can be reversible. This situation can occur after poisoning with poisons or medications.

Reviews of relatives of deceased patients also speak of the frequent lightning-fast course of the disease. So, the user Drunia describes that her friend's sister died at a young age, she was only 27 years old. She didn’t have anything special, she didn’t complain about the liver.

The ambulance took her to the hospital with a diagnosis of pneumonia. All the symptoms pointed to it. After some time, he was urgently transferred to another hospital for surgery. She died during her execution. In the certificate, the diagnosis consists of two words: liver failure.

The main symptoms of liver failure are:

1. Nausea, loss of appetite. Most often, these symptoms occur with diseases of the gastrointestinal tract.
2. The occurrence of swelling. If the liver fails, then blood circulation is disturbed. A large amount of fluid is released from the blood. It accumulates in the limbs and abdominal cavity. With puffiness, there are "bags" under the eyes.
3. Change in the color of the skin, urine and feces.
4. The appearance of pain. Since the liver does not have nerve endings, pain can only occur due to an increase in the organ. The sensations do not go away during movement and often radiate to the region of the right shoulder blade. They can be long.

Diagnostic methods

Diagnosis of liver disease always begins with anamnesis. The doctor asks the patient if he has been using alcohol or drugs for a long time, and if he has any diseases.

A blood test is then ordered to determine the number of red blood cells, white blood cells, and platelets. In pathology, the level of hemoglobin decreases, this is due to disturbances in the metabolism of iron and protein. Both general and biochemical blood tests are examined.

When conducting laboratory diagnostics, the performance of the organ and the degree of its damage are assessed. When performing research (liver tests), the quantitative content is determined:

• total bilirubin;
• alanine aminotransferase, or ALT;
• aspartate aminotransferase, AST;
• protein ratios - thymol test;
• enzyme GGT, necessary for protein metabolism.

A study of urine and feces is carried out. Occult blood may be found in the feces. This indicates bleeding from the gastric dilated veins. Urine with illness is similar in color to dark beer. This is due to the bile pigments in it.

Protein in the urine indicates the development of a pathological process, namely liver failure.

After that, the patient must undergo the following procedures:

1. ultrasound. The study allows you to evaluate the performance, as well as the general condition of the liver. The dimensions of the liver, its structure, as well as the state of the bile system and blood vessels are viewed.
2. MRI and CT. It is carried out to more accurately identify all changes in the structure and structure of the liver tissues. Then the patient is assigned an EEG (electroencephalography) in order to determine the presence of encephalopathy (brain pathology).
3. Biopsy. It is carried out in order to identify the cause of the development of the disease and to see accurate data on the state of the liver tissues. This analysis confirms or refutes the presence of a cancerous tumor, which is the root cause of the deficiency.

Inna, Cherepovets, 32 years old:“My father was recently diagnosed with liver failure. What tests did he just not hand over. Blood was taken 20 times. I also underwent ultrasound and MRI. The diagnosis is disappointing. There is no money for a donor liver. Yes, the process is too long. They say it's a queue.

Therapeutic measures

Therapy of the disease occurs for a rather long period of time. This is a laborious process, which depends on the stage of the pathology. In this case, proper nutrition and cleansing of the body of toxins should be observed. Treatment improves microcirculation in the liver and normalizes the balance between acids and alkali.

The management of the patient in the hospital is carried out according to the general principles, according to which the following is performed:

1. Constant monitoring of the patient, his condition is assessed.
2. The patient is weighed daily.
3. An assessment is made of the balance of the drunk liquid in relation to the allocated one.
4. The amount of electrolytes and creatine is determined daily by blood tests.
5. Twice a week, blood is donated for biochemical research and liver tests.
6. Coagulogram is performed regularly.

Medical impact

The list of drugs used in the medical treatment of the disease is quite large. Drugs are used depending on the condition of the patient and the degree of damage to the organ.

Organ failure, which is caused by viruses, is treated with the following drugs:

If the pathology is caused by bacteria, it is treated with third and fourth generation cephalosporins (intramuscularly or intravenously), fluoroquinolones (intravenously), and macrolides (taken by mouth).

When the disease is due to an autoimmune lesion, take Prednisolone 40 to 80 mg during the day. In case of insufficiency, which arose as a result of helminthic invasions, aminoglycosides (Neomycin) and Metronidazole are used.

Symptomatic therapy is also carried out, such medicines are used:

Glucose solution is used to replenish the energy reserves of the body. It is administered intravenously by drip.

The amount of the required solution per day can reach 500 ml. Lactulose preparations may also be used. It is a synthetic sugar derived from lactose. It is decomposed by intestinal bacteria, and absorption from the stomach does not occur. The action of lactulose allows you to suspend the absorption of water.

To improve the regeneration of liver cells, vitamins C, PP, group B are needed. Antibiotics with a wide spectrum are also used. When performing therapy for liver disease, neomycin is often used. Antibiotics are required to suppress the intestinal microflora that releases ammonia. Neomycin is prescribed twice a day, one tablet for a ten-day course.

Other Methods

Often, extracorporeal methods of therapy are used, in which the process of treating a patient takes place outside his body. In hemodialysis, blood is filtered using a machine called an artificial kidney. The blood is “released” of toxins. Blood purification can also be carried out using plasmapheresis.

The method involves the use of special filters, after passing through which the plasma returns back to the body. In the treatment of pathology, this technique received the best reviews. Both methods are used most often in the event of a hepatic coma or in case of poisoning with poisons.

