Terminal liver failure. Liver failure: treatment and symptoms

Liver failure is a complex of clinical symptoms resulting from a violation of the compensatory capabilities and functions of the organ, as a result of which the liver cannot maintain homeostasis in the body and provide normal exchange substances. There are many 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, so under certain conditions, liver failure can develop very quickly and be fatal.

Causes of liver failure

Chronic hepatitis and liver cirrhosis sooner or later lead to liver failure.

Liver diseases (acute and chronic hepatitis, cirrhosis, echinococcosis, etc.);
diseases associated with obstruction of the bile ducts, leading to hepatic hypertension and the development of dystrophic changes in liver cells;
extrahepatic diseases (cardiovascular and endocrine systems, infectious and autoimmune diseases and 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 transfusion and other similar conditions).

Symptoms of liver failure

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

Cholestasis syndrome

This syndrome occurs as a result of obstruction of the flow of bile through the biliary tract due to blockage, most often by a stone or tumor. As a consequence of this, one of the most striking manifestations of the disease occurs - jaundice. The severity of this symptom depends on the level of biliary obstruction. The skin, sclera and mucous membranes may become various shades, from pale yellow to orange and greenish. With a long course of the pathological process, jaundice may not occur.

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, it enters the blood a large number of toxic substances that the liver was supposed to neutralize. Exactly cytolytic syndrome and are caused by the main symptoms of the disease.

If hepatocytes die, the patient begins to experience 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, arterial 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 are revealed, endocrine disorders(menstrual irregularities in women, gynecomastia in men). With further progression of the process, the nervous system suffers. Patients are lethargic, apathetic, drowsy, but sometimes the opposite reaction can be observed, expressed in the form of increased excitability, tremors of the limbs and convulsions. Impaired liver function leads to impaired kidney function, as a result of which harmful substances that are normally excreted in the urine accumulate in the body, which increases the symptoms of intoxication. As a result of impaired protein synthesis, anemia can develop.

Portal hypertension syndrome

This syndrome occurs with long-term progression of the process and is practically impossible to correct. IN venous system liver pressure increases, resulting in edema and ascites (fluid accumulation in the abdominal cavity). There is also overflow of the superficial venous plexuses on the patient’s abdomen, this symptom is called “head of the jellyfish”. Varicose veins of the esophagus also occur, which can cause bleeding from them. Spider veins appear on the patient's chest and shoulders, and erythema (redness) of the palms attracts attention.

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

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.
The decompensated (severe) 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, slow, and tremor (shaking) of the limbs appears.
The terminal stage (dystrophic) stage is characterized by stupor, the patient can hardly be awakened, and apathy is replaced by excitement. Sometimes patients are completely non-communicative, but the reaction to pain is preserved.
The last stage of liver failure is hepatic coma. Patients are unconscious, there is no reaction to painful stimuli, convulsions and pathological reflexes appear.

Treatment of liver failure

A patient with liver failure will be prescribed a number of medications (antibacterial, hepatoprotectors, vitamins, laxatives and others). It is unlikely that they will help get rid of the disease, but they will certainly improve a person’s quality of life.

Treatment for this serious illness- Very difficult process, which depends on the stage and form of liver failure.

Patients need treatment for the underlying disease that led to the development of liver failure.
Patients are strongly recommended to follow a diet limiting protein 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.
Antibacterial therapy begins immediately upon admission of the patient to the hospital; before receiving the results of an analysis of the sensitivity of microflora to antibiotics, broad-spectrum drugs (most often from the group of cephalosporins) are used.
Hypoammonemic drugs (Ornithine, Hepa-Merz) help reduce ammonia levels in the body.
Lactulose-based laxatives (Duphalac, Normaze) also help reduce the absorption of ammonia in the intestine and also suppress the intestinal flora that produces it. For constipation, patients are also given enemas with magnesium sulfate.
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 administered intravenously.
Vitamin therapy and replenishment of microelements. B vitamins, ascorbic, folic, nicotinic, glutamic, and lipoic acids are introduced. To maintain mineral metabolism, it is necessary to introduce calcium, magnesium and phosphorus.
Upon joining renal failure patients may need hemodialysis to remove ammonia and other toxic substances from the patient's blood that are normally detoxified by the liver. At stages 3–4 of the disease, hemodialysis can improve the prognosis for patients.
With severe ascites, paracentesis is performed to evacuate fluid accumulated in the abdominal cavity.

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

Which doctor to contact

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

Liver failure syndrome is a symptom complex characterized by a violation of one or many liver functions 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 - severe (decompensated) and stage III - terminal (dystrophic). End-stage liver failure ends in hepatic coma.

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

Source health.mail.ru

Symptoms
Signs
Causes
Diagnostics
In children
stages
Treatment methods

Symptoms

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

In the first case, due to obstruction of the bile ducts and, consequently, the cessation of normal excretion of bile, jaundice occurs. It is the most characteristic and noticeable manifestation of liver disease and can be acute or chronic. The severity of jaundice can vary from brightly pigmented to almost invisible.

In the second case it starts large quantity hazardous processes. Hepatocellular 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 gastrointestinal tract (discolored stools).

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

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

Source vseopecheni.ru

Signs

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

Hepatic cell failure is characterized by an increase in the syndromes of jaundice, hemorrhagic, edematous-ascitic, dyspeptic, abdominal pain, fever, decreased liver size, and weight loss are possible. Hepatic odor appears from the mouth, caused by the release of methyl mercaptan due to a violation of demethylation processes in the liver.

Laboratory signs of hepatic cell failure 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 mental disorders (emotional instability, anxiety, apathy, possible delirious states accompanied by agitation, aggression; impaired orientation, sleep, etc.) and neuromuscular disorders (speech disorders, “flapping” tremor of the fingers, impaired writing, increased reflexes, ataxia).

Source lekmed.ru

Causes

The following conditions may be the causes of liver failure:

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 increased pressure of biliary hypertension, which disrupts lymph and blood circulation in the liver and leads to the development of dystrophic changes in hepatocytes (liver cells);

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

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

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

Clinical and experimental studies show that, whatever the reason, morphological changes liver tissue is 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, they find out the facts of alcohol abuse, past viral hepatitis, existing metabolic diseases, chronic liver diseases, malignant tumors, taking medications.

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, tumor processes in the abdominal cavity.

Hepatoscintigraphy is used to diagnose diffuse lesions liver (hepatitis, cirrhosis, fatty hepatosis), liver tumors, 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, it ends in 50% of cases. lethal outcome. And saving the child’s life depends only on the competent and timely actions of parents and doctors.

In newborns under 15 days of age, liver failure is often caused by immaturity in the production of certain enzymes.

In addition, in children 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, and has a headache. Digestion of food is impaired: diarrhea, bloating, vomiting. My stomach hurts, my heart rate is slow.

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. Subsequently, after being discharged home, the child must adhere to a special diet for a long time and take increased doses of vitamins B, A, C, K.

Source tiensmed.ru

stages

Liver failure is classified into 3 stages:

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

In stage 1, there are no clinical symptoms, but immunity to alcohol and other toxic influences 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, profound metabolic disorders are observed in the body, degenerative phenomena not only in the liver, but also in other organs (central nervous system, kidneys, etc.);

End-stage liver failure ends in hepatic coma.

Source curemed.ru

Treatment methods

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

Strict diet. Protein intake is carefully controlled: excess protein can cause brain dysfunction, and deficiency can lead to weight loss. Sodium intake should be kept low to avoid fluid accumulation in the abdomen (ascites).

Symptomatic therapy.

Correction of pathology of the coagulation system and electrolyte disturbances.

The surgical method of treatment is liver transplantation.

Source zdorovieinfo.ru

liver-up.ru

Causes of liver failure

Chronic hepatitis and liver cirrhosis sooner or later lead to liver failure.

Liver diseases (acute and chronic hepatitis, cirrhosis and liver tumors, echinococcosis, etc.);
diseases associated with obstruction of the bile ducts, leading to hepatic hypertension and the development of degenerative changes in the liver cells;
extrahepatic diseases (cardiovascular and endocrine systems, infectious and autoimmune diseases, etc.);
poisoning with drugs, poisonous mushrooms, alcohol surrogates, chemicals;
extreme effects on the human body (extensive burns, injuries, traumatic and septic shock, massive blood loss and blood 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 obstruction of the flow of bile through the biliary tract due to blockage, most often by a stone or tumor. As a consequence of this, one of the most striking manifestations of the disease occurs - jaundice. The severity of this symptom depends on the level of biliary obstruction. The skin, sclera and mucous membranes can take on various shades, from pale yellow to orange and greenish. With a long course of the pathological process, jaundice may not occur.

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.

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 and endocrine disorders are identified (menstrual cycle disorders in women, sexual dysfunction, gynecomastia in men). With further progression of the process, the nervous system suffers. Patients are lethargic, apathetic, drowsy, but sometimes the opposite reaction can be observed, expressed in the form of increased excitability, tremors of the limbs and convulsions. Impaired liver function leads to impaired kidney function, as a result of which harmful substances that are normally excreted in the urine accumulate in the body, which increases the symptoms of intoxication. As a result of impaired protein synthesis, anemia can develop.

Portal hypertension syndrome

This syndrome occurs with long-term progression of the process and is practically impossible to correct. Pressure increases in the liver venous system, resulting in edema and ascites (fluid accumulation in the abdominal cavity). There is also overflow of the superficial venous plexuses on the patient’s abdomen, this symptom is called “head of the jellyfish”. Varicose veins of the esophagus also occur, which can cause bleeding from them. Spider veins appear on the patient's chest and shoulders, and erythema (redness) of the palms attracts attention.

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

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.
The decompensated (severe) 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, slow, and tremor (shaking) of the limbs appears.
The terminal stage (dystrophic) stage is characterized by stupor, the patient can hardly be awakened, and apathy is replaced by excitement. Sometimes patients are completely non-communicative, but the reaction to pain is preserved.
The last stage of liver failure is hepatic coma. Patients are unconscious, there is no reaction to painful stimuli, convulsions and pathological reflexes appear.

Treatment of liver failure

Treatment of this serious disease is a very complex process, which depends on the stage and form of liver failure.

Patients need treatment for the underlying disease that led to the development of liver failure.
Patients are strongly recommended to follow a diet limiting protein to 40–60 g/day and table salt to 5 g/day. If necessary, patients are transferred to tube feeding; fat emulsions can be used to increase the calorie content of the diet.
Antibacterial therapy begins immediately upon admission of the patient to the hospital; before receiving the results of an analysis of the sensitivity of microflora to antibiotics, broad-spectrum drugs (most often from the group of cephalosporins) are used.
Hypoammonemic drugs (Ornithine, Hepa-Merz) help reduce ammonia levels in the body.
Lactulose-based laxatives (Duphalac, Normaze) also help reduce the absorption of ammonia in the intestine and also suppress the intestinal flora that produces it. For constipation, patients are also given enemas with magnesium sulfate.
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 administered intravenously.
Vitamin therapy and replenishment of microelements. B vitamins, ascorbic, folic, nicotinic, glutamic, and lipoic acids are introduced. To maintain mineral metabolism, it is necessary to introduce calcium, magnesium and phosphorus.
When kidney failure occurs, patients may need hemodialysis to remove ammonia and other toxic substances from the patient's blood that are normally neutralized by the liver. At stages 3–4 of the disease, hemodialysis can improve the prognosis for patients.
With severe ascites, paracentesis is performed to evacuate fluid accumulated in the abdominal cavity.

