Hepatic coma duration. What is renal coma and causes of liver failure. Etiology and causes of manifestation of hepatic coma

Pathology begins with the fact that hepatocytes (liver cells) die under the influence of a number of reasons. The organ can no longer neutralize toxins. All these products and their metabolites accumulate in the bloodstream and lead to the development of hepatic encephalopathy. Without treatment, death quickly occurs.

• the mood is constantly changing, several times throughout the day;
• there are bouts of euphoria, which turn into a state of stunning;
• during the day there is a pathological desire to sleep, and at night the patient is awake.

Important! Handwriting may change, distraction of thoughts appears.

Before hepatic coma develops, there is one more stage - precoma. In this period disease state increases sharply, comes to the absence of consciousness in the patient. When examining or talking with a patient in a state of precoma, the following symptoms are noted:

• nausea and vomiting, abdominal pain, a sharp decline body weight;
• yellowness of the skin, sclera and mucous membranes, which gradually increases;
• color skin becomes bright red, and lips and tongue - raspberry;
• development of hemorrhagic syndrome - in the precoma stage, bruises and hematomas occur, internal bleeding appears.

Important! From the moment of loss of consciousness, there are several hours to provide qualified assistance.

• toxic agents ( chemical substances, ethanol and its derivatives, mushrooms);
• action medicines(non-steroidal anti-inflammatory drugs, antibiotics, barbiturates, inhalation anesthetics) - especially pronounced against the background of bearing a child, with alcohol abuse;
• viruses (hepatitis, mononucleosis);
• liver pathology, against the background of which there is a sharp decrease in the volume of organ tissues; diseases of the heart and blood vessels;
• stress, burns, septic abortions, shock conditions.

Stages of hepatic coma

• coma 1 - oppression of consciousness occurs in waves, everything physiological reflexes saved;
• coma 2 - the person is in an unconscious state, does not get out of it, all physiological reflexes are normal;
• coma 3 - the patient is unconscious, there are no reflexes.

• glucose with insulin into a vein;
• fat emulsions;
• mixtures of amino acids.

Hepatic coma - the most severe stage of hepatic encephalopathy - develops as a result of diffuse damage to the liver and a sharp violation of its vitality. important functions and is observed in acute and chronic diseases, when the pathological process leads to the death of most of the liver tissue. Among the causes of acute liver failure, viral hepatitis is in the first place, another common cause is toxic liver damage, including drug-induced hepatitis. In this article, we will consider what a hepatic coma is, and what needs to be done with a hepatic coma, what help to provide if the diagnosis is confirmed.

Hepatic coma can also develop with chronic hepatitis cirrhosis of the liver, severe obstructive jaundice, malignant neoplasm liver, severe cholangitis, poisoning with poisons acting on the liver: phosphorus, arsenic, mercury, lead, carbon tetrachloride, mushroom poison. Next, you will learn what to do with a hepatic coma, what are its causes and symptoms.

Reasons for the development of hepatic coma

The pathogenesis of nerve cell damage in acute liver failure is associated primarily with parenchymal liver failure and a violation of its antitoxic function, i.e., the ability to neutralize numerous toxic products formed during metabolism. In chronic liver diseases, the development of porto-caval anastomoses leads to the fact that part of the blood from the portal vein enters the hollow, bypassing the liver, which exacerbates intoxication.

Particularly toxic to nervous system ammonia, which is formed in the large intestine as a result of the breakdown of food proteins under the influence of intestinal flora. Ammonia entering through the portal vein system is neutralized healthy liver by the formation of urea from it, which is excreted from the body with urine. In hepatic coma, the patient's blood accumulates a large number of ammonia and other toxic products of protein breakdown. The irritating effect of ammonia on respiratory center- the cause of hyperventilation often observed in hepatic encephalopathy.

In conditions of turning off the antitoxic function of the liver, the breakdown of food proteins contributes to increased intoxication. intestinal bacteria. At the same time, the concentration of aromatic amino acids (the metabolism of which is normally carried out by the liver) increases in the blood and, apparently, in the brain, and the concentration of branched-chain amino acids decreases. Aromatic acids (phenylalanine, tyrosine, tryptophan) are precursors of false neurotransmitters. False neurotransmitters compete with normal brain mediators (dopamine, norepinephrine), disrupt the interaction of neurons in the brain, which leads to depression of the nervous system.