Surgical methods include partial removal of the affected part of the organ and liver transplantation. Transplantation is performed from a donor who is suitable for a number of parameters. Only part of the liver is taken. In this case, most often the donor recovers quite quickly, since its remaining part of the organ gradually regenerates.

The process of restoration and renewal of tissues occurs in the patient. This allows hepatocytes to "start" to perform their functions. However, the transplanted organ is sometimes rejected because it is a foreign agent.

In this regard, the patient will have to take the drugs prescribed after the operation for the rest of his life. These are hormones and cytostatics. It should be understood that the search for a suitable donor is very difficult, and the cost of the method is quite high, which are significant problems.

Dietary nutrition and prevention

There are several basic principles of dietary nutrition for liver disease:

There are special diets for patients with liver pathologies. One of them is table number 5. The purpose of the diet is to maintain a correct, balanced and sparing diet. It allows you to restore the functioning of the liver and biliary tract.

If the liver ceases to perform one of the functions, the work of the whole organism is disrupted. This condition is called liver failure. At the same time, liver failure is accompanied by metabolic disorders, dysfunction of the central nervous system, and intoxication. Acute insufficiency without due attention from physicians leads to hepatic coma.

What it is?

Liver failure is a syndrome manifested by a complex of symptoms that arise as a result of a malfunction of the liver. All metabolic processes in the body are controlled by the liver, which means that in case of certain failures, the organ also suffers, and in case of complication, its insufficiency may develop.

Classification

Liver failure can develop and manifest itself in three forms. Namely, it can be noted:

1. Hepatocellular insufficiency. This form is also called endogenous, it develops when an organ is poisoned with toxic substances. Due to the development of this form of the disease, the rapid death of liver cells begins.
2. Exogenous form of liver failure. This is a dysfunction of the blood circulation in the body. That is, the liver ceases to function, as it should be, and the blood does not pass through the liver, which means that it is not cleared of toxins that further poison all organs.
3. mixed form. These are violations of the work of hepatocytes, and failures in blood circulation in the hepatic vessels.

Diagnostics

Currently, the following methods for diagnosing cellular liver failure are used, which allow creating a complete picture:

1. Collecting an anamnesis in order to clarify the facts of the patient's alcohol abuse, whether he is a drug addict, whether or not he had viral hepatitis, whether the body's metabolism is disturbed, whether there are chronic liver diseases and malignant tumors, what medications he is currently taking, whether he suffers from edema limbs.
2. Ultrasound of the organ, which allows the most accurate assessment of its condition.
3. A biochemical blood test aimed at detecting an elevated level of bilirubin, a decrease in the amount of protein, coagulation pathology, electrolyte disturbances and other indicators.
4. An electroencephalography method used to detect disturbances in the amplitude of the brain rhythm.
5. Biopsy, which is a method of establishing the cause of the development of the disease and current indicators of the organ.
6. MRI, which reveals the degree of changes in the tissues of the liver.

Fulminant liver failure is defined on the basis of such clinical manifestations as jaundice, a significant decrease in the size of the liver, encephalopathy and biochemical parameters determined by a blood test.

Acute liver failure

Acute liver failure is an extremely serious condition of the body that requires immediate detoxification therapy.

It develops as a result of rapid liver damage. The clinical picture of this syndrome develops very quickly (from several hours to 8 weeks) and also quickly leads to hepatic encephalopathy and coma. It is also possible the lightning-fast development of liver failure - fulminant liver failure, which often occurs when poisoned by poisons, chemicals, drugs, and so on.

Causes of acute liver failure

• Poisoning by alcohol substitutes.
• Poisoning with poisons that are toxic to the liver: phosphorus, chlorocarbons and others.
• Poisoning with poisonous mushrooms: pale grebes, lines, crosses, heliotrope. The mortality rate for this condition is over 50%.
• Taking antipyretic drugs with fever in children 4-12 years old. Particularly dangerous in this regard are acetysalicylic acid ("Aspirin"), products containing salicylates. Less dangerous are paracetamol, ibuprofen (Nurofen), analgin. The disease is called Reye's syndrome or acute hepatic encephalopathy. Mortality in children is 20-30%.
• Viruses, E, as well as viruses of the herpetic group (herpes simplex, cytomegalovirus, Epstein-Barr virus, - varicella-zoster virus).
• Other microbes, not viruses, that can cause a generalized infection of the whole body with liver damage. This is the most diverse bacterial infection (staphylococcal, enterococcal, pneumococcal, streptococcal, salmonella, and so on), as well as rickettsiosis, mycoplasmosis, mixed fungal infections.
• Acute blood poisoning in liver abscesses, purulent inflammation of the intrahepatic bile ducts.
• Acute circulatory disorders in the liver due to embolism of a large branch of the hepatic artery of blood clots, gas, fat.
• Diseases of unknown origin: for example, acute fatty liver of pregnancy.
• Rupture of an echinococcal cyst in the liver.
• Severe oncological diseases: hemoblastoses, lymphogranulomatosis, cancer metastases of various localization in the liver.
• Poisoning with drugs, especially with their overdose. So, you can exceed the maximum dose of Paracetamol, Aminazine, Ketoconazole, Tetracycline, Co-trimoxazole, sulfonamides, drugs for the treatment of tuberculosis, drugs based on male sex hormones.
• Operations on the abdominal organs, in which the blood circulation of the liver was disturbed (for example, a large branch of the hepatic artery was clamped, stitched or cut for a long time).