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

myfamilydoctor.ru

About the liver

The liver is the most heavy organ, performing a lot of functions. Yes, she:

inspects almost all substances that enter the intestines or are absorbed into the circulatory system;
synthesizes urea from toxic ammonia;
neutralizes substances formed during its own metabolism. Thus, indirect bilirubin, formed from hemoglobin, is poison for the brain. The liver binds it with glucuronic acid, and it, becoming less toxic, should be excreted in the bile;
stores “energy” for “the most extreme case.” This is glycogen - glucose interconnected by special bonds;
forms various proteins. This:
- albumins, which, by attracting water into the vessels, allow it to exist in liquid form. Also, albumins, by binding many toxic substances (including bilirubin, salts of heavy metals, and other substances), make them less harmful;
- globulins - proteins that carry out immune surveillance in the body, transport iron (globin in hemoglobin), and perform the blood clotting process;
responsible for the destruction of hormones and enzymes;
deposits a certain volume of blood that enters the vessels during shock or blood loss;
synthesizes bile, which is involved in the emulsification of fats supplied with food;
some vitamins are deposited in it, for example, A, D, B 12;
in prenatal period the liver is able to form hemoglobin, which later, after birth, the bone marrow will do.

These were the main functions of this body. In total there are more than five hundred of them. Moreover, every minute it performs up to 20 million chemical reactions (detoxification, synthesis of proteins, enzymes, and so on).

The liver is the organ that is best able to recover. If 25% or more of living cells remain, when exposure ceases toxic factors it can completely restore its volume. But it does this not by dividing cells, but by increasing their volume. The speed of regeneration depends on the age of the person (faster in children), and the individual characteristics of his body. The underlying disease determines no less the ability to recover.

Liver failure can occur due to many reasons. This includes taking aspirin (especially by children), and viruses, and the use of mushrooms (the “leader” in this case is toadstool), and alcohol substitutes. It is from this condition that people die in 80-100% of cases, because if the liver cells die, there is no one to perform their function.

Forms of liver failure

Based on the rate of development of liver cell death, liver failure can be acute or chronic. According to the mechanism of development of the pathology, the following 3 forms of the condition are distinguished:

Hepatocellular failure

It occurs when the cells of an organ are affected by substances that are toxic to them (mushroom poisons, special viruses, poisons from alcohol substitutes). This type of liver failure can be acute, when cells die en masse, and chronic, when poisoning occurs gradually, cells die slowly.

Portocaval form

It is, in most cases, chronic. This name indicates that high pressure occurs in the portal vein (called “vena porte” in Latin), carrying blood to the liver for cleansing. In order not to “flood” the liver with blood, this vein “dumps” blood into the inferior vena cava (it is called the “vena cava”) through connecting veins. These veins normally exist to save a life if severe hypertension develops in the portal vein. But if high pressure is maintained in them for a long time, which they are not designed for, ruptures of various sizes periodically occur in them, which leads to bleeding: esophageal-gastric, rectal, retroperitoneal.

Since the blood is shunted bypassing the liver, it turns out that it is not being cleansed of toxins. In addition, the portal vein normally provided part of the liver’s nutrition, that is, with the portacaval form of failure, the liver cells will suffer from hypoxia. The latter will be chronic, since the hepatic artery still remains, which brings blood to the liver directly from the aorta.

Mixed form

This is also a type of chronic liver failure, combining both the suffering of liver cells (hepatocellular failure) and the “discharge” of unfiltered blood into the general bloodstream.

Acute form of liver failure

When large volumes of liver cells stop functioning all at once, a condition called acute liver failure develops. Symptoms of this condition develop quickly - from several hours to 2 months, during which bleeding, severe intoxication, impaired consciousness to the level of coma, and dysfunction of other organs develop. Further, in 20% of cases, the symptoms regress, and a slow recovery process begins, but in 80-100%, especially if a coma of hepatic origin has developed, the person dies.

If such a process develops and ends within a few days, it is called fulminant liver failure. Developing as a result of inflammation of the liver, it is called fulminant hepatitis. Most often, fulminant hepatitis occurs due to an inflammatory process caused by viruses. The “leader” in this regard is viral hepatitis B. The prognosis for fulminant forms of liver failure is unfavorable for life. Such people can be saved by liver transplantation, performed before the development of severe bleeding and coma, which is difficult to achieve. Complications after liver transplantation performed to treat fulminant liver failure are also extremely high.

Causes of acute liver failure

Acute liver failure occurs in the form of liver cell failure. This may occur due to the following reasons:

Poisoning with poisonous mushrooms: toadstools, stitches, crosses, heliotrope. The mortality rate for this condition is more than 50%.
Taking antipyretic drugs for fever in children 4-12 years old. Particularly dangerous in this regard are acetisalicylic acid (“Aspirin”) and products containing salicylates. Less dangerous are paracetamol, ibuprofen (Nurofen), and analgin. The disease is called Reye's syndrome or acute hepatic encephalopathy. The mortality rate for children is 20-30%.
Viruses:
- hepatitis A (only in people over 40 years of age, when Botkin’s disease occurs against the background of biliary tract disease);
- hepatitis B - alone or in combination with infection with hepatitis D (the hepatitis D virus is defective, it can only enter an organism that already has the hepatitis B virus). Fulminant hepatitis B occurs only in people with “strong” immunity, especially young people. Drug addicts, people taking drugs to reduce immune defense(after transplantation, for autoimmune diseases, during cancer treatment), patients with diabetes mellitus, pregnant women with fulminant hepatitis B practically do not get sick;
- hepatitis E. This virus is transmitted through dirty hands, like virus A. It occurs easily in men and women outside of pregnancy, but is extremely dangerous for pregnant women, ending in the fulminant form in 20%. Most often - in 21% of cases - this disease develops in the 3rd trimester of pregnancy; dangerous even 1 month after birth;
- yellow fever virus;
- viruses of the herpes group (herpes simplex, cytomegalovirus, Epstein-Barr virus, varicella-zoster virus);
Other microbes, not viruses, that can cause a generalized infection of the entire body with liver damage. This is a wide variety of bacterial infections (staphylococcal, enterococcal, pneumococcal, streptococcal, salmonella, and so on), as well as rickettsiosis, mycoplasmosis, and mixed fungal infections.
Poisoning with alcohol substitutes.
Acute blood poisoning with liver abscesses, purulent inflammation of intrahepatic bile ducts.
Poisoning with poisons that are toxic to the liver: phosphorus, chlorocarbons and others.
Poisoning with drugs, especially in case of 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.
Acute circulatory disorder in the liver due to embolism of a large branch of the hepatic artery of blood clots, gas, fat.
Severe course of oncological diseases: hemoblastosis, lymphogranulomatosis, cancer metastases of various localizations in the liver.
Diseases of unknown origin: for example, acute fatty hepatosis of pregnancy.
Rupture of an echinococcal cyst in the liver.
Surgeries on the abdominal organs in which the blood circulation of the liver is disrupted (for example, a large branch of the hepatic artery is clamped, stitched or cut for a long time).

How does acute liver failure manifest?

Depending on the symptoms and test results, acute liver failure is divided into 2 types:

minor acute failure (synonyms: liver dysfunction, hepatosuppression);
severe liver failure (hepatargia, cholemia).

Both types of disease manifest themselves differently.

Hepatosuppression

Symptoms of this type of liver failure are hidden behind the manifestations of the underlying disease (sepsis, poisoning, pneumonia, pneumonia, meningitis, shock or another), which has led to deterioration of the liver. This:

drowsiness;
mild nausea;
decreased appetite.

There is no jaundice, no spontaneous bleeding, no effusion of fluid into the tissue or cavity.

If the cause of hepatodepression is a long-term (more than a day) intractable state of shock, when there is either little blood in the vessels, or they dilate too much and cease to normally supply oxygen to the internal organs, renal-liver failure develops. This shows up:

decreased amount of urine;
cloudy urine;
skin itching;
nausea;
decreased appetite;
sleep disturbance.

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

This condition is accompanied by a high mortality rate. Arising as a result of viral hepatitis, it can have a fulminant course, when a maximum of three days pass from the appearance of the first signs to the end, and most often it ends within 24 hours. They talk about the subfulminant variant when the development of symptoms lasts not hours, but a day or longer.

Acute liver failure develops, although quickly, but it goes through certain stages in its development. Sometimes it is difficult to distinguish between them in time, since everything happens in minutes or hours.

The development of acute liver failure should be suspected and immediate action should be taken if at least one of the following symptoms is present:

strange behavior;
errors when performing usual work;
constant nausea;
vomiting that is difficult to stop and does not bring relief;
aversion to food;
daytime sleepiness;
acute, severe pain in the right hypochondrium, not associated with food intake, it can independently decrease or intensify, taking no-shpa or papaverine does not affect it;
perversion of taste and smell.

Those symptoms that only in cooperation with a doctor can suspect a catastrophe are:

a decrease in the size of the liver according to the results of examination and ultrasound - with persistent or increasing jaundice;
softening and tenderness of the liver - according to palpation;
a decrease in the level of prothrombin index below 70%, a decrease in the level of fibrinogen below 1.5 g/l in a blood test such as a coagulogram;
increased heart rate;
increased temperature in the absence of signs of allergies and chronic cholecystitis;
the appearance of liver odor from the mouth.

Precoma I (stage 1)

Here behavior is disrupted, the person becomes more irritable or, conversely, euphoric. He may be tormented by a feeling of anxiety or, on the contrary, he becomes apathetic. Sleep may be inverted (drowsiness during the day, insomnia at night), and lost in the area. Relatives may notice in an already yellowed patient new personality traits, aggression, stubbornness, previously unusual for him. At the same time, he understands that his character has changed. They also say about the fulminant course:

nightmares;
noise in ears;
hiccups;
speech disorders;
handwriting changes;
increased sweating;
"floaters" before the eyes.

Precoma II (stage 2)

At this stage, conscious control over behavior is lost: the person performs meaningless actions, periodically becomes agitated, tries to escape, and becomes aggressive. The patient's hands begin to tremble, he makes repetitive movements, and his speech is not always understandable. Orientation in place and time is lost, consciousness becomes confused.

Coma I (stage 3)

There is no consciousness, the person does not react to a shout, but periodically, without coming to his senses, he begins to fuss. Marked spontaneous urination and defecation; There are muscle twitches. The pupils are wide and almost do not react to light.

Coma II (stage 4)

There is no consciousness. A person lies in one position without moving. There is no reaction to cold, heat or pain. The face is swollen. Breathing quickens, blood pressure decreases. Periodically there may be cramps throughout the body.