It may also play a role increased content in the blood and brain of the inhibitory mediator of gamma-aminobutyric acid formed in the intestine, apparently due to a decrease in its hepatic clearance.

Thus, with hepatic coma, self-poisoning of the body and, mainly, the nervous system occurs. In hepatitis, toxic liver dystrophy and hepatic encephalopathy often develop with severe course, serious comorbidities and also in pregnant women. Coma develops more often on the 1st week of illness, less often on the 2nd, sometimes after the start of recovery. With cirrhosis, the causes leading to decompensation of liver functions, in particular detoxification, are different. Among them, alcohol overload, infection, hypokalemia, exacerbation of hepatitis, use of hepatotoxic drugs. With esophageal bleeding, often complicating the course of cirrhosis of the liver, which has poured into intestinal tract blood when broken down becomes additional source ammonium, aggravating the existing disorders of nitrogen metabolism.

Symptoms of hepatic coma

The clinical picture of progressive liver failure is manifested primarily cerebral symptoms caused by toxic damage to the central nervous system. The dynamics of these disorders, which make up a large symptom complex of hepatic encephalopathy, allows us to conditionally distinguish the following main stages of hepatic encephalopathy:

1. Minor disturbances of consciousness and motor skills; in this period, lethargy, apathy, agitation, anxiety, euphoria, fatigue, stubborn headache, drowsiness during the day and insomnia at night, weakness.

2. Drowsiness, disorientation, inappropriate behavior.

3. Gross disturbances of consciousness, stupor, severe disorientation in time and space, fuzzy speech.

4. Deep unconsciousness, coma.

Simultaneously with mental disorders, changes appear muscle tone, tremor of the hands, sometimes twitching of the muscles of the limbs (asterixis), ataxia and rigidity.

In the diagnosis of progressive liver failure, in addition to signs of damage to the nervous system, a characteristic "hepatic" sweet smell from mouth. This sign appears quite early, as liver failure and encephalopathy increase, the intensity of breath odor increases.

In patients with viral hepatitis and cirrhosis, hepatic coma most often develops gradually. Early signs deterioration is a decrease in appetite, the occurrence or intensification of nausea, headache, pain in the epigastric region or right hypochondrium. Often, before this, it is possible to note that the patient's working capacity has decreased, he has become lethargic, taciturn, indifferent to the environment. Sometimes the deterioration is accompanied by irritability and general restlessness. These changes in the behavior and psyche of the patient are the result of incipient toxic damage to the brain. Among early symptoms also note dizziness, fainting, insomnia at night with drowsiness during the day, memory loss, delirium. Sometimes observed persistent hiccups and yawn. Often there is pruritus.

In the precomatous state of hepatic coma, there is a complete aversion to food, persistent repeated vomiting. Pain in the area of ​​the liver intensifies, its size decreases in acute hepatitis, the consistency becomes soft. Patients lose weight. The appearance or increase in the intensity of jaundice can also be one of the signs of an impending coma. The progression of liver dysfunction in the pre-coma state is manifested, in particular, by hemorrhagic diathesis caused by a decrease in the production of prothrombin and fibrinogen in the liver.

Characteristic is the sequence with which neuro-cerebral phenomena develop in time for coma. Lethargy is gradually replaced by drowsiness, which is especially noticeable during the day and turns into a long sleep. During this dream, you can a short time wake up the patient. He opens his eyes, mumbles something in response to a question, sometimes performs simple requests (stick out his tongue, open his eyes, etc.) and after that again plunges into deep dream. Periodically in the background long sleep there is a strong motor excitation, convulsions, delirium. Finally, the excitement stops, the reaction even to strong stimuli gradually disappears.

Diagnosis of hepatic coma

A patient in a state of hepatic coma is motionless, does not respond to stimuli (appeal, touch, injection), which indicates deep defeat nervous system. Face sunken. An unpleasant "liver" smell comes from the mouth. Draws attention to the intense icteric color of the skin, sclera and oral mucosa. The skin is dry, cold, covered with numerous abrasions from scratching. There are multiple hemorrhages on the skin and conjunctiva, which is especially noticeable at the injection sites. Often nasal and uterine bleeding, as well as vomiting coffee grounds. In the terminal period, the temperature rises to 39 - 40 °C. The abdomen is somewhat swollen. On percussion, hepatic dullness was reduced. The liver becomes soft, doughy. Its palpation is sharply painful and causes the patient's reaction in the form of a groan or a short motor excitation. Progressive shrinkage of the liver is hallmark hepatic coma in acute hepatitis. The spleen is often enlarged; against the background of pronounced ascites, it can be difficult to palpate it.