Depending on the causes of development, there are forms of acute liver failure:

1. Exogenous form - develops as a result of a violation of the hepatic and / or extrahepatic circulation (in the systems of the portal and inferior vena cava), most often with cirrhosis of the liver. At the same time, blood with toxic substances bypasses the liver, affecting all organs and systems of the body.
2. Endogenous or hepatocellular form - occurs when liver cells are damaged as a result of exposure to hepatotoxic factors. It is characterized by rapid necrosis (or death) of hepatocytes.
3. Mixed form - when exposed to both hepatocellular and vascular factors of liver dysfunction.

After the development of acute liver failure, all toxins that come from the environment or are formed as a result of metabolism have a negative effect on the cells of the whole organism. With brain damage, hepatic encephalopathy occurs, then coma and death of the patient.

Acute liver failure includes the following symptoms:

• Nausea, vomiting, a sharp decrease in body weight, fever, severe weakness and fatigue with the most minor physical exertion;
• Jaundice (yellowing of the skin, mucous membranes due to an increase in the level of bilirubin), severe itching;
• "Liver" smell from the mouth (reminiscent of the smell of rotten meat);
• (accumulation of fluid in the abdominal cavity), swelling of the extremities;
• Tremor, or trembling of the upper limbs (involuntary waving of the arms);
• Bleeding from the gastrointestinal tract, injection sites, nosebleeds;
• Decreased blood pressure, cardiac arrhythmias (different types);
• Hypoglycemia (low blood glucose levels).

In most cases, hepatorenal syndrome develops (hepatorenal insufficiency). The cause may be exposure to toxic metabolic products that are not properly excreted from the body, or a sharp drop in blood pressure.

The main symptom of acute liver failure is hepatic encephalopathy. These are potentially reversible disorders in the neurological and mental sphere, provoked by a decrease in the detoxification function of the liver and the formation of vascular connections (shunts).

Treatment of acute liver failure

Acute liver failure requires emergency care. The patient must be immediately admitted to a medical facility. Treatment of the underlying disease and disorders that have arisen is carried out. It consists of the following activities:

• Infusion therapy (administration of solutions intravenously to maintain blood pressure and detoxification). Includes glucocorticosteroids (hormones of the adrenal cortex), glucose (for adequate energy support of the body), isotonic sodium chloride solution.
• Forcing (stimulating) diuresis (furosemide).
• Reducing the formation of ammonia (lactulose is used).
• Antibacterial therapy (metronidazole, cephalosporins).
• Tranquilizers for mental and motor agitation (diazepam, sodium hydroxybutyrate).
• Oxygen therapy (oxygen inhalation).

As additional methods, they use hemosorption, hyperbaric oxygenation, exchange blood transfusion, etc. In case of poisoning with paracetamol, an antidote is administered - N-acetylcysteine. The main goal is to stabilize the condition, after which the root cause of liver failure can be eliminated.

Chronic liver failure

It develops gradually with prolonged (chronic) exposure to hepatotoxic factors (from 2 months to several years). It is characterized by the gradual development of symptoms against the background of exacerbation of chronic diseases of the liver and biliary system.

As in acute liver failure, there are forms:

• exogenous form - damage and necrosis of liver cells occurs gradually, some of the cells are regenerated, but with continued exposure to adverse factors, the death of hepatocytes continues.
• endogenous form - circulatory disorders of the liver,
• mixed form.

In chronic liver failure, the compensatory capabilities of the liver are more developed, that is, the liver has time to restore some of its cells, which partially continue to perform their functions. But toxins that are not utilized in the liver enter the bloodstream and chronically poison the body.

In the presence of additional hepatotoxic factors, decompensation occurs (loss of opportunities for regeneration of hepatocytes), while hepatic encephalopathy and then coma and death may develop.

Symptoms of chronic liver failure

Chronic liver failure is characterized by a gradual, gradual increase in symptoms. And no matter how long the disease does not exist at the initial stage, sooner or later it will begin to progress.

• I. The initial stage, also called compensated. As a rule, there are no symptoms and the patient has no complaints. Any disturbances in the body at this stage can only be determined through laboratory tests;
• II. Expressed or decompensated. At this stage, intoxication, portal hypertension, as well as disorders of the central nervous system are expressed;
• III. Terminal, or dystrophic. All symptoms become pronounced, at this stage, poor blood clotting, the liver becomes smaller. At the same time, the central nervous system is not stable, that is, inhibition is replaced by activity;
• IV. Coma. This state is expressed by loss of consciousness, while reflexes appear only to strong stimuli. It can develop into a deep coma, in which there are no reactions, since swelling of the brain and multiple organ failure are usually present.

To confirm the diagnosis of chronic liver failure, it is necessary to carry out a set of diagnostic measures. An approximate set of studies looks like this:

1. Clinical blood test - an increase in the number of leukocytes, as well as a decrease in the number of erythrocytes, platelets and a decrease in hemoglobin levels can be determined;
2. Biochemical blood test - pay attention to the levels of bilirubin, ALaT and ASAT, alkaline phosphatase, creatinine;
3. Coagulogram - a decrease in the prothrombin index of the blood;
4. Ultrasound of the abdominal organs - allows the doctor to assess the state of the hepatic parenchyma, the size of the liver.