Other symptoms

The stages of impaired consciousness were described above. But besides them, liver failure is characterized by:

Jaundice. Yellow the skin and whites of the eyes become stained. Later you can see that other fluids turned out to be colored with bilirubin. So, tears and sputum turn yellow. Urine, on the contrary, is dark.
Liver odor from the patient. It is caused by the accumulation of mercaptans in the blood, which were produced in the colon from sulfur-containing amino acids, which were produced by the bacteria located there, but were not neutralized by the liver.
Light cal. Due to the lack of bile acids in it.
Internal and abdominal bleeding. They occur because the liver can no longer synthesize blood clotting factors. Thus, uterine, intestinal (black loose stool), gastric (vomiting brown contents) bleeding. They can all occur together. They may be subtle, so a stool test for occult blood is performed daily.
Bruises on yellow skin. They occur due to low levels of platelets in the blood.

At the height of the disease, acute renal failure also joins the liver. It is caused by spasm of blood vessels due to a decrease in the amount of fluid in them, as well as death renal tissue when exposed to bilirubin, bile acids, and other toxic metabolites. Renal failure manifests itself as a decrease in the amount of urine and edema. If the person is still conscious at this moment, he complains of thirst and a hoarse voice.

How to make a diagnosis

If at the latent (zero) stage it is very difficult to diagnose acute liver failure, then in the future the clinician only needs a visual examination, checking reflexes, determining the boundaries of the liver and analyzing ALT and bilirubin to make this diagnosis. To determine tactics and prognosis, the following examinations are also important:

proteinogram. It defines a decrease total protein and albumin;
biochemical blood test: decreased level of urea in the blood, increased creatine phosphokinase. When renal failure occurs, an increase in the level of creatinine in the blood and an increase in potassium are determined;
coagulogram: decrease in the level of all coagulation factors, prothrombin index, fibrinogen. Fibrinogen B – from one to four pluses;
electroencephalography: an increase in the amplitude of the waves, a decrease in their frequency, then triphasic waves appear, in a deep coma brain activity completely absent.

Next, the cause of liver failure must be established. They determine markers of viral hepatitis, antibodies to viruses of the herpetic group, look at a thick drop of blood for the presence of malarial plasmodia in it, perform bacteriological examination blood for sepsis. Be sure to find out the medical history from relatives and, if possible, from the person himself: has the person eaten mushrooms, how does he feel about alcohol, when was the last time he drank it, whether he works in a hazardous industry.

Treatment of acute liver failure

The diet for this disease is liquid, without animal proteins, and in the first 1-2 days it may be without protein at all, but high in carbohydrates, with a total volume of up to 1.5 liters.

The following drugs are used for this:

amino acid mixtures without essential amino acids are administered intravenously: Aminosteril N-Hepa, hepaferil;
to replenish the protein, a pharmaceutical solution of albumin is transfused;
It is necessary to administer intravenous drips of drugs: Ornitox (Hepa-Merz), Glutargin;
medications are administered intravenously that block the production of hydrochloric acid in the stomach: Rantak, Contraloc, Omez;
Inhibitors of proteolytic enzymes are definitely needed: Kontrikal, Gordox;
lactulose preparations are administered orally (on their own or through a tube), neutralizing amino acids that are toxic to the brain: Duphalac, Normaze, Lactuvit;
also through the mouth (or gastric tube) sorbent preparations are introduced that “take away” toxins: Enterosgel, Atoxil, White Coal;
for viral hepatitis, glucocorticoid hormones are prescribed: Dexamethasone, Methylprednisolone;
to create better conditions for the blood coagulation system, fresh frozen single-group plasma, Vikasol (vitamin K), Etamzilat are prescribed

Chronic form of liver failure

Chronic liver failure can develop according to one of three course options:

hepatocellular form;
porto-caval form;
mixed deficiency.

This condition, unlike acute failure, progresses for quite a long time: from 2 months to several years. During this time, the cells gradually die off, but some of them appear again, which compensates for the functions of the liver. Symptoms of this condition do not appear immediately, but when more than 60% of hepatocytes die. In chronic liver failure, symptoms of portal hypertension necessarily appear. This also distinguishes chronic from acute failure.

Chronic liver failure, unlike acute liver failure, is an irreversible process. Once launched, it can only be stopped at the beginning. Further treatment is aimed at maintaining a decent quality of life for as long as possible and preventing the development of hepatic coma.

Causes of chronic liver failure

The following diseases and conditions lead to this condition:

Signs of a condition where liver cells gradually die are as follows:

redness of the palm in the area of the eminence of the thumb and little finger, as well as the last phalanx of the fingers;
the appearance of spider veins on the skin;
skin itching;
icteric staining of the skin and sclera;
dark urine;
light stool;
heaviness in the right hypochondrium;
decreased appetite;
nausea;
heaviness in the left hypochondrium;
periodic bleeding from the rectum, veins of the esophagus, when vomiting brown contents or loose black stools appears;
enlargement of the abdomen due to the accumulation of fluid in it; dilated veins are visible on its front wall;
weight loss;
loss of muscle tone;
joint pain;
personality change;
dyspnea;
attacks of rapid breathing, especially during sleep;
there may be a cough with pink, frothy sputum;
arrhythmias;
increased blood pressure;
swelling.

Treatment of chronic liver failure

Treatment of liver failure involves eliminating 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 an amount of carbohydrates of 400-500 g/day, and fats of 80-90 g/day, excluding alcohol, caffeine, and limiting fluids. The daily routine is also changing: now you will need to move enough, but without lifting weights more than 2 kg and avoiding open sun rays. People with chronic liver failure need to get enough sleep, and when taking any medication, even for a runny nose, consult a hepatologist (almost all drugs pass through the liver).

The following medications are also required:

To neutralize ammonia you need: Hepa-Merz, Glutargin.
Antibiotics, which, being absorbed only in the intestines, destroy the local flora, which, by processing food proteins, produce amino acids that poison the brain (previously they would have been neutralized by a healthy liver). This is Kanamycin, Gentamicin.
Lactulose preparations that bind substances toxic to the brain: Lactuvit, Prelaxan, Duphalac, Lactulose.
To reduce the level of edema and ascites, Veroshpiron is prescribed.
In order to reduce pressure in the portal vein system - Molsidomin, Propranolol, Nebilet.
When the biliary tract is blocked, cholespasmolytic drugs are prescribed. These are Flamin, Buskopan, No-shpa.
For increased bleeding, Vikasol and Etamzilat tablets are used.

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

autoimmune hepatitis;
cirrhosis of the liver;
alveococcosis of the liver;
congenital organ pathologies;
tumors that allow partial preservation of one’s own liver.

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Symptoms of the disease

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

Jaundice

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

Discoloration of feces

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

Urine color

As the kidneys try to remove excess bilirubin, the urine turns dark brown or yellowish brown, the color of the desired pigment.

Itchy skin

Uncontrollable itching appears, which is not relieved by any medications, and eczema is not observed. It often starts from the feet and moves higher.

Gastrointestinal lesion

Violation of the functions of bile secretion negatively affects the process of food absorption. Nausea becomes a constant companion of the patient, and after eating without additional enzymes, vomiting occurs.

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

Poisoning by internal toxins

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

Liver degeneration

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

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

A completely opposite picture is observed in liver cirrhosis, when functional tissue is replaced by connective tissue. The liver decreases in size, hardens, the surface becomes wrinkled,

An accumulation of fluid in the abdominal cavity, or ascites.

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

Circulatory disorders

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

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

Enlargement of the spleen.

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

Hematemesis

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

Pulmonary edema

Against the background of portal hypertension, the pressure in all blood vessels increases, and sooner or later the lungs are affected by hypertension due to liver failure. Patients complain of shortness of breath and cough. Over time, the condition worsens, they burst blood vessels piercing the alveoli. A cough appears with bubbling bright scarlet arterial blood.

Pulmonary edema can develop either quickly or very slowly, it all depends on the individual characteristics of the body. This symptom is extremely dangerous as it can cause respiratory arrest.

13.Hepatic encephalopathy

The last thing that takes the toxic blow is the brain. The nervous system, due to the existence of the blood-brain barrier, holds on to the last, and malfunctions in its functioning can lead to coma and even death. Classic symptoms of any encephalopathy are dizziness, lethargy, insomnia, impaired cognitive function, delirium, convulsions, disorientation in time and space, loss of sensitivity, hyperreactivity, psychosis, depression, etc.

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

Causes

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

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

Pathogenesis and stages of the disease

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

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

Hepatocytes are exposed to a harmful agent. Cells begin to secrete enzymes that destroy dead hepatocytes and damage healthy ones along the way.
The immune system releases bodies that attack damaged hepatocytes and completely destroy them.
The process extends to healthy tissue.
When more than 70% of hepatocytes die, symptoms of liver failure appear.
Metabolism cannot proceed normally. The liver can no longer store glycogen, synthesize urea and decompose ammonia, and it poisons the body.

The severity of symptoms depends on the percentage of functional and dead cells, as well as the rate at which they die.

The disease is divided into three stages:

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

Types and forms of liver failure

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

Acute liver failure

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

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

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

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

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

Chronic liver failure

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

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

The causes of chronic liver failure may be alcoholism, hepatitis types B and C, liver cancer, diabetes and other endocrine system disorders, autoimmune diseases

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

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

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

What can lead to complications in chronic liver failure:

alcohol in any quantity;
Taking medications in large doses;
Eating large amounts of fatty and protein foods;
Stress;
Infections that affect all body systems;
Pregnancy;
General anesthesia for operations.

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

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

Diagnostics

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

Diagnostic methods include:

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

Treatment of acute and chronic forms

The most important thing for successful treatment liver failure - to recognize it in time. What follows are quite logical recommendations based on the symptoms and causes described above.

It is necessary to adjust the daily routine for five meals a day, split meals.
Eliminate the source of chronic intake of harmful substances.
Follow a diet (in medicine it is called “table No. 5” for people with liver disease.
Prevent the entry of toxic substances into the body. This implies a complete abstinence from alcohol, medications (except those prescribed by the attending physician), and it is advisable to completely abandon bad habits.
Carry out procedures aimed at quickly removing toxins from the body.

Naturally, relieving the symptoms of acute liver failure is significantly different from treating chronic liver failure.

Necessary measures for acute liver failure:

Detoxification: administration of solutions of sodium chloride, ac-salt, rheosorbilact or its analogues intravenously.
Protein-free diet: Proteins are one of the sources of nitrogen, which when decomposed by intestinal bacteria is converted into ammonia. A diseased liver cannot convert ammonia into urea, and ammonia travels through the body along with the blood, poisoning the organs.
Ammonia removal - the use of glutamic acid and ornithine
Cauterization of ulcers - in case of hemorrhage of the esophagus, it is necessary to eliminate the bleeding, possibly through surgery.
Drugs that promote liver restoration: arginine, ornithine, hepatoprotectors (Essentiale, Hepa-Merz, etc.)
Sedatives, analgesics, antispasmodics - to calm the patient.
Ensuring the patency of the bile ducts, possibly through surgery.
Fast acting vasodilators and blood pressure lowering drugs.

All drugs are administered intravenously.