Hepatic coma is accompanied by severe arterial hypotension. Instead of the characteristic viral hepatitis bradycardia appears tachycardia, pulse weak content. Breathing becomes noisy, sometimes arrhythmic in the form of Cheyne-Stokes or Kussmaul breathing. The pupils are dilated and poorly responsive to light. Involuntary defecation and urination are noted, and the amount of urine is significantly reduced. Urine dark brown, contains urobilin and bile pigments, as well as protein, erythrocytes, cylinders.

Thus, the diagnosis of hepatic encephalopathy may be suspected at the prehospital stage based on a thorough history and examination. For correct assessment the condition of a patient with jaundice and cirrhosis of the liver and the timely establishment of the first signs of coma, it must be remembered that the severity of the condition is determined not by the severity of jaundice, but by the presence and severity of neuropsychic symptoms. The diagnostic value of the latter is especially great due to its constancy, a certain sequence of development and early appearance. In this regard, such microsymptoms as persistent, increasing lethargy, drowsiness, headache, loss of appetite, nausea and abdominal pain in patients with jaundice should be regarded as the first symptoms of an impending coma and serve as a signal for urgent action.

In the hospital, liver dysfunction is confirmed by biochemical research blood, however, correlations between the severity of encephalopathy and indicators hepatic function no. Encephalopathy, apart from clinical signs, is manifested by nonspecific EEG changes in the form of slow high-amplitude three-phase waves.

Differential Diagnosis hepatic coma

Differential Diagnosis carried out with uremic, diabetic and hypoglycemic coma. The similarity of hepatic coma with uremic, which develops in the final stage of some kidney diseases, is due to disorders of the nervous system, the appearance of mild jaundice in uremia, skin hemorrhages and skin itching. However, upon careful examination of a patient with uremia, a characteristic ammonia smell from the mouth, an earthy skin tone is observed with a coating of urea in the form of small bran-like scales, sharp narrowing pupils. Uremic coma is characterized arterial hypertension and left ventricular hypertrophy. Sometimes a pericardial friction rub is heard. With uremia, hypothermia is noted throughout the disease. Special meaning for diagnosis has the character of urine. With hepatic coma, urine is the color of beer, contains urobilin and bile pigments, and with uremia, it is light, with low relative density. Urine rich yellow color, with a high relative density, even in the presence of other changes in it, allows you to completely eliminate uremia. In favor of hepatic coma, a rapid decrease and soreness of the liver speak.

diabetic coma characterized by pink or pale, very dry skin, the smell of acetone from the mouth. As a rule, there is a large Kussmaul breathing, a sharp decrease in muscle tone and hypotension of the eyeballs.

In some cases, it is necessary to differentiate hepatic coma from hypoglycemic. Signs of hypoglycemia: increased tone muscles, rhythmic, calm breathing, convulsions, profuse sweating, suddenness and rapidity of the development of these phenomena and a rapid improvement in well-being after intravenous administration of 20-40 ml of a 40% glucose solution.

What to do with hepatic coma: treatment methods

Treatment initiated with severe symptoms of hepatic coma is usually ineffective. Mortality in this case exceeds 80%, the causes of death may be intoxication, gastrointestinal bleeding, cerebral edema, disorders heart rate. Timely should be considered the diagnosis of hepatic coma during the period of precursors or with the initial manifestations of precoma. It is during this period that intensive detoxification therapy can have an effect, so patients with increasing liver failure in the initial stages of precoma are subject to immediate hospitalization in a therapeutic or infectious hospital. The doctor is required to ensure the transportation of the patient with maximum physical rest. Application sedatives even when psychomotor agitation Not recommended. Symptomatic therapy for hepatic coma at the prehospital stage with severe intoxication and persistent arterial hypotension may include detoxification therapy (isotonic sodium chloride solution, 5% glucose solution, hemodez), polyglucin, mezaton, or dopamine.