Treatment of chronic liver failure

Treatment of liver failure is to eliminate the factors that cause the disease. In some cases, such as liver cancer, surgical treatment may be performed. A low-protein diet is prescribed with the amount of carbohydrates 400-500 g / day, and fats - 80-90 g / day, with the exception of alcohol, caffeine, fluid restriction.

The daily routine is also changing: now you will need to move enough, but without lifting weights of more than 2 kg and avoiding open sunlight. Persons with chronic liver failure need to get enough sleep, and about taking any medication, even for a cold, consult a hepatologist (almost all drugs pass through the liver).

It is also necessary to prescribe the following medications:

• in order to neutralize ammonia: "Glutargin", "Hepa-Merz";
• antibiotics, which are adsorbed only in the intestines and destroy the local flora that process proteins obtained from food, produce amino acids that negatively affect the brain. These are "Gentamicin", "Kanamycin";
• lactulose preparations that bind substances toxic to the brain: Lactulose, Dufalac, Prelaxan, Lactuvit;
• veroshpiron - to reduce the risk of ascites and edema;
• to reduce pressure in the portal vein - "Nebilet", "Propranolol", "Molsidomine";
• with blockade of the bile ducts, cholespasmolytics are used. "No-Shpa", "Buscopan", "Flamin";
• with increased bleeding, use "Etamzilat" and "Vikasol2" in tablet form.

In chronic liver failure, they try to avoid complications and prepare the person for a liver transplant as much as possible. The indications for the latter are:

• tumors that allow you to at least partially preserve your liver;
• congenital hepatic pathologies;
• alveococcosis of the liver;
• cirrhosis of the liver;
• autoimmune hepatitis

The prognosis is unfavorable. In 50-80% of cases of hepatic encephalopathy, the patient dies. With compensated chronic liver failure, it is possible to restore the liver only if all hepatotoxic factors are eliminated and adequate therapy is carried out. Often, chronic liver failure in its initial stages is asymptomatic and the diagnosis can only be made on the basis of targeted examinations. This is the reason for late diagnosis and treatment of the disease, which significantly reduces the chances of recovery.

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:

• the emphasis is on fractional nutrition - you need to eat a little, but often (5-6 times a day);
• protein products are completely excluded from the diet or reduced to a minimum;
• 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;
• in the diet it is necessary to increase the amount of fiber and eat more fresh fruits and vegetables;
• 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.

The liver works around the clock and tolerates our weaknesses, bad habits, stress, illness and the world around us. The liver has a lot of functions: it neutralizes toxins, digests food, maintains the constancy of the body and does a lot of other work.

With the deterioration of the environment due to human activities, the spread of viral hepatitis and other infections, alcoholism and drug addiction, the deterioration of food quality, a sedentary lifestyle and the development of the pharmaceutical industry, the load on our liver has increased significantly. And when all this falls down at the same time and in large quantities, the liver may not be able to cope, and then the risk of developing liver failure develops, which, in turn, can lead to irreversible processes in the body and to the death of the patient.

So, liver failure- this is a pathological condition, a syndrome characterized by damage to the liver cells and disruption of the liver with the loss of its compensatory capabilities and basic functions, manifested by chronic intoxication of the body. Liver failure can lead to hepatic coma, that is, complete liver failure and extensive damage to the brain by decay products.

Some statistics!

• From 50 to 80% of all cases of the disease die from liver failure.
• Worldwide, an average of 2,000 people die every year due to liver failure.
• In 15% of cases of liver failure, it is not possible to explain the cause of its development.
• The most common causes of liver failure are liver damage from alcohol, drugs, and viral hepatitis.

• The liver has about 500 functions, and in one minute more than 20,000,000 chemical reactions take place in it.
• When conducting experiments on animals, it was found that after removal of the liver, the animals are in a normal state for 4-8 hours, and after 1-2 days they die in a state of hepatic coma.
• Cirrhosis of the liver always presents with liver failure.
• Botkin's disease, or viral hepatitis A, in people over 40 years of age with a history of liver and gallbladder diseases in 40% of cases leads to liver failure. Viral hepatitis A among the people is considered to be a disease of childhood, which is quite easily tolerated (equate to chicken pox, rubella, scarlet fever, and so on).
• Viral hepatitis E in pregnant women, 20% ends with liver failure, while in men and non-pregnant women, viral hepatitis E may not appear at all.
• Taking such a seemingly ordinary drug as paracetamol, can lead to the development of a fulminant course of liver failure (fulminant liver failure). And in many countries it is customary to take paracetamol in large doses for common colds and SARS.
• It is from liver failure that most people die due to poisonous mushroom poisoning(pale grebes, fly agarics and others).
• In most cases of liver failure in adults, in addition to other causes of the development of the syndrome, the fact alcohol abuse.

Liver anatomy

Characteristics of the liver:

• weight - about 1.5 kg,
• shape - pear-shaped,
• normal size of the liver in adults:
  • oblique length - up to 15 cm,
  • the length of the right lobe - 11.0-12.5 cm,
  • the length of the left lobe is 6-8 cm,
  • height - 8-12 cm,
  • thickness - 6-8 cm,
• the edges of the liver are smooth,
• texture is soft
• structure is homogeneous,
• surfaces are shiny and smooth,
• color - brown,
• covered with peritoneum - a serous membrane that limits the organs of the abdominal cavity.
• has the ability to regenerate (restore).