Treatment of chronic liver failure:

Search and relief of the underlying disease that caused liver failure.
Maintain a strict diet throughout the entire treatment.
Symptomatic correction of metabolism based on individual test results.
Monitoring the condition of the liver using instrumental methods.
Cleansing the intestines using enemas, lactulose preparations and drugs that inhibit the activity of microflora.
Conducting courses of intramuscular administration of vitamins to support liver recovery
Taking hepatoprotectors.
Remember traditional methods this disease has no cure!

Radical treatment methods

Fast-track and high-cost treatment options include hemodialysis, plasmapheresis, and liver transplantation. general characteristics Plasmapheresis and hemodialysis are the purification of blood from toxins outside the body. Hemodialysis passes blood through an artificial kidney apparatus, and plasmapheresis drives the plasma through special filters, leaving everything on them harmful impurities. Plasmapheresis is better suited for the treatment of liver failure.

Liver transplantation is a complex and quite dangerous operation, used only in extreme cases. In order for the liver to take root, a close relationship with the donor is desirable. The operation can result in death for both the donor and the patient. The organ is donated directly, within a few minutes from the donor's office. A complete transplant is not required: they take part of the liver and stitch it to the diseased part, connecting all the vessels and nerve endings. In Russia, such operations are carried out in the most extreme cases.

Diet and daily routine

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

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

To begin with, it is recommended to reduce protein intake to 40 grams per day (at a norm of healthy person from 120 g, calculating 2.5 g of protein per kilogram of live weight). Note that the calculation is based on digestible protein, and its amount varies in different protein products. Some patients feel calm when the amount of protein is increased to 60-80 grams per day. Remember, a long-term protein deficiency is fraught with metabolic disorders, hematopoiesis, and muscle functionality, so the doctor will gradually bring it to normal. Protein should be introduced gradually, starting with vegetable protein and, over time, in the absence of a negative reaction, meat and meat products should be given.

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

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

Prevention

Prevention in this case comes down to three basic principles:

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Causes of problems

Chronic liver failure can be caused by many factors, but the most common causes of problems lie in the following:

chronic alcohol abuse;
poor nutrition;
viral hepatitis B or C;
liver cancer.

On the other hand, acute liver failure most often occurs as a result of drug poisoning (paracetamol or other hepatotoxic agents).

Acute liver failure may also result from acute hepatitis, hepatic thrombosis and other liver diseases (for example, chronic autoimmune hepatitis, Wilson's disease). Sometimes systemic diseases (for example, sepsis) are to blame.

Symptoms

The chronic form may be asymptomatic. The first signs appear only when most of this organ is damaged. Initially, the patient complains of weakness, as well as problems with digestive system, such as:

weight loss;
feeling of fullness after eating;
bad reaction to fats and alcohol;
pain in the abdomen, especially on the right side;
flatulence;
nausea.

Acute liver failure produces symptoms very similar to those that appear in the later stages of chronic disease. In addition, the patient's consciousness is impaired, so contact with him is impossible. These symptoms appear between 4 and 26 weeks after the onset of liver damage.

The last stage of liver failure is profound metabolic disorders (metabolic acidosis) and hepatic coma. The patient needs urgent help, otherwise he will die.

Diet

If liver failure begins to cause severe symptoms, the patient should reduce the amount of protein. The diet should be sufficiently high in calories (35-40 kcal per 1 kg of weight) and based on pasta, cereals and vegetables.

Research shows that it is advisable to combine proteins derived from dairy and plant products(about 40 g per day) with nutritional amino acids. Such amino acids can be found in many plants (more on this below). Thanks to this, you compensate for the negative nitrogen balance and reduce the concentration of ammonia in the blood.

At the time of the onset of symptoms of hepatic encephalopathy (sleep disturbance, confusion, hand tremors), protein should be reduced to 20-30 g/day. It should be a protein of high biological value - look for it in milk, cottage cheese, eggs. At the same time, you cannot consume the daily protein intake in one meal - divide it into 5-6 servings.

It is important to increase reserves of vitamins A, C, K and B vitamins, because their absorption and use are impaired due to liver dysfunction.

Treatment

To at least partially restore liver function, you need not only a diet, but also folk remedies. However, they should only be used in cases of chronic liver failure. In the acute form, as we have already said, emergency care is needed, and self-medication in this case can be fatal.

radish

Treatment of kidney failure with radish is very popular among people. This product cleanses the diseased organ, due to which it begins to work much better.

For one course you will need approximately 3.5 - 4 kg of fresh radish. Wash it and put it through a juicer. You will get about a liter of juice. It needs to be stored in the refrigerator.

The pulp that remains in the juicer does not need to be thrown away. Mix it with natural linden honey (in equal proportions), and also put it in the refrigerator.

The treatment looks like this: take a tablespoon of juice every morning on an empty stomach. Then after breakfast, eat a teaspoon of radish pulp with honey. This must be done until the medicinal drugs run out. During this time, you will notice that the signs of the disease have ceased to bother you. Courses can be repeated every six months.

Rosehip infusion

If you have liver failure, you should regularly take rosehip infusion with lemon juice. It is prepared like this: pour a handful of dry berries into a thermos, pour a liter of boiling water and leave the potion overnight. Strain in the morning. This will be your daily drink requirement. Every time after a meal, drink a glass of infusion, adding a tablespoon of lemon juice to it. You need to drink all the medicine in a day. Treatment course continue until the signs of the disease disappear or at least decrease.

Burdock-based remedy

And now we will tell you how to treat acute liver failure with the help of burdock. This remedy has helped many people improve the functioning of this organ and get rid of discomfort in the stomach.
So, take half a kilogram of a fresh plant (both roots and leaves). Rinse the roots, peel with a knife and grate on a medium grater. Pour boiling water over the leaves and cut into small pieces. Mix all this with a liter of liquid linden honey. Store the resulting product in the refrigerator. Take a tablespoon of it twice a day on an empty stomach. Soon, liver failure will no longer bother you, or its symptoms will significantly decrease.

Chinese remedy

IN Ancient China it was customary to treat many diseases garlic tincture. It will also help those who have liver failure. To prepare the tincture, crush 20 cloves of garlic under a press and chop a small ginseng root (the size of a finger) with a knife. Mix the ingredients and add 500 ml of medical alcohol. Leave the mixture for 10 days in a warm place. After the tincture is ready, start taking it one teaspoon at a time, eating it with honey. The course of treatment is one month. Such courses can be repeated 3-4 times a year.

woodruff

With the help of fragrant woodruff, acute liver failure is treated in the remission stage (that is, when the risk of life has passed). If you drink the infusion of this plant regularly, you can completely restore the damaged organ.

Brew a tablespoon of dry herb with a glass of boiling water, cover with a lid and wait 15 minutes. Then add ¼ teaspoon of xylitol to the infusion and drink in small sips half an hour before meals. You need to drink 2-3 servings of this drug per day. Continue the course until you start to feel good again.

Chicory root

Chicory root will help those who have chronic liver failure. You can use it in different ways.

So, the most effective recipe is to take half a teaspoon of plant juice daily for two weeks. Then take a break for a month and take the course again. To restore liver function, you will need from 3 to 10 such therapeutic courses.

Dry chicory root can be brewed instead of tea (a tablespoon per glass of boiling water) and drunk one serving 2-3 times a day.

Herbal infusions

In case of liver failure, it is useful to drink all kinds of herbal teas. Here is one of the recipes:

Rosehip (fruit) - 30 g;
Wintergreen herb - 20 g;
Nettle leaves - 20 g.

Take 1 cup of boiling water for 3 tablespoons of the mixture. The product should be infused for half an hour, then it should be strained and taken half a glass twice a day.

Old Russian healers treated the liver with the following mixture:

Yarrow herb - 30 g;
Cornflower flowers - 30 g;
Peppermint leaves - 30 g;
Smoke grass - 30 g;
Blackberry leaves - 30 g;
Buckthorn bark - 30 g
Ledum shoots – 30g;
Dandelion root - 30 g.

Brew a tablespoon of the mixture in a glass of boiling water, cover with a lid, wrap in a warm towel and leave for about one hour. Drink 1/3 cup of infusion three times a day. The course of treatment should last at least 2 months.

The following collection helps with liver failure:

Yarrow herb - 100 g;
Calendula flowers - 50 g;
Chamomile flowers - 50 g;
Dandelion root - 20 g;
Flax seeds – 20g;
Fennel fruits - 20 g;
Bearberry leaves – 20g.

Infusions are prepared from this collection. Mix the herbs thoroughly, brew 2 teaspoons of the mixture in a glass of boiling water, leave for 30 minutes in a closed container, then strain. Drink a glass of medicine 2-3 times a day in between meals.

Liver failure is a medical term that refers to a set of symptoms that develop as a result of the destruction of the liver parenchyma and disruption of its basic functions. This pathological condition manifests itself as intoxication of the body, since the liver ceases to perform a detoxification function and harmful substances accumulate in high concentrations in the blood and tissues.

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

Purpose of the liver

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

the liver produces bile, which is necessary for the breakdown and further absorption of lipids (fats) entering the body with food;
this organ is directly involved in protein, fat and carbohydrate metabolism;
utilizes hemoglobin breakdown products, converting them into bile acids and removing them from the body with bile;
neutralizes toxins, allergens and other harmful and toxic substances, accelerates their elimination from the body naturally;
deposits glycogen reserves, vitamins and microelements;
synthesizes bilirubin, cholesterol, lipids and other substances involved in the digestion process;
ensures the breakdown and utilization of excess hormones, enzymes and other biological active substances.

The liver is the main filter of our body

This organ is exposed to high stress every day, which we further intensify if we violate the diet, eat fatty, spicy, fried foods, overeat, abuse alcohol, or haphazardly take medications with hepatotoxic effects.

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

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

Types and forms of liver failure

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

Acute liver failure manifests itself against the background of toxic damage to the organ (alcohol, drugs, viral hepatitis).

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

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

Liver cellular failure - develops when organ cells are damaged by toxic substances (poisons, viruses, alcohol surrogates). In this case, the disease can occur in an acute form, accompanied by massive death of hepatocytes, or in a chronic form, when the cells die slowly and the severity of symptoms increases gradually.
Portocaval form - associated with impaired hepatic blood flow. As a result, blood saturated with toxic substances bypasses the liver and from the portal vein enters directly into the general circulation. In addition, with this form of failure, liver cells suffer from hypoxia. Such disorders occur due to cirrhosis or during bypass surgery for portal hypertension.
Mixed form. In this case, chronic liver failure is diagnosed, accompanied by the death of liver cells and the release of blood saturated with toxins into the general bloodstream.