In the hospital, the principle of maximum physical and mental sparing of patients is also observed. For the purpose of detoxification, laxatives are used, high cleansing enemas 1 - 2 times a day. The use of lactulose is shown - a synthetic disaccharide that decomposes in the large intestine into milk, formic and acetic acid. Acidification of intestinal contents causes osmotic and acidic diarrhea, changes the bacterial flora in favor of non-nitrogen-producing bacteria, and reduces the concentration of free (non-ionized) ammonia in the intestine. Lactulose inside appoint 15 - 45 ml 2 - 4 times a day. The drug is contraindicated in cases of suspected intestinal obstruction. Side effects in overdose - dehydration, hypernatremia, severe diarrhea. In addition, lactulose can be prescribed in the form of enemas (300 ml of lactulose is added to 700 ml of water, 2-4 enemas per day).

An alternative to lactulose in the treatment of hepatic encephalopathy can be the antibiotic neomycin, which suppresses the ammonia-producing intestinal flora. The drug can be administered orally (1 g every 4-6 hours) or in the form of enemas (1-2 g in 100-200 ml isotonic solution sodium chloride 2-4 times a day). His side effects– nephro- and ototoxic action. If neomycin is intolerant, metronidazole may be indicated - 250 mg 3 times a day. In severe cases, with the ineffectiveness of monotherapy, combined treatment lactulose and neomycin.

Limit, and in case of severe encephalopathy, proteins (meat, fish, cottage cheese, eggs) are completely excluded from the diet. Sufficient energy supply is achieved intravenous administration glucose - up to 3 liters of a 10% solution in a precomatous state. For better assimilation glucose in hepatic coma, insulin is simultaneously used at the rate of 10 IU per 50 g of pure glucose. Considering the usual hypokalemia for these patients, 3-6 g of potassium chloride are added to the solution. Vitamin therapy is indicated (vitamins of group B, ascorbic acid, to combat bleeding - vitamin K, vikasol). Appointment expediency steroid hormones is not recognized by all, their use is possible, apparently, with alcoholic liver damage.

It should be emphasized that only early hospitalization in many cases can save the life of a patient with progressive liver failure.

Hepatic coma is pathological condition, which is the final stage of hepatic encephalopathy.

Coma develops due to an increase in the concentration in the body of substances such as ammonia, phenols, sulfur-containing and aromatic amino acids, and fatty acids with low molecular weight.

These substances are metabolic products, and have a detrimental poisoning effect on the brain. The pathogenesis of this state of the body is diverse.

An important question is "How long do people with hepatic coma live"?

Unfortunately, all the signs and pathogenesis of the disease indicate irreversible processes in the body. This means that death occurs in almost 90% of cases.

Kinds

There are several types of hepatic coma, namely:

stages

hepatic coma by clinical picture can manifest itself in 3 stages. These include a precoma, threatening someone, a frolicking coma.

In this state, sepsis often also manifests itself, as a result of which there is heat body, leukocytosis and olirugia are injected. This stage can last for several minutes or several days.

Symptoms and Causes

Symptoms can be completely different depending on the stage and type:

Other symptoms may also appear, as there may be different reasons and complications of this condition.

The reasons

To the very common reason hepatic coma can be attributed to hepatitis B different forms: alcoholic, viral, acute, toxic.

Also, coma can develop with a progressive disorder. This disorder is caused by thrombosis. hepatic vein, and possibly with surgical intervention, in case of erroneous ligation of the vein. And also one of the most common causes is cirrhosis of the liver.

Less frequent signs- this is portal vein thrombosis, schistosomiasis, etc.

Pathogenesis. It should be noted that significantly accelerates the onset of hepatic coma disorders metabolic processes. The main toxic substance is ammonia, as well as aromatic amino acids, etc. These substances are produced in the large intestine.

The pathogenesis of hepatic coma includes a process in which lipids are oxidized, namely, this leads to the fact that the permeability of cells becomes much greater and, in connection with this, accumulate various products autolysis, etc., that is, toxic poisons.

Also, the pathogenesis of this condition includes circulatory disorders, circulatory hypoxia and intravascular hypercoagulability. Aggravate CNS disorders in hepatic coma, such processes:

• Violation of acid-base and water-electrolyte balance;
• Hemodynamic processes;
• hypoxia;
• Renal failure.

First aid

If a person shows signs of a baked coma, first of all, you need to call " ambulance” and note how much time has passed to inform the doctors.

urgent first first aid is to put the person on their side and make sure that there is a normal air supply.

This condition is characterized by disorders of thinking and behavior, so you still need to make sure that the person does not injure himself. If the patient has vomiting, then the oral cavity should be cleaned of vomit.