• diaphragmatic surface- corresponds to the shape of the diaphragm,
• visceral(addressed to authorities) surface- attached to surrounding organs
• bottom edge - at an acute angle
• upper back edge at an obtuse angle, rounded.

• right lobe,
• left lobe,
• square for,
• tail share.

Between the square and caudal lobes of the liver, in the right longitudinal sulcus, there are gates of the liver, which include the following structures:

• hepatic artery,
• portal vein,
• bile duct,
• nerves and lymphatics.

Liver regeneration

Recovery of the liver occurs through the proliferation of hepatocytes (growth and increase in their number), although scientists still do not know why this happens.

The rate of liver regeneration directly depends on age. In children, the rate of organ recovery and the volume to which it recovers are greater than in the elderly. Regeneration occurs slowly: in children this period is 2-4 weeks, and in the elderly - from 1 month. The speed and volume of regeneration also depends on individual characteristics and the disease that caused its damage.

Restoration of the liver is possible only when the causes of hepatitis are eliminated, the load on it is reduced, and when a normal amount of useful nutrients enters the body.

The liver is not restored if there is an active infectious process in it (with viral hepatitis).

The structure of the liver

1. Serous membrane- peritoneum.
2. fibrous sheath- a capsule from which thin branches of connective tissue pass. They divide the parenchyma (part of an organ that contains special functioning structures or an organ without membranes) of the liver into lobules.
3. Liver lobules- the structural and functional unit of the liver, its size is about 1 mm, there are about half a million of them in the liver.
4. Kupffer cells- hepatic stellate macrophages, immune cells, are located in large numbers in the capillaries of the hepatic lobule. They perform a protective function of the liver.

• Central lobule of the liver- located in the center of the hepatic lobule.
• Hepatocytes- liver cells, which perform the secretory function of the liver, produce bile all the time. Liver cells are located in hepatic beams - in two layers. The hepatocyte is located between the bile canaliculi and the intralobular capillary.
• Bile ducts- located between the hepatic beams, along them bile from hepatocytes enters the bile ducts.
• intralobular capillaries or sinusoids- blood vessels through which chemical compounds enter the hepatocytes and processed substances leave them.

1. Portal vein and hepatic artery - through these vessels, blood from the internal organs enters the liver, and the rate of blood flow in the liver slows down significantly, which contributes to the plethora of the organ;
2. Interlobular vessels, together with interlobular bile ducts, form the interlobular hepatic triad;
3. Around the lobular vessels;
4. Intralobular vessels or sinusoids;
5. Central vein - collects blood from the sinusoids of the hepatic lobule;
6. Collecting or sublobular vessels,
7. Hepatic vein - carries blood to the inferior vena cava.

Biliary vessels of the liver

• Bile ducts - do not have a membrane, are located between hepatocytes, collect bile from them;
• Interlobular bile ducts;
• Around the lobular bile ducts;
• Collecting bile ducts;
• bile ducts;
• The gallbladder, where from all the bile ducts bile enters through the cystic duct, the gallbladder is a temporary reservoir for bile, where it settles and "ripens"; gallbladder volume from 50 to 80 ml;
• The common bile duct connects the gallbladder and hepatic ducts to the duodenal bulb, where bile is needed to digest food.

The composition of bile

The main function of bile- digestion of fats in the intestine, due to emulsification by bile micelles.

Bile micelles are particles of bile components surrounded by ions, part of a colloid.

Bile happens:

• Young or hepatic bile- excreted directly from the liver, bypassing the gallbladder, has a yellowish straw color, transparent.
• Mature or gallbladder bile- stands out from the gallbladder, has a dark olive color, transparent. In the gallbladder, fluid is absorbed from the bile and mucus (mucin) is secreted, thus the bile becomes viscous and concentrated.
• Basal bile- a mixture of young and mature bile, which enters the duodenum, golden yellow, transparent.

1. Water - in bile, part of the water is about 97%, the main components of bile are dissolved in it.


2. Bile acids:
   • cholic chenodeoxycholic acid - primary bile acids,
   • glycocholic and taurocholic acids (compounds with amino acids),
   • deoxycholic and lithocholic acids (secondary bile acids, formed in the intestine under the action of intestinal microflora).
   Bile acids are formed from cholesterol in hepatocytes. In bile they are in the form of salts and anions. The role of bile acids is great in the digestion of fats and the absorption of fatty acids and triglycerides in the intestine. Part of the bile acids is absorbed in the intestine back into the blood, and again enter the liver.


3. Bile pigments:
   • bilirubin
   • biliverdin.
   Bile pigments are formed from hemoglobin in the spleen and in Kupffer cells. Any erythrocyte is formed in the red bone marrow (erythropoiesis) and destroyed in the spleen, and a small part of them in the liver. Erythrocytes contain hemoglobin, which carries oxygen and carbon dioxide atoms, that is, it carries out gas exchange in tissues. After the destruction of the erythrocyte, there is a question about the utilization of hemoglobin. Bile pigments are intermediate products of the breakdown of hemoglobin; they are excreted from the body with the help of bile.

   These pigments color bile yellow, green, and brown. And also, after binding with oxygen, it slightly stains urine (urobilinogen) and feces (stercobilinogen).



4. Hepatic phospholipids (lecithins)- are formed by the synthesis of phospholipids that come with food. It differs from conventional phospholipids in that they are not affected by pancreatic enzymes, and in unchanged form, together with bile acids, they participate in the digestion of fats and are partially absorbed back into the blood and enter hepatocytes, and then into bile.