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

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

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

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

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

Causes of liver failure

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

Symptoms of liver failure

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

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

Features of the course of the disease

Cholestasis syndrome. It is associated with a violation of the outflow of bile from the liver and the accumulation in the blood of the breakdown product of hemoglobin - bilirubin. This substance exhibits a toxic effect and causes itching and yellowness of the skin and sclera. In addition, with cholestasis, lightening of feces and darkening of urine, which takes on the shade of dark beer, are observed. There are pulling, aching pains in the right hypochondrium associated with obstruction of the biliary tract.
Dyspeptic disorders. Nausea and vomiting may occur periodically after eating certain foods or be constant. This is due to the fact that the liver does not synthesize enough bile, which is necessary for the complete digestion of fats. Lack of appetite, up to a perversion of taste and the desire to consume incompatible or inedible foods (chalk, soil), are associated with intoxication of the body and damage to the nervous system against the background of liver necrosis. Developing deficiency is additionally indicated by a specific liver odor from the mouth, redness of the palms, and weight loss.
Symptoms of intoxication of the body. Constant weakness, increased irritability, headaches, joint and muscle pain, increased temperature, fever, chills, profuse sweating at night - these manifestations are especially pronounced in acute renal failure. In this case, the temperature can rise sharply to high values or remain at 38°C for a long time, which, together with severe weakness and malaise have an extremely negative impact on performance and general health person.
Hepatic encephalopathy manifests itself as a dysfunction of the nervous system, since toxic substances and breakdown products are not neutralized by the liver and, acting on the brain, cause a number of characteristic symptoms. Patients complain of dizziness, decreased concentration, lethargy, apathy, lethargy, confusion, daytime sleepiness and insomnia at night. As the disease progresses further, increased anxiety, depression, excessive excitability, convulsions, loss of consciousness, and hallucinations occur.
Symptoms of the heart and blood vessels. There are jumps in blood pressure, changes in heart rhythm (arrhythmias), and disturbances in general circulation.
Pulmonary symptoms. From the respiratory system, cough, shortness of breath, rapid or difficult breathing are observed against the background of increasing pulmonary edema. In this case, the patient experiences fear of suffocation and takes a forced sitting position. Shortness of breath can increase not only with physical activity, but also at rest.
Portal hypertension syndrome is expressed by ascites (an increase in the volume of the abdomen due to accumulating fluid) and the appearance of spider veins on the surface of the abdomen and shoulders. Another characteristic symptom– an increase in size of the spleen and liver, which is easily determined by palpation of the abdomen.
Muscle weakness (atrophy) develops against the background of a lack of glycogen, the main supplier of energy for muscles. The muscles become flabby, lethargic, the person gets tired quickly and has difficulty performing physical work.
Bleeding disorder leads to gastrointestinal and nasal bleeding. This may cause bloody vomiting or blood in the stool (melena). The development of bleeding is facilitated by dilation of the esophageal veins, which, against the background of portal hypertension, lose their permeability and mobility.

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

Diagnostic methods

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

(general and biochemistry);
urine test (general);
stool occult blood test;
blood test for viral hepatitis;
liver tests.

Modern instrumental diagnostic methods include ultrasound, CT or MRI. These methods make it possible to assess the size of the liver, its structure, the degree of damage to the parenchyma and blood vessels, as well as the presence of concomitant diseases associated with dysfunction of the biliary system (the presence of stones in the gall bladder, compression of the bile ducts).

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

Treatment

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

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

In hemorrhagic syndrome, hemostatic agents are used to stop bleeding. If their use is ineffective, they resort to blood transfusions.

To reduce the symptoms of intoxication, drugs are administered whose action is aimed at enhancing intestinal motility and cleansing the body. For detoxification purposes, rheosorbilact or neohemadez is infused.

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

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

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

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

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

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

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

Diet and nutritional habits

In the treatment of liver failure Special attention given proper nutrition. The principles of dietary nutrition in this pathology are as follows:

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

After the condition improves, they gradually return to their previous diet and first introduce vegetable proteins into the menu, then dairy products. If such a diet is well tolerated, dietary meat is included in the patient’s diet.

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

You should completely avoid taking any drinks, as well as the unsystematic use of medications. You can only take medications prescribed by your doctor. As the condition improves, it is recommended to move more and take long walks. fresh air.

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

With the deterioration of the environment due to human activity, the spread of viral hepatitis and other infections, alcoholism and drug addiction, deterioration in the quality of food, in a sedentary manner life and with the development of the pharmaceutical industry, the load on our liver has increased significantly. And when all this happens 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 the death of the patient.

So, liver failure- this is a pathological condition, a syndrome characterized by damage to 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 failure of the liver 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.
Globally, an average of two thousand people die every year due to liver failure.
In 15% of cases of liver failure, the cause of its development cannot be explained.
The most common causes of liver failure are liver damage from alcohol, drugs and viral hepatitis.

Interesting Facts!

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

Anatomy of the liver

Liver- an unpaired organ that is located in the upper right part of the abdominal cavity, or in the right hypochondrium. The liver is the largest endocrine gland.

Liver characteristics:

weight - about 1.5 kg,
shape - pear-shaped,
normal sizes liver in adults:
- oblique length - up to 15 cm,
- length of the right lobe - 11.0-12.5 cm,
- length of the left lobe - 6-8 cm,
- height - 8-12 cm,
- thickness - 6-8 cm,
the edges of the liver are smooth,
consistency - soft,
structure - 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 (restoration).

Distinguish liver surface:

diaphragmatic surface- corresponds to the shape of the diaphragm,
visceral(addressed to the authorities) surface- adjacent to surrounding organs,
bottom edge - at an acute angle,
superior posterior edge - at an obtuse angle, rounded.

With the help of the falciform hepatic ligament, as well as two longitudinal and transverse grooves, the liver is divided into shares:

right lobe,
left lobe,
square for,
caudal lobe.

From the falciform ligament of the liver comes the circular ligament, which is a transformed umbilical vein, which in the womb connected the placenta to the fetus.

Between the quadrate and caudal lobes of the liver, in the right longitudinal groove there are the gates of the liver, which include the structures:

hepatic artery,
portal vein,
bile duct,
nerves and lymphatic vessels.

Liver regeneration

The liver is an organ that can completely restore its structure after damage, that is, it is capable of regenerating. Even with the defeat of 70% of the liver cells, it can recover to its normal volume. The same regeneration occurs in lizards when they “grow” their tail.

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: for children this period is 2-4 weeks, and for older people - 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 if the causes of hepatitis are eliminated, the load on it is reduced, and the body receives a normal amount of useful nutrients.

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

Structure of the liver

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

The structure of the hepatic lobule:

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 arranged in hepatic beams - in two layers. The hepatocyte is located between the bile canaliculus and the intralobular capillary.
Bile ducts- located between the hepatic beams, through which bile from hepatocytes enters the bile ducts.
intralobular capillaries or sinusoids- blood vessels through which chemical compounds enter hepatocytes and processed substances exit them.

Blood vessels of the liver

Portal vein and hepatic artery - through these vessels, blood from the internal organs enters the liver, and the speed of blood flow in the liver slows down significantly, which contributes to the plethora of the organ;
Interlobular vessels, together with interlobular bile ducts, form the interlobular hepatic triad;
Circumlobular vessels;
Intralobular vessels or sinusoids;
Central vein - collects blood from the sinusoids of the hepatic lobule;
Collecting or sublobular vessels
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, and 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 “matures”; 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.

Composition of bile

The liver secretes a huge amount of bile per day - up to 1 liter, at least half a liter.

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 liver bile- secreted directly from the liver, bypassing the gallbladder, has a yellowish straw color, transparent.
Mature or cystic bile- secreted 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 color, transparent.

What is in bile?

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

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 intestines under the influence of intestinal microflora).
Bile acids are formed from cholesterol in hepatocytes. They are found in bile in the form of salts and anions. The role of bile acids is important in the digestion of fats and the absorption of fatty acids and triglycerides in the intestine. Some of the bile acids are absorbed in the intestines back into the blood and again enter the liver.

Bile pigments:
- bilirubin
- biliverdin.
Bile pigments are formed from hemoglobin in the spleen and Kupffer cells. Any red blood cell is formed in the red bone marrow (erythropoiesis) and destroyed in the spleen, and a small part of them in the liver. Red blood cells contain hemoglobin, which carries oxygen atoms and carbon dioxide, that is, it carries out gas exchange in tissues. After the destruction of the red blood cell, the question arises 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 colors. And also, after binding to oxygen, it slightly stains urine (urobilinogen) and feces (stercobilinogen).

Liver phospholipids (lecithins)- are formed by the synthesis of phospholipids that come from 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.

Cholesterol- found in bile 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.

Ions:
- sodium,
- calcium,
- potassium,
- chlorine,
- bicarbonates
The ions enter the blood and liver along with food. Their main role is to improve the permeability of cell walls, and ions are also included in the micelle in 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.

Bile also contains immunoglobulins, heavy metals, and foreign chemical compounds that come from environment.

Schematic representation of a bile micelle.

Basic 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. At elevated levels, ammonia becomes poisonous to the body. Urea from the liver enters the blood and is then excreted through the kidneys.
Participation in carbohydrate metabolism- when there is an excess of glucose in the blood, the liver synthesizes glycogen from it - the glycogenesis reaction. The liver, as well as skeletal muscles, are depots for glycogen reserves. When there is a lack of glucose in the body, glycogen is transformed into glucose - the reaction of glucogenolysis. Glycogen - the body's supply of glucose and energy for work 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).
Disposal 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 disposal of excess hormones, vitamins and other biologically active substances.
Depot for some vitamins and microelements, such as vitamins B 12, A, D.

Causes and pathogenesis of liver failure

The mechanism of development of liver failure by stages

Impact unfavorable (hepatotoxic) factors on the membrane of liver cells - hepatocytes.
Start from hepatocytes release enzymes, which continue to destroy (digest) liver cells.
The immune system begins to secrete autoimmune antibodies to damaged hepatocytes, which completely destroy them (necrosis of liver tissue).
Distribution of this process to other hepatocytes.
When 70-80% of liver cells are affected, liver failure.
Full or partial loss of liver function.
During a long process, they form anastomoses(additional vessels that, bypassing damaged areas, unite intact vessels) between the portal and inferior vena cava (normally they are connected by liver vessels). Through these anastomoses, 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, since the liver stops synthesizing and storing glycogen, forming urea and removing ammonia from the body.
Disruption of the biliary system - bile stagnation (or cholestasis) leads to the release of a large amount of bilirubin into the blood, 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 brain decay products.
Hepatic coma- damage to large areas of the central nervous system is often an irreversible process.