Also, emergency first aid is to give the patient a drink, in large quantities. In order not to aggravate the situation, no further actions are taken.More urgent care provided by doctors in the intensive care unit. Since in this case only drug therapy is needed.

Treatment

Treatment of hepatic coma consists of the following activities:

Therapeutic therapy is prescribed individually for each patient, based on the indicators of analyzes (general, biochemical, liver tests).

Forecast and conclusions

Hepatic coma is the last stage of encephalopathy, which has a very poor prognosis. It is better, of course, to treat encephalopathy in its early stages. Self-medication in this case is strictly prohibited.

According to medical practice, the prognosis is as follows: about 80-90% of cases end in death.

How long do patients with a diagnosis of hepatic coma live? As a rule, death occurs after a few days. With subacute prognosis, the prognosis is favorable, since with correct therapy the mortality rate is much lower, but cirrhosis of the liver can develop as a result.

Patient Victor, 43 years old. The man was admitted with a diagnosis of hepatic coma, the condition is extremely serious. Symptoms of the disease: tremor of the limbs, strong smell bile from the oral cavity, severe pain in the right hypochondrium. Additional Research showed that ascitic syndrome is also present.

Carried out urgent hospitalization to the intensive care unit. The patient was prescribed intravenous detoxification solutions, antibacterial drugs a wide range actions, glucocorticoids, Furosemide and Aldactone. As well as a complex of vitamins. An enema was given to reduce the ammonia concentration.

Short reference. Furosemide and Aldactone are taken in combination with ascites.

Liver pathologies today come to one of the first places in terms of prevalence among the inhabitants of our country. greatest danger represents such a complication of many pathologies as hepatic coma. To understand what it is and why pathology is dangerous, it is necessary to understand the causes of its occurrence, the mechanism of development, to find out whether the disease can be cured and how to increase the life expectancy of patients with this diagnosis.

Coma is last stage. In fact, coma is a pathological coma associated with complete inhibition of liver function. It is characterized by deterioration of the condition, fainting, impaired breathing, blood circulation, and a decrease in human vital activity. In most cases, the end result of the pathology is death.

Hepatic coma is not independent disease, but becomes a consequence of the progression of the existing disease. It can also cause disease toxic injury organism.

Coma may be caused by:

The main factors of pathogenesis:

Factors for the development of pathology:

• liver failure;
• the breakdown of protein products that come with food (ammonia is a particular threat);
• anastomosis (bypassing the filtration through the liver of toxic, harmful components, which later enter the bloodstream).

Symptoms may differ depending on the cause that influenced the onset of liver coma. Pathology is characterized by common symptoms:

Coma with cirrhosis

Hepatic coma is a common consequence of the progression of cirrhosis. It occurs at a severe stage of pathology, which is characterized by a critical one (in particular, the inability to synthesize protein and neutralize toxic substances that enter the human body).

First signals initial stage pathologies against the background of cirrhosis:

Gradually, the patient's condition worsens. This can be facilitated not only by natural negative processes occurring in the body, but by unfavorable third-party factors (excessive consumption of protein foods, alcohol consumption, the appearance of an infectious disease). New symptoms appear:

• fainting;
• no response to external stimuli in particular to bright light;
• muscle atrophy, so the face resembles a mask;
• respiratory arrest and death.

Types and stages of development

There are two types of coma:

Coma has several stages of development:

Often, the first 2 stages of pathology are mistaken for mental disorders. This greatly complicates correct setting diagnosis. Sometimes relatives of the patient, noticing characteristic symptoms, begin self-treatment - give antidepressants, psychostimulants. Such pseudo-treatment only worsens the patient's condition.

Choice of method of therapy

Coma is determined by a blood test for biochemistry. The main signs of pathology:

• critical excess of bilirubin;
• significant increase in nitrogen content;
• low lipid levels;
• reduced levels of glucose and prothrombin.

Urine and feces are also analyzed. When the disease is noted increased performance urobilin and bile acids.

When emergency At home, emergency care consists of the following activities:

1. Turn the victim to the left side to facilitate his breathing process.
2. Call an ambulance as soon as possible. Until the doctors arrive, do not touch the patient, do not change his position.
3. Doctors hospitalize the patient in a hospital.
4. Glucose and Panangin are administered intravenously, which helps to activate the brain, restore blood circulation.
5. The introduction of a physical solution with insulin to eliminate the catatonic state of the patient.
6. During the first day, the patient is actively injected with Prednisolone to neutralize ammonia and remove toxins from the body.
7. Riboflavin, Pyridoxine, Thiamine and Nicotinic acid are administered to restore liver functions.