5. Cholesterol- in bile is in free form or in the form of bile acids synthesized from it. Enters the body with food. Participates in the digestion of fats in the intestines.


6. Ions:
   • sodium,
   • calcium,
   • potassium,
   • chlorine,
   • bicarbonates
   Ions enter the bloodstream and liver along with food. Their main role is to improve the permeability of cell walls, and ions are part of the micelles in the small intestine. Due to them, water is absorbed from bile in the gallbladder and its concentration, as well as improved absorption of nutrients in the intestinal wall.

Schematic representation of a bile micelle.

The main functions of the liver - the main laboratory of the body

• bile formation- bile promotes the breakdown and absorption of fat in the intestines.
• Detoxification of toxins and other foreign substances coming from the outside, converting them into harmless substances, which, in turn, are excreted by the kidneys in the urine. This occurs through chemical reactions in hepatocytes (biotransformation). Biotransformation is carried out by combining with proteins, ions, acids and other chemicals.
• Participation in protein metabolism- the formation of urea from the breakdown products of protein molecules - ammonia. With an increased amount of ammonia becomes a poison for the body. Urea from the liver enters the bloodstream, and then excreted with the kidneys.
• Participation in carbohydrate metabolism- with an excess of glucose in the blood, the liver synthesizes glycogen from it - the reaction of glycogenesis. The liver, as well as skeletal muscles, are depots for glycogen storage. With a lack of glucose in the body, glycogen is transformed into glucose - the reaction of glucogenolysis. Glycogen is the body's supply of glucose and energy for the functioning of the musculoskeletal system.
• Participation in fat metabolism- with a lack of fat in the body, the liver is able to synthesize carbohydrates (namely glycogen) into fats (triglycerides).
• Utilization of hemoglobin breakdown products by converting it into bile pigments and excreting them with bile.
• hematopoiesis in the fetus during pregnancy. The liver is also involved in the formation of blood clotting factors.
• Destruction and utilization of excess hormones, vitamins and other biologically active substances.
• Depot for some vitamins and trace elements, such as vitamins B 12, A, D.

Causes and pathogenesis of liver failure

The mechanism of development of liver failure in stages

• Impact adverse (hepatotoxic) factors on the membrane of liver cells - hepatocytes.
• Starts from hepatocytes secrete enzymes, which continue to destroy (digest) liver cells.
• The immune system begins to secrete autoimmune antibodies to damaged hepatocytes, which completely destroy them (hepatic tissue necrosis).
• Distribution of this process to other hepatocytes.
• With the defeat of 70-80% of liver cells develops liver failure.
• Full or partial loss of liver function.
• With a long process - are formed anastomoses(additional vessels, which, bypassing the damaged areas, unite intact vessels) between the portal and inferior vena cava (normally, they are connected by the vessels of the liver). Through these anastomoses, the blood circulates without entering the liver, which reduces the chances for liver regeneration.
• metabolic acidosis- getting into the blood of toxins that are not processed by the liver, they damage all systems and tissues, possibly brain damage.
• Violation of all metabolic processes in the body, as the liver ceases to synthesize and store glycogen, form urea and remove ammonia from the body.
• Violation of the biliary system - bile stasis (or cholestasis) leads to the entry into the blood of a large amount of bilirubin, which has a toxic-allergic reaction to all systems, organs and tissues. In this case, the liver may increase in size.
• Hepatic encephalopathy- damage by decay products of the brain.
• hepatic coma- damage to large areas of the central nervous system is often an irreversible process.

Causes of liver failure

• hypo- or avitaminosis,
• chronic renal failure (CRF),
• hormonal diseases,
• lack of oxygen in the body, including anemia,
• massive blood loss
• transfusion of an incompatible blood type,
• surgical operations in the abdominal cavity.

Types of liver failure

Acute liver failure

It is also possible the lightning-fast development of liver failure - fulminant liver failure, which often occurs when poisoned by poisons, chemicals, drugs, and so on.

Causes that can lead to acute liver failure:

Depending on the causes of development, there are forms of acute liver failure:

• Endogenous or hepatocellular form- occurs when liver cells are damaged as a result of exposure to hepatotoxic factors. It is characterized by rapid necrosis (or death) of hepatocytes.
• Exogenous form- develops as a result of a violation of the hepatic and / or extrahepatic circulation (in the systems of the portal and inferior vena cava), most often with cirrhosis of the liver. At the same time, blood with toxic substances bypasses the liver, affecting all organs and systems of the body.
• mixed form- when exposed to both hepatocellular and vascular factors of liver dysfunction.

After the development of acute liver failure, all toxins that come from the environment or are formed as a result of metabolism have a negative effect on the cells of the whole organism. With brain damage, hepatic encephalopathy occurs, then coma and death of the patient.

Acute liver failure is an extremely serious condition of the body that requires immediate detoxification therapy.

Disease prognosis- in most cases, unfavorable, the chance to restore the vital functions of the liver depends on the ability of the liver to regenerate (its compensatory capabilities), the time before the start of therapeutic measures, the degree of brain damage and the elimination of hepatotoxic factors. Acute liver failure itself is a reversible process. And from the hepatic coma come out only in 10-15% of cases.