Causes of liver failure

A disease that can lead to liver failure syndrome	Reasons for development this disease	What happens in the liver?
Cirrhosis of the liver	Alcohol abuse. Chronic viral hepatitis. Working with toxins, poisons, chemicals, heavy metals, paints and so on. Taking many medications (especially long-term): nonsteroidal anti-inflammatory drugs(paracetamol, analgin, nimesulide and others), antibiotics and antiviral drugs(aminoglycosides, tetracyclines, anti-tuberculosis drugs, antiretroviral drugs for the treatment of AIDS and many others), cytostatics(drugs for the treatment of autoimmune diseases and cancer), any other medicines. Use narcotic drugs, precursors (ingredients for the synthesis of drugs) and psychotropic drugs. Diseases of the biliary system: cholecystitis, biliary dyskinesia, cholelithiasis. Frequent consumption of food dyes, preservatives, flavor enhancers, which are widely used in this moment in the food industry. Abuse fatty, fried, spicy, salty or smoked foods. Eating poisonous mushrooms(pale toadstool, fly agarics and others). Common infectious diseases(sepsis, HIV, influenza and others). Autoimmune diseases - diseases in which the immune system perceives its own as foreign, affecting its own cells. Congenital liver pathologies(congenital viral hepatitis, congenital tuberculosis, atresia (absence) of blood or biliary vessels, etc.) Other liver diseases in the absence of proper treatment, the presence of concomitant diseases and other factors of stress on the liver, especially dietary disorders.	The development of liver cirrhosis is long, sometimes last for years. Under the influence of hepatotoxic factors, partial destruction of hepatocytes constantly occurs, but thanks to the regenerative function of the liver, hepatocytes are partially restored. With prolonged continuous exposure to toxic factors, when autoimmune processes are involved, the gene material of liver cells changes. In this case, the liver tissue gradually begins to be replaced by connective tissue (which does not have specialized functions). The connective tissue deforms and blocks the hepatic vessels, which increases the pressure in the portal vein (portal hypertension), as a result - the appearance of vascular anastomoses between the portal and inferior vena cava, the appearance of fluid in the abdominal cavity - ascites, the enlargement of the spleen - splenomegaly. At the same time, the liver decreases in size, shrinks, and a syndrome of liver failure appears.
Dystrophies liver (hepatosis): Parenchymatous fatty degeneration liver	overeating fats and carbohydrates, diseases of the gastrointestinal tract, poor nutrition, starvation, anorexia, bulimia, eating badger, bear, dog, camel fat and so on.	The entry of excess fat into the liver (also increased content in the liver of carbohydrates, increased glycogen consumption) or difficulty in the exit of fats from the liver (lack of proteins, impaired liver enzyme work) lead to the deposition of "excess" fat (triglycerides) in the cytoplasm of hepatocytes. Fat accumulates and gradually ruptures the hepatocyte. Adipose tissue gradually replaces the liver tissue, which leads to the syndrome of liver failure.
Parenchymal protein degeneration of the liver	protein metabolism disorder, congenital deficiency of liver enzymes for protein processing, diabetes mellitus and other endocrine diseases, alcoholism, viral hepatitis, cholestasis (stagnation of bile in the liver), intoxication in infectious diseases, hypo- and avitaminosis, intoxication as a result of taking medications, drugs, poisonous mushrooms, poisons, chemicals, and so on.	There are three types of proteinaceous liver dystrophy: Granular dystrophy liver- deposition of "excess" protein in the cytoplasm of hepatocytes, while the liver increases in size due to an increase in the content of water in hepatocytes (protein molecules attract water molecules by osmosis). This process is also reversible and occurs quite often. Hydropic dystrophy of the liver - due to a lack of protein in the liver, accumulation of fluid in the cytoplasm of hepatocytes is observed. Excess fluid is produced in the cytoplasmic vacuole. At the same time, the liver increases in size. With a long process, hepatocytes are destroyed, balloon degeneration of the liver and its necrosis develop, and as a result, liver failure. Hyaline droplet dystrophy develops as a result of alcoholism, the breakdown products of alcohol with excess protein form hyaline bodies (Mallory bodies). This hyaline accumulates in hepatocytes. In this case, the liver cells lose fluid and begin to produce connective tissue. At this stage, liver cirrhosis may develop. Hyaline can also destroy the hepatocyte wall, leading to its necrosis. In any case, sooner or later liver failure develops.
Parenchymal carbohydrate dystrophy of the liver	glycogen metabolism disorder, diabetes, lack of enzymes for reactions with glycogen, hypo- and avitaminosis, alcoholism and other types of liver intoxication.	Glycogen is normally deposited in the cytoplasm of hepatocytes. During development carbohydrate dystrophy glycogen accumulates not in the cytoplasm, but in the nucleus of the hepatocyte. At the same time, hepatocytes increase significantly in size. With a long process, the death of hepatocytes occurs or connective tissue develops (liver cirrhosis). The outcome is liver failure.
Mesenchymal liver dystrophy or liver amyloidosis	chronic infectious diseases (tuberculosis, syphilis, osteomyelitis and others), diseases immune system, genetic predisposition to amyloid formation.	Amyloidosis - systemic disease associated with disruption of the immune system, is characterized by the deposition of amyloid (insoluble protein) in the wall of the hepatic vessels and bile ducts. Amyloid is produced in mutating immune cells: plasma cells, eosinophils, immunoglobulins and so on. Condensed liver vessels cannot function fully, there is stagnation of bile in the liver, portal hypertension (increased pressure in the portal vein), and then liver failure.
Hepatitis - inflammation of the liver	viral hepatitis A, B, C, D, E, F. alcoholism, effects on the liver of toxic substances and factors.	The pathogenesis of viral hepatitis is quite complex. But the main role in the damage to hepatocytes is played by immunity. If in viral hepatitis A and E immunity contributes to the release of hepatocytes from the virus, then in viral hepatitis B, D, and F, immunity affects infected hepatocytes along with the virus. And when special immunoglobulins are produced, the immune system still removes viruses from the liver cells and recovery occurs. Recovery from all viral hepatitis is possible only with the elimination of other hepatotoxic factors, otherwise chronic hepatitis, necrosis or cirrhosis of the liver develops, and the outcome is liver failure. With viral hepatitis C (experts call it the "gentle killer"), the elimination of the virus does not occur due to its variability. And the outcome of this disease is chronic hepatitis, cirrhosis or liver cancer, and then liver failure. In addition to liver problems, portal hypertension develops varicose veins in the portal system, as well as an overload of the lymphatic system, which stops completely collecting fluid from the abdominal cavity. Complications of portal hypertension develop: ascites or accumulation of fluid in the abdominal cavity, while the abdomen increases in size, and the amount of fluid in the abdomen reaches up to 5-10 liters; bleeding from varicose veins of the esophagus - can lead to the death of the patient; splenomegaly or enlargement of the spleen, accompanied by a violation of its function.

Can also lead to liver failure extrahepatic causes:

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

Types of liver failure

There are acute and chronic liver failure.

Acute liver failure

- a type of liver failure that 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 to develop liver failure at lightning speed - fulminant liver failure, which more often occurs when poisoned by poisons, chemicals, drugs, and so on.

Causes that can lead to acute liver failure:

Depending on the reasons for development, they distinguish forms of acute liver failure:

Endogenous or hepatocellular form- occurs when liver cells are damaged as a result of exposure to hepatotoxic factors. 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 portal and inferior vena cava systems), most often with cirrhosis of the liver. In this case, 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 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 influence to cells throughout the body. When the brain is damaged, 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, the unfavorable chance of restoring the vital functions of the liver depends on the ability of the liver to regenerate (its compensatory capabilities), the time before the start of treatment, the degree of brain damage and the elimination of hepatotoxic factors. Acute liver failure itself is a reversible process. And they recover from hepatic coma only in 10-15% of cases.

Chronic liver failure

Chronic liver failure is a type of liver failure that 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.

Causes of chronic liver failure:

As with acute liver failure, there are forms:

exogenous form- damage and necrosis of liver cells occurs gradually, some cells are regenerated, but with continued exposure unfavorable factors, the death of hepatocytes continues.
endogenous form- liver circulatory disorders,
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 the ability to regenerate hepatocytes), and hepatic encephalopathy may develop, followed by coma and death.

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

alcohol consumption,
self-administration medicines,
violation of diet, eating large amounts of proteins and fats,
nervous stress,
common infectious process (sepsis, influenza, meningococcemia, chicken pox, tuberculosis and others),
pregnancy, childbirth, termination of pregnancy,
abdominal surgeries and so on.

Current - heavy. As liver failure increases, the patient's condition gradually worsens.

The disease requires urgent adequate treatment and detoxification.

Forecast: unfavorable, in 50-80% of cases of hepatic encephalopathy the patient’s death occurs. In case of compensated chronic liver failure, liver restoration is possible 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 be made only on the basis of data from targeted examinations. This is the reason for untimely diagnosis and treatment of the disease, which significantly reduces the chances of recovery.

Photo: liver preparation of a patient suffering from cirrhosis of the liver. The liver is wrinkled, reduced in size, and dilation of the hepatic vessels is observed. The liver tissue was completely overgrown with connective tissue.

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

Criteria	Acute liver failure	Chronic liver failure
Development timeframe	From a few days to 8 weeks.	From 2 months to several years.
Development mechanism	Develops as a result of rapid necrosis of the liver tissue or a sharp violation of the blood circulation of the liver.	Liver necrosis occurs gradually, some of the damaged cells have time to regenerate, and the liver is able to partially compensate for its functions. It can also develop with a gradual disruption of blood circulation.
Degree of liver damage	Rapid damage to more than 80-90% of all liver cells.	Gradual defeat more than 80% of hepatocytes. Chronic liver failure almost always contributes to the development of symptoms of portal hypertension, in contrast to the acute course of liver failure, in which portal hypertension is not an obligatory symptom.
Severity of the current	The course of the disease is extremely severe, more severe than with chronic liver failure.	The course is severe; in the initial stages it may be asymptomatic.
Forecast	The prognosis is unfavorable, hepatic encephalopathy and then coma often develop. But the process is reversible with timely therapeutic measures and elimination of hepatotoxic factors.	The prognosis is unfavorable, in the absence timely treatment and elimination of provoking factors leads sooner or later to hepatic encephalopathy. Chronic liver failure is an irreversible process. Treatment is aimed at preventing the development of hepatic coma.