Further treatment is carried out in a hospital with the help of drug therapy:

Hepatic coma is a pathology with dangerous severe consequences. In fact, the coma has no complications, but the entire vital activity of the body is disrupted. Pathology provokes irreversible disorders, significantly worsens the patient's condition. Extremely high risk lethal outcome.

As for survival, it directly depends on timely diagnosis and well-prescribed treatment. Full recovery after past illness extremely doubtful and practically does not occur in medical practice.

The probability of restoring the patient's vital activity at the stage of the ancestor is about 20%, at the second stage - no more than 10%.

Patients who are in a deep coma rarely come out of it. It succeeds only in 1% of all registered clinical cases. The chances of survival increase with .

Preventive measures regarding the disease does not exist. You can only try to prevent the occurrence of liver disease by quitting smoking, drinking alcoholic beverages and fatty, fried foods.

Expert reviews

Hepatic coma is a frequently discussed topic among doctors. A few comments from experts on pathology are presented below:

Egorov B.V., doctor:“Pathology is one of the most severe. It progresses quickly and spontaneously, carries a large number of deaths. It is catastrophically difficult to deal with it even at the initial stage. Most favorable course disease is possible in case of transplantation healthy organ. However, based on my practice, many patients do not live up to this point.

Martynov A.K., doctor:“The disease is skillfully disguised, quite often its first symptoms are perceived as a disruption of the nervous system, a failure psycho-emotional state person. First of all, this is indicated by disorientation, and the patient not only loses a sense of the reality of place and time, but also experiences difficulties in determining his own personality.

Apathy, depression, aggression, mood swings are all characteristic symptoms of a nervous system disorder. With the manifestation of such signs, relatives of the patient send him for treatment to a neurologist, psychologist, psychotherapist.

Meanwhile, the body continues to destroy the real cause of this condition - liver coma. It is not always possible to determine the correct diagnosis. Moreover, when a pathology is detected in 15% of cases, it is not possible to identify the cause of its occurrence.

Filatova E.N., doctor:“Liver coma is a global danger that can affect a person at any age. According to statistics and clinical data, adults over 40 years of age are in a special risk group. But the worst thing is that in the same group there are children under 10 years old.

An effective method of saving a human life in case of pathology is the transplantation of a donor organ. But such an operation is extremely dangerous for the child, moreover, in this case difficult to find a suitable donor. As a result, children's body can't handle this load. Unfortunately, on this moment the most gentle and reliable, effective method There is no cure for the pathology yet.

Hepatic coma is a terrible threat to the liver. It is very difficult to protect yourself from it, since it is one of the few diseases that is difficult to prevent through preventive measures.

Most best option- always be attentive to your health, monitor the quality of nutrition, get rid of bad habits, devote time to at least minimal physical activity and walks in the air, which will help strengthen the body. Perhaps it is these simple tips help to avoid death due to this disease.

Hepatic coma is the final stage of the progression of liver failure, accompanied by disorders of the central nervous system. This pathology occurs due to the influence on general state organism various kinds intoxications, as well as cirrhosis or death of the body.

despite the bright severe symptoms and various methods treatment of this pathological process, a high mortality rate is recorded. This may be due to the fact that pathogenesis advanced stage the disease is characterized by an effect on the brain, which leads to its swelling.

The main group of people who have been diagnosed with such an ailment are patients under the age of forty. This problem can develop in the human body for some time, and does not make itself felt immediately. The first signs of the disease are: depression the patient and sleep disturbance - a person sleeps during the day and stays awake at night.

When the first indicators of the disease appear, the patient must be given first aid, either independently to those who are nearby, or to doctors. This must be done immediately, since the disease entails multiple complications for the health and life of the affected person.

Etiology

The degree of intensity of manifestation of symptoms of such a condition directly depends on the stage of the disease, or rather, the damage to the nervous system. actually provoke this pathology could be many reasons. The main causes of the disease include:

• impact medicines that adversely affect the liver;
• various kinds of toxins and chemicals that enter the human body through the air or through contact in working conditions;
• alcohol, tobacco and drug abuse;
• infections in which the structure and performance of organ functions are disturbed;
• neoplasms of a benign or malignant nature with oncology or cirrhosis;
• congenital anomalies in the structure of the internal organ;
• bleeding in the gastrointestinal tract;
• disruption of the cardiovascular system;
• liver injury;
• termination of pregnancy (abortion);
• poisoning the body with poisons of various origins - industrial or natural;
• bacteria.