Chronic liver failure

It is characterized by the gradual development of symptoms against the background of exacerbation of chronic diseases of the liver and biliary system.

Causes of chronic liver failure:

As in acute liver failure, there are forms:

• exogenous form- damage and necrosis of liver cells occurs gradually, some of the cells are regenerated, but with continued exposure to adverse factors, the death of hepatocytes continues.
• endogenous form- violation of the blood circulation of the liver,
• mixed the form.

In the presence of additional hepatotoxic factors, decompensation occurs (loss of opportunities for regeneration of hepatocytes), while hepatic encephalopathy and then coma and death may develop.

Factors that can lead to encephalopathy and coma in chronic liver failure:

• alcohol consumption,
• self medication,
• violation of the diet, eating a large amount of proteins and fats,
• nervous stress,
• a common infectious process (sepsis, influenza, meningococcemia, chickenpox, tuberculosis, and others),
• pregnancy, childbirth, abortion,
• abdominal surgery and so on.

The disease requires urgent adequate treatment and detoxification.

Forecast: unfavorable, in 50-80% of cases of hepatic encephalopathy, the death of the patient occurs. With compensated chronic liver failure, it is possible to restore the liver only if all hepatotoxic factors are eliminated and adequate therapy is carried out. Often, chronic liver failure in its initial stages is asymptomatic and the diagnosis can only be made on the basis of targeted examinations. This is the reason for late diagnosis and treatment of the disease, which significantly reduces the chances of recovery.

A photo: preparation of the liver of a patient with cirrhosis of the liver. The liver is shriveled, reduced in size, there is an expansion of the hepatic vessels. The liver tissue is all overgrown with connective tissue.

What is the difference between acute and chronic liver failure (features)?

Symptoms of liver failure

Acute liver failure, features of the clinical course

1. Latent stage of hepatic encephalopathy - at this stage, patients have no complaints, and there are no pronounced symptoms of liver damage. Changes can only be detected by examination.
2. I stage of hepatic encephalopathy - precoma. At the same time, symptoms of liver failure increase: cholestasis syndromes, portal hypertension, intoxication symptoms, the first symptoms of damage to the nervous system appear in the form of its inhibition.
3. II stage of hepatic encephalopathy - precoma. At this stage, the patient's condition is aggravated, symptoms of hepatic encephalopathy increase, inhibition is replaced by excitation of the nervous system, and a few pathological reflexes appear. Symptoms of blood clotting disorders become more pronounced, intoxication increases, the liver sharply decreases in size, it cannot be detected on palpation (symptom of "empty hypochondrium"). At this stage, a liver smell from the mouth appears.
4. Coma- loss of consciousness, the patient shows reflexes only to stronger stimuli, there are signs of multiple organ failure (simultaneous course of hepatic, pulmonary, cardiac, renal failure, cerebral edema).
5. deep coma- the patient is unconscious, there is a complete absence of reflexes to any stimuli as a result of cerebral edema, multiple organ failure develops. In most cases, this is an irreversible process, the death of the patient occurs.

A favorable fact is the possibility of reversibility of the process in the case of timely detoxification therapy in the early stages.

Chronic liver failure, features of the clinical course

1. I stage - the functionality of the liver is still preserved. This stage is characterized by the appearance of dyspeptic disorders, mild intoxication (weakness, drowsiness).
2. II stage - an increase in dyspeptic disorders, intoxication, the appearance of symptoms of damage to the nervous system in the form of inhibition, memory loss, and impaired coordination of movement. There is a liver smell from the mouth. At this stage, short-term memory loss is possible. At this stage, the liver only partially performs its functions.
3. III stage - a significant decrease in the functionality of the liver. Previously appeared symptoms become more pronounced. There are manifestations of cholestasis and portal hypertension, blood clotting disorders, aggravation of the state of the nervous system (severe weakness, impaired speech).
4. IV stage (hepatic coma) - the liver completely dies and does not function at all. There is a loss of consciousness, a decrease in reflexes, then their absence. Brain edema develops. Multiple organ failure is on the rise. Most often, this is an irreversible process, the patient dies.

• each stage develops gradually, over weeks, months, years;
• Mandatory symptoms are manifestations of portal hypertension;
• all symptoms are less pronounced than in the acute course of the syndrome.
• chronic liver failure is an irreversible process and sooner or later will lead to hepatic encephalopathy and coma.

Diagnosis of liver failure

Laboratory methods for studying the state of the liver

*All indicators are indicated for adults only.

Instrumental methods for diagnosing liver diseases

Additional research methods for liver failure

1. chest x-ray,
2. CT or MRI of the brain
3. fibrogastroduodenoscopy (probing of the esophagus, stomach, duodenal bulb),
4. others as indicated.

Treatment of acute liver failure

• Most importantly, if possible, eliminate the possible cause of liver failure.
• Treatment must begin immediately.
• Hospitalization is required! Acute liver failure is treated only in a hospital, with severe encephalopathy - in the intensive care unit.
• Treatment is aimed at maintaining the state of the body and metabolism.
• If the cause of liver failure is excluded and the life support of the patient is fully maintained for 10 days, hepatocyte regeneration occurs, which makes it possible for the patient to survive.