Symptoms of liver failure

Group of symptoms	Symptom	How does it manifest	Mechanism of occurrence
Cholestasis syndrome	Jaundice	Coloring of the skin and visible mucous membranes in yellow shades: from green and lemon to orange. In dark-skinned people, jaundice may be noticeable only on the mucous membranes, especially on the sclera of the eyeballs.	Cholestasis syndrome associated with impaired outflow of bile from the liver. This occurs due to compression of the biliary tract and the inability of damaged hepatocytes to remove bile. In this case, the breakdown product of hemoglobin, bilirubin, is not excreted in bile and feces. There is a large amount of bile pigments in the blood (bilirubin and biliverdin), which ensure that all tissues are colored in the color of bile. But stool loses its staining with stercobilin. The kidneys try to remove excess bilirubin from the blood, and an increased content of bile pigments in the urine is observed, and as a result, its more intense coloring. An increased amount of bilirubin also has a toxic-allergic effect on the skin, which contributes to the development of itching.
	Stool discoloration	Feces acquires light color, up to white and beige.
	Darkening of urine	The color of urine becomes darker, it is compared to the shades of dark beer.
	Itchy skin	A patient with cholestasis is accompanied by itching all over the body, although there may not be a rash.
	Pain in the right hypochondrium	Not a necessary symptom for liver failure. The pain may appear after eating and is aching or cramping in nature.	Pain in the right hypochondrium occurs due to obstruction of the biliary vessels. In this case, the bile bursts the bile ducts and compresses the lobular nerves.
Dyspeptic disorders	Nausea, vomiting, stool disturbances, decreased and perverted appetite.	Nausea and vomiting are associated with food intake and are periodic or constant. Stool disorders in the form of diarrhea, more than 3 times a day. Poor appetite, to the point of refusing to eat. Some patients have a desire to try inedible things (soil, chalk, hair, incompatible foods, etc.).	Digestive disorders are associated with the inability of the liver to participate in the digestion of fats. Decreased appetite may also be a sign of damage to the nervous system and intoxication, which develops against the background of liver necrosis.
Intoxication symptoms	Increased body temperature, weakness, malaise, joint pain (arthralgia), loss of appetite.	Body temperature can rise to high numbers or be of a permanent subfebrile character (up to 38C). Weakness and malaise are mild or leave the patient bedridden. Arthralgia in large or all groups of joints.	Intoxication symptoms develop as a result of the breakdown products of liver tissues entering the bloodstream. In acute liver failure, these symptoms are more pronounced than in chronic form. Intoxication can also be caused by viral hepatitis, in which case not only toxins of the destroyed liver enter the blood, but also toxins released during the life of the virus.
Changes in liver size	Enlarged liver (hepatomegaly)	These changes in the liver can be determined by the doctor by palpation of the abdomen, as well as during additional methods research.	An enlarged liver is a common symptom of liver failure associated with circulatory disorders in the hepatic vessels, cholestasis, the presence of hepatosis, as well as tumors, cysts, abscesses, tuberculosis, and so on.
Changes in liver size	Liver shrinkage		A decrease in the liver is observed in cirrhosis of the liver, when the liver tissue is completely replaced by connective tissue.
Portal hypertension syndrome	Ascites	The abdomen increases significantly in size, reminiscent of pregnancy.	Ascites is the accumulation of fluid in the abdominal cavity. Its development is associated with a violation of the patency of the lymphatic vessels, which develops as a result of their compression in the liver by dilated hepatic vessels. The lymphatic system helps drain fluid in soft tissues.
	Spider veins	Spider veins are dilations of blood vessels and resemble jellyfish in appearance. Appear on the front wall of the abdomen and on the shoulders.	Spider veins are dilated vessels that arise from the portal veins. Against the background of portal hypertension, anastomoses develop - additional (abnormal) vessels that connect more large veins between themselves. Thus, the body tries to restore impaired blood circulation.
	Splenomegaly - enlarged spleen	This symptom can be determined using abdominal palpation and instrumental research methods.	Splenomegaly develops due to circulatory disorders in the spleen, which is a blood depot. It is supplied with blood from the portal and inferior vena cava systems. When the pressure in these vessels increases, more blood is deposited in the spleen. The spleen also takes on some of the functions of the liver, in particular the destruction of red blood cells and the utilization of hemoglobin.
	Bleeding from dilated veins of the esophagus	There is vomiting of bloody contents (or “coffee grounds”), sometimes blood remains are detected only in the stool (melena). It can be acute or chronic. The amount of blood loss also differs individually. It is necessary to differentiate from pulmonary hemorrhage when the secreted blood is bright scarlet in color, with air bubbles. Aspiration of blood is dangerous (blood entering the lungs - suffocation).	The veins of the esophagus dilate due to portal hypertension. Constantly and long-term dilated vessels lose their mobility and permeability, which is why bleeding occurs from them. Bleeding is also promoted by a blood clotting disorder (associated with liver dysfunction, one of which is the synthesis of certain clotting factors).
Hepatic encephalopathy	Nervous system dysfunction	Dizziness, lethargy, sleep disturbance, confusion or loss of consciousness, inattention, memory loss, lethargy, "blurred mind" increased excitability, delirium, impaired coordination of movements, anxiety, apathy, depression and so on.	Metabolic products and toxins are not neutralized in the liver due to its insufficiency, and affect the structures of the brain, encephalopathy develops. Further brain damage can lead to hepatic coma.
Pulmonary symptoms	Shortness of breath, cough	Patients may complain of shortness of breath, its increase (more than 20 per minute at rest for adults). Shortness of breath first manifests itself during physical exertion, and then during rest, especially in the supine position. During sleep, there may be attacks of a sharp increase in breathing (the patient develops a fear of suffocation). To facilitate breathing, patients take a forced sitting position. There may also be a cough that produces bloody, blistered sputum.	Appearance pulmonary symptoms associated with an increase in pulmonary edema. Pulmonary edema is the filling of the pulmonary vessels with blood. This occurs due to disturbances in protein metabolism as a result of liver damage. The blood simply begins to sweat through the walls of the vessels into the alveoli. The development of this symptom is life-threatening, since when the alveoli are completely filled with liquid, respiratory arrest is possible.
Circulatory disorders	Increased blood pressure, cardiac arrhythmia.	Increased blood pressure over 140/90 mm Hg. Art. Arterial hypertension will soon be replaced by hypotension, a decrease in pressure below 90/60 mmHg. Art. Cardiac arrhythmia first manifests itself in the form of bradycardia (less than 60 beats per hour), and then, in the form of tachycardia (more than 90 beats per hour).	Violations of general circulation are associated with portal hypertension. In the presence of edema and ascites, a large amount of fluid leaves the bloodstream and enters the soft tissues. This reduces blood pressure. With these changes in the bloodstream, the work of the heart is also associated, arrhythmia appears.
Amyotrophy	Muscle weakness	The muscles decrease in size, become flabby, and weak. It is difficult for the patient to perform even the simplest physical exercises.	Muscle atrophy is associated with a lack of glycogen - the main source of energy for muscle work. The conversion of glucose to glycogen occurs in the liver, and with liver failure, glycogen is practically not synthesized. After using the stored glycogen, skeletal muscle atrophy gradually increases.
Bleeding disorder	Bleeding	Bleeding from dilated veins of the esophagus, from the vessels of the stomach, nosebleeds, hemorrhagic rash (like bruises), and so on.	Violation of blood clotting occurs due to the failure of the liver to function - the formation of blood clotting factors. In this case, the blood becomes “liquid”, and it is extremely difficult to stop the bleeding.

Also, with liver failure, anemia, pulmonary heart failure, acute or chronic renal failure, and intestinal paresis may develop. Absolutely all organs and systems of the body suffer.
Liver failure is characterized by a specific liver odor from the mouth.

Photo of a patient with manifestations of jaundice.

Acute liver failure, clinical features

Stages of acute liver failure:

Latent stage of hepatic encephalopathy - at this stage, patients have no complaints and no pronounced symptoms of liver damage. Changes can only be detected through examination.
Stage I of hepatic encephalopathy - precoma. At the same time, symptoms of liver failure increase: syndromes of cholestasis, portal hypertension, intoxication symptoms, and the first symptoms of damage to the nervous system appear in the form of its inhibition.
Stage II of hepatic encephalopathy - precoma. At this stage, the patient’s condition becomes aggravated, the 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, and cannot be detected by palpation (symptom of “empty hypochondrium”). At this stage, a liver odor appears from the mouth.
Coma- loss of consciousness, the patient exhibits reflexes only to stronger stimuli, signs of multiple organ failure appear (simultaneous hepatic, pulmonary, cardiac, renal failure, cerebral edema).
deep coma- the patient is unconscious, there is a complete absence of reflexes to any stimuli as a result of cerebral edema, and multiple organ failure develops. In most cases, this is an irreversible process and the patient’s death occurs.

The main feature of acute liver failure is that each stage lasts from several hours to several days, less often weeks.

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

Photo of a patient with liver cirrhosis and chronic liver failure syndrome. There is a significant increase in the abdomen due to ascites; dilated vessels are visible on the anterior wall of the abdomen. The skin is icteric, dry, the muscles are flabby.

Stages of chronic liver failure:

I stage - The functionality of the liver is still preserved. This stage is characterized by the appearance of dyspeptic disorders and mild intoxication (weakness, drowsiness).
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 motor coordination. A liver odor appears from the mouth. At this stage, short-term memory loss is possible. At this stage, the liver only partially performs its functions.
Stage III - significant decrease in liver functionality. Previously occurring symptoms become more pronounced. Manifestations of cholestasis and portal hypertension, blood clotting disorders, aggravation of the nervous system (severe weakness, speech impairment) appear.
Stage IV (hepatic coma) - the liver completely dies and does not function at all. There is loss of consciousness, decreased reflexes, then their absence. Brain swelling develops. Multiple organ failure increases. Most often, this is an irreversible process and the patient dies.

Features of clinical manifestations of chronic liver failure:

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 will sooner or later lead to hepatic encephalopathy and coma.

Diagnosis of liver failure

Examination of the patient by a general practitioner, hepatologist or gastroenterologist, or in case of coma - by a resuscitator- determining the history of life and illness, identifying the above symptoms, determining the size of the liver, assessing the condition of the skin and visible mucous membranes.

Laboratory methods for studying the condition of the liver

Laboratory diagnostics make it possible to assess the functional state of the liver and the degree of its damage.

Indicators	Norm of indicators*		Changes in liver failure

Total bilirubin	Total bilirubin: 8 - 20 µmol/l, indirect bilirubin: up to 15 µmol/l, direct bilirubin: up to 5 µmol/l.			A significant increase in bile pigments - 50-100 times or more, up to 1000 µmol/l. Hepatic encephalopathy occurs when the bilirubin level is more than 200 µmol/l.
ALT(alanine aminotransferase)	0.1 - 0.68 µmol/l or up to 40 IU			Transaminases are enzymes that are released from deteriorating liver or heart cells. The more transaminases, the more pronounced the process of necrosis of liver tissue. In liver failure, transaminases increase tenfold. With complete destruction of the liver, it is noted a sharp decline transaminase indicators.
AsT(aspartate aminotransferase)	0.1 - 0.45 µmol/l or up to 40 IU
Thymol test	0 - 5 units - negative test.			Thymol test - determination of the qualitative ratio of protein components of blood serum. A positive test indicates the presence of a violation of protein metabolism, almost always positive in liver failure.
De Ritis coefficient	1,3 - 1,4			This ratio reflects the ratio of AST to ALT. In liver failure due to chronic liver diseases, this indicator increases by more than 2. And in the acute process of viral hepatitis, on the contrary, it decreases by less than 1.
GGT(gamma glutamate transferase)	6 - 42 U/l for women, 10 - 71 U/l for adults.			GGT is an enzyme involved in protein metabolism. In liver failure, this figure can increase several times if the patient has symptoms of bile stasis. Interestingly, GGT is used by narcologists in diagnosing alcoholism.

Glucose	3.3 - 5.5 mmol/l			There is a decrease in glucose levels or, more rarely, its increase, this is due to a violation of carbohydrate metabolism, in which the liver plays an important role.
Urea	2.5 - 8.3 mmol/l			With liver failure, a decrease in the level of urea is observed, this is due to violations of protein metabolism, the lack of synthesis of urea in the liver from ammonia - protein breakdown products.
Total protein, globulins, albumins	Total protein: 65 - 85 g/l, globulins: 20 - 36 g/l, albumins: 30 - 65 g/l			A decrease in the level of total protein, albumin and globulins occurs due to a violation of protein metabolism.
Cholesterol	3.4 - 6.5 mmol/l			An increase in cholesterol levels is observed with severe cholestasis syndrome, but with further liver necrosis, a sharp decrease in cholesterol levels occurs.
Iron	10 - 35 µmol/l			An increase in the level of iron in the blood is associated with necrosis of hepatocytes, in which it is deposited as a result of the destruction of hemoglobin.
Alkaline phosphatase	Up to 240 units/l for women and up to 270 units/l for men			In liver failure there is an increase in activity alkaline phosphatase 3 to 10 times due to cholestasis syndrome, the inner lining of the biliary tract is a source of alkaline phosphatase.
Blood ammonia	11-32 µmol/l			With liver failure, the level of ammonia nitrogen in the blood increases up to 2 times; with the increase of hepatic encephalopathy, the level of ammonia increases.
Fibrinogen	2 - 4 g/l			There is a decrease in fibrinogen levels due to disruption of its formation in the liver. Fibrinogen is a blood clotting factor; its deficiency, together with the deficiency of other factors, leads to the development hemorrhagic syndrome.