Varieties

The course of the disease can take place in several stages:

• precomatose state of the patient - observed abrupt change the mood of the victim, slow thinking and disorientation in space and time. Duration from two hours to several days;
• threatening coma - a person gets worse every hour. This stage is characterized by memory lapses and loss of consciousness. Duration - from one or two days to ten;
• hepatic coma - at this stage, the patient's situation is extremely difficult, rare periods of full consciousness, there is a smell of ammonia from the mouth, breathing is weak and heavy.

The causes of the disease are:

• endogenous - in which the liver ceases to fully perform its functions. Occurs due to exposure to toxic substances;
• exogenous - often expressed in cirrhosis;
• mixed;
• false.

Symptoms

Symptoms of the disease directly depend on the stage of hepatic coma. So, at the initial stage, there are:

• changes in behavior from depressed to unreasonably cheerful;
• sleep problems;
• slow thinking;
• impaired concentration, but the patient correctly answers questions and recognizes people;
• bouts of dizziness;
• increased perspiration.

For the second stage of the course, the following symptoms will be characteristic:

• forgetfulness;
• periodic loss of consciousness;
• the patient is completely disoriented;
• trembling appears in the lower and upper limbs, increasing over time;
• unpleasant odor from the mouth;
• the skin takes on a yellow tint.

Symptoms of the most severe stage:

• the face does not express any emotions;
• unconscious state;
• rapid pulse;
• the smell of ammonia hovers over the patient;
• pupils are weakly responsive to light.

Without treatment, convulsions appear in the third stage and complete absence breathing.

Since hepatic coma develops slowly, a few weeks before the onset of the first stage of the disease, a person complains of:

• aversion to food;
• seizures;
• severe weakness;
• loss of sense of taste and smell;
• bleeding from mucous membranes;
• burning skin that cannot be tolerated.

Complications

Since the pathogenesis of the disease is quite severe, with untimely treatment hepatic coma can develop such consequences as:

• hemorrhage in the brain;
• sharp and;
• blood poisoning;
• cirrhosis, in the case of this disease, not only the cause, but also a complication;
• which invariably leads to the death of the patient.

Diagnostics

To establish correct diagnosis it is important to determine in detail the causes of hepatic coma, pathogenesis and classification of the disease. In addition, the following diagnostic methods are carried out:

• study of pathogenesis and determination of the time of manifestation of the first symptoms - special attention deserve people with cirrhosis of the liver and hepatitis B;
• and , general and biochemical;
• and gastrointestinal tract;
• electroencephalogram;
• additional consultations of a gastroenterologist, neuropathologist, resuscitator;
• cerebrospinal fluid analysis.

Treatment

Before the experts get down to business professional treatment, it is necessary to carry out first aid, because most often the deterioration of the patient's condition is observed at home (only ambulance attendants together with those who were close to the patient can carry it out). Thus, the methods of emergency care are:

• first medical care- a person is provided with peace and plentiful drink, during bouts of vomiting, it is necessary to clean the oral cavity from vomit;
• first aid emergency - reduce the increased excitability of a person;
• assistance directly to medical institution- immediately prescribed droppers medicinal substances. Spend various methods detoxification and lowering the acidity of the blood.

The only way to treat hepatic coma is organ transplantation, most often this method of therapy is prescribed for cirrhosis. The operation is carried out only in case of stabilization of the patient's condition.

But, despite all the methods of treatment, the prognosis of the disease is rather sad, because most patients do not live to see an organ transplant. Of all those who have been subjected to hepatic coma, only a quarter receive a new organ. The highest mortality is observed in patients younger than ten and older than forty years. This happens due to progression, a decrease in the size of the liver, cerebral edema and acute respiratory failure.

Prevention

Measures to prevent hepatic coma:

• timely treatment various diseases liver, especially cirrhosis;
• adequate use of drugs;
• rejection self-treatment any disease;
• contact with caution toxic substances, wear protective clothing and other means to prevent getting chemical compounds into the body;
• observe healthy lifestyle life, abandoning all bad habits;
• enrich food with vitamins and nutritious minerals;
• pass full examination clinic twice a year.

Is everything correct in the article with medical point vision?

Answer only if you have proven medical knowledge

Diseases with similar symptoms:

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