Stages of intensive care for acute liver failure

1. Stop bleeding in the presence of hemorrhagic syndrome:
   • If necessary, surgical treatment aimed at restoring the integrity of blood vessels
   • The introduction of hemostatic drugs: aminocaproic acid (etamsylate), vitamin K (vikasol), ascorbic acid (vitamin C), vitamin P (rutin), fibrinogen and others.
   • With the ineffectiveness of these measures, it is possible to transfuse donor blood products, namely, platelet mass and other blood coagulation factors.
2. Reducing toxicity:
   • bowel cleansing,
   • protein free diet,
   • the introduction of drugs that stimulate intestinal motility (cerucal, methaclopramide and others),
   • infusion of neogemadez, rheosorbilact for the purpose of detoxification.
3. Restoration of circulating blood volume: intravenous drip injection of physical. solution, other saline solutions under the control of the volume of excreted urine.
4. Improving the blood supply to the liver:
   • Oxygen mask or mechanical ventilation if symptoms of pulmonary edema are present,
   • reduction of swelling of the liver cells: the introduction of osmotic drugs (reopoliglyukin, sorbitol),
   • expansion of intrahepatic vessels: eufillin, droperidol, thiotriazoline,
   • drugs that improve the ability of the liver to perceive oxygen: cocarboxylase, cytochrome C and others.
5. Replenishment of the necessary energy reserves of the body: introduction of glucose, albumin.
6. Decreased intestinal absorption lactulose (dufalac, normase and others), the appointment of antibiotics to disrupt the intestinal microflora.
7. Restoration of liver functions and promotion of its regeneration:
   • Arginine, ornithine, Hepa-Merz - improve the function of the liver, the formation of urea from ammonia,
   • vitamins P, group B,
   • hepatoprotectors with phospholipids and fatty acids: Essentiale, LIV-52, essliver, lipoid C and others,
   • amino acids, except for phenylalanine, tryptophan, methionine, tyrosine.
8. Correction of the brain:
   • sedative (sedative) drugs,
   • improvement of blood circulation of the brain (actovegin, cerebrolysin and others),
   • diuretics (diuretics, for example, lasix, mannitol) to reduce cerebral edema.

Treatment of chronic liver failure

• treatment of diseases that led to the development of liver failure,
• symptomatic treatment,
• treatment and prevention of complications of liver failure.
• Traditional medicine is powerless in the treatment of this syndrome!
• Diet is one of the main activities aimed at restoring liver cells and reducing the formation of ammonia in the body. The diet is protein-free.
• Cleansing the intestines, since the pathogenic intestinal microflora contributes to the formation of ammonia and its absorption into the blood, and the liver has lost its ability to form urea from ammonia. For this, cleansing enemas are prescribed 2 times a day.
• It is necessary to correct the main indicators of metabolism, according to biochemical blood tests (electrolytes, lipoproteins, glucose, and so on).
• In addition to taking the main medications, in the presence of complications, it is necessary to carry out their treatment.

The main drugs used in chronic liver failure

Indications for extracorporeal treatments

Hemodialysis- purification and filtration of blood, through an artificial kidney apparatus, it is also possible through a sheet of peritoneum (abdominal hemodialysis). In this case, the blood is driven through the filters, freeing it from toxins.

Plasmapheresis - purification of blood from toxic substances with the help of special filters, followed by the return of the plasma back into the bloodstream. It is plasmapheresis that has proven itself better in the treatment of liver failure.

Indications:

• The development of renal and hepatic insufficiency, this usually occurs at the stage of hepatic coma;
• Fulminant liver failure, which develops against the background of poisoning with poisons and toxins;
• Acute and chronic liver failure with severe intoxication with ammonia, bile pigments, bile acids and other toxic substances.

Indications for liver transplant

The transplanted part of the liver in the body of the recipient (the one to whom the organ was transplanted) begins to gradually regenerate to the size of a healthy liver. At the same time, hepatocytes begin to perform their main functions.

The danger of this method is a possible rejection of the transplanted organ (foreign agent), so the patient will have to take special drugs (cytostatics and hormones) throughout his life.
Another problem in using this method in the treatment of liver failure is its high cost and difficulties in selecting the most suitable donor.

Complications of the condition in the form of hemorrhagic syndrome, pulmonary heart failure make it difficult to prepare such a patient for a difficult and lengthy operation.

Principles of diet therapy for liver failure:

• low-protein, and preferably a protein-free diet;
• daily calorie content of food should not be less than 1500 kcal;
• food should be tasty and look appetizing, as patients experience a sharp decrease in appetite;
• you need to eat often, fractionally;
• food should contain a sufficient amount of easily digestible carbohydrates (honey, sugar, fruits, vegetables);
• food should contain a large amount of vitamins and minerals;
• need to get more fiber
• fat restriction is necessary only in the presence of symptoms of cholestasis;
• after the patient's condition improves, you can restore the usual diet by introducing protein products gradually (as complementary foods for children), starting with vegetable protein (buckwheat, cereals, legumes), then dairy products and, with good protein tolerance, meat;
• with the development of hepatic encephalopathy in a patient with a violation of the act of swallowing or hepatic coma, parenteral nutrition is recommended (introduction of solutions of amino acids, carbohydrates, lipoproteins, vitamins, microelements through a vein).

• it is necessary to stop taking alcohol and other hepatotoxic substances (especially drugs without consulting a doctor),
• drink enough liquid
• refuse heavy physical exertion,
• get enough sleep, improve your mental state,
• to prevent constipation, it is necessary to carry out cleansing enemas 2 times a day,
• if the condition allows, more to be in the fresh air, while avoiding open sunlight.