Hemoglobin	120 - 140 g/l			With liver failure, there is always a decrease in hemoglobin of less than 90 g/l. This is due to disturbances in protein and iron metabolism, as well as the presence of blood loss in hemorrhagic syndrome.
Leukocytes	4 - 9*10 9 /l			An increase in the level of leukocytes and ESR accompanies intoxication syndrome due to liver necrosis or the action of viral hepatitis, that is, inflammation.
ESR(erythrocyte sedimentation rate)	2 - 15 mm/h
Platelets	180 - 320*10 9 /l			There is a decrease in the level of platelets due to an increased need for them, as a result of hemorrhagic syndrome.

Color	Straw, light yellow			Darkening of urine, the color of dark beer is associated with the appearance of bile pigments in it, due to cholestasis.
Urobilin	5 - 10 mg/l			An increase in the level of urobilin in the urine is associated with cholestasis syndrome and impaired metabolism of bile pigments.
Protein	Normally there is no protein in urine			The appearance of protein in the urine is associated with a violation of protein metabolism, may indicate the development of renal failure.

Stercobilin	Normally, stercobilin is present in feces, it contributes to the coloring of feces in yellow-brown colors.			The absence of stercobilin in feces is associated with a violation of the outflow of bile.
hidden blood	Normally, there should be no hidden blood in the stool			The appearance of occult blood in the stool indicates the presence of bleeding from dilated veins of the esophagus or stomach.
Blood test for viral hepatitis
Markers viral hepatitis A: Ig M HAV; viral hepatitis B: antibodies to HBs antigen; viral hepatitis C: Anti-HCV		Normally, in a person who does not suffer from viral hepatitis, markers for hepatitis are not detected.		Definition of markers viral hepatitis indicate an acute or chronic process.

*All indicator standards are indicated for adults only.

Instrumental methods for diagnosing liver diseases

With the help of special equipment, it is possible to visualize the liver, assess its condition, size, presence of additional education, condition of the liver vessels, bile ducts.

Additional research methods for liver failure

An additional examination is necessary to assess the condition of other organs, since the whole body suffers with liver failure.

chest x-ray,
CT or MRI of the brain,
fibrogastroduodenoscopy (probing of the esophagus, stomach, duodenal bulb),
others according to indications.

Treatment of acute liver failure

Basic principles of treatment of acute liver failure:

The most important thing is, if possible, to eliminate the possible cause of liver failure.
Treatment must be started immediately.
Hospitalization is required! Acute liver failure is treated only in a hospital setting, with severe encephalopathy - in the intensive care unit.
Treatment is aimed at maintaining the body’s condition and metabolism.
If we exclude the cause of the development of liver failure and fully support the patient’s life support for 10 days, regeneration of hepatocytes occurs, which allows the patient to survive.

Stages of intensive care for acute liver failure

Stopping bleeding in the presence of hemorrhagic syndrome:
- If necessary, surgical treatment aimed at restoring the integrity of blood vessels
- Administration of hemostatic drugs: aminocaproic acid (etamsylate), vitamin K (vicasol), ascorbic acid (vitamin C), vitamin P (rutin), fibrinogen and others.
- If these measures are ineffective, drug transfusions are possible. donated blood, namely, platelet mass and other blood clotting factors.
Reducing intoxication:
- colon cleansing,
- protein-free diet,
- administration of drugs that stimulate intestinal motility (cerucal, metaclopramide and others),
- infusion of neogemadez, rheosorbilact for the purpose of detoxification.
Restoring circulating blood volume: intravenous drip administration of saline. solution, other saline solutions under control of the volume of urine excreted.
Improving blood supply to the liver:
- Oxygen mask or mechanical ventilation if symptoms of pulmonary edema are present,
- reduction of edema of liver cells: administration of osmotic drugs (reopolyglucin, sorbitol),
- dilatation of intrahepatic vessels: aminophylline, droperidol, thiotriazoline,
- drugs that improve the liver’s ability to perceive oxygen: cocarboxylase, cytochrome C and others.
Replenishment of the body's necessary energy reserves: administration of glucose, albumin.
Reduced absorption in the intestine - lactulose (Duphalak, Normaze and others), prescription of antibiotics to disrupt the intestinal microflora.
Restoring liver function and promoting its regeneration:
- Arginine, ornithine, Hepa-Merz - improve the function of the liver in 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 phenylalanine, tryptophan, methionine, tyrosine.
Correction of brain function:
- sedatives (calming) drugs,
- improvement of blood circulation in the brain (Actovegin, Cerebrolysin and others),
- diuretics (diuretics, for example, Lasix, mannitol) to reduce swelling of the brain.

Treatment of chronic liver failure

Principles of 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 treating this syndrome!
Diet is one of the main measures aimed at restoring liver cells and reducing the formation of ammonia in the body. Protein-free diet.
Cleansing the intestines, since pathogenic intestinal microflora promotes the formation of ammonia and its absorption into the blood, and the liver has lost its ability to form urea from ammonia. To do this, cleansing enemas are prescribed 2 times a day.
It is necessary to correct the main metabolic indicators, according to biochemical blood tests (electrolytes, lipoproteins, glucose, and so on).
In addition to taking basic medications, if there are complications, it is necessary to treat them.

The main medications used for chronic liver failure

Type of drugs	Representatives	Mechanism of action	How to use
Lactulose	Dufalac, Normaze, Good luck, Portolac	Lactulose changes the acidity of the intestines, thereby inhibiting the pathogenic intestinal microflora that releases nitrogen. Nitrogen is absorbed into the blood and combines with hydrogen atoms in water to form ammonia. A damaged liver is unable to form urea from this ammonia, and ammonia intoxication occurs.	30 - 50 ml 3 times a day with food. Lactulose can be used long-term.
Broad-spectrum antibiotics	Neomycin has proven itself most well in the treatment of liver failure.	Antibiotics are necessary to suppress intestinal microflora that produces ammonia. Any antibacterial drugs can be used, with the exception of those that have a hepatotoxic effect.	Tablets 100 mg - 1-2 tablets 2 times a day. The course of treatment is 5-10 days.
Amino acids	Glutamic acid	Amino acids of these groups bind ammonia in the blood and remove it from the body. It is prescribed for ammonia intoxication, which has developed as a result of chronic liver failure. Do not use with vikasol (vitamin K), which is prescribed to stop bleeding, for example, from dilated veins of the esophagus.	Orally 1 g 2-3 times a day. The course of treatment lasts from 1 month to 1 year.
	Ornithine (ornicetyl)		Inside, 3 g granules, diluted in a glass of liquid 2-3 times a day. For intravenous drip - 20-40g / day per 500 ml of glucose 5% or saline.
Detoxification infusion therapy	Glucose 5%	Glucose helps replenish necessary energy reserves.	Up to 200 - 500 ml per day of each solution intravenously. Total solutions per day can be poured up to 2 - 3 liters, only under the control of the volume of excreted urine (diuresis).
Detoxification infusion therapy	Sodium chloride solution 0.9% (saline solution), Ringer's solution, Lact	Electrolyte solutions replenish the volume of circulating blood, the electrolyte composition of the blood improves the blood supply to the liver.
Potassium preparations	Potassium chloride	Compensates for the lack of potassium, which is almost always present in liver failure. Only under control of the level of potassium in the blood, since its excess can lead to heart failure.	10 ml of 4% solution diluted in 200 ml of any liquid for infusion.
Vitamins	Vitamin C	Many vitamins are antioxidants, improve the condition of the vascular walls, improve blood circulation, and help improve the regeneration of liver cells.	Up to 5 ml per day intramuscularly or intravenously.
	B vitamins (B1, B6, B12)		1 ml per day intramuscularly or intravenously with infusion solutions
	Vitamin PP (nicotinic acid)		1 ml per 10 ml of water for injection intravenously 1 time per day.
Hepatoprotectors	Essentiale forte	Contains phospholipids, vitamins B1, B2, B6, B12, PP, pantothenate - a substance that promotes the elimination of alcohol. Phospholipids are a source for the structure of hepatocytes and improve their regeneration.	Solution for injection - 5 ml 2-4 times a day, diluted with saline. solution or glucose. After 10 days of injections, you can switch to taking tableted Essentiale. For oral administration: 1st month - 600 mg (2 capsules of 300 mg each) 2-3 times a day with food. Next - 300 mg (1 capsule) 2-3 times a day. The course of treatment is from 2-3 months.
Hepatoprotectors	Heptral	Contains amino acids that improve liver regeneration and help neutralize bile acids.	1 tablet for every 20 kg of patient weight in the morning between meals.

Indications for extracorporeal treatment methods

Extracorporeal methods- methods of treatment outside the patient’s body. In recent years, these methods have become promising for the treatment of liver failure.

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 forced through filters, freeing it from toxins.

Plasmapheresis - purification of blood from toxic substances using special filters, followed by the return of 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 failure, usually this occurs at the stage of hepatic coma;
Fulminant liver failure, developing 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 transplantation

Liver transplantation occurs after partial removal of the affected organ. The liver is transplanted from a donor who is suitable in many respects. Only part of the liver is taken from the donor; for him, this procedure in most cases does not pose a threat to life, since the liver is gradually regenerated.

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 there is a possible rejection of the transplanted organ (foreign agent), so the patient will have to take special medications (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 and 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, or better yet, 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, in small portions;
food should contain a sufficient amount of easily digestible carbohydrates (honey, sugar, fruits, vegetables);
food should contain a large amount of vitamins and microelements;
you need to get an increased amount of fiber;
Fat restriction is necessary only if there are symptoms of cholestasis;
after the patient’s condition improves, you can restore your normal diet by introducing protein products gradually (like complementary foods for children), starting with protein of plant origin (buckwheat, cereals, legumes), then dairy products and, if protein is well tolerated, meat;
If a patient develops hepatic encephalopathy with impaired swallowing or hepatic coma, parenteral nutrition is recommended (administration of solutions of amino acids, carbohydrates, lipoproteins, vitamins, microelements through a vein).

Daily regime:

it is necessary to stop taking alcohol and other hepatotoxic substances (especially medications without consulting a doctor),
drink enough fluids,
give up heavy physical activity,
get enough sleep, improve your psychological state,
avoid constipation, it is necessary to carry out cleansing enemas 2 times a day,
if your condition allows, spend more time in the fresh air, while avoiding open sunlight.

Take care of your health!

With this syndrome, metabolic processes in the body are disrupted and the body is poisoned by the products of protein metabolism.

Classification

Failure is classified according to the nature of the course and stages.
Acute and chronic insufficiency differ in nature.
The acute form develops with an acute form of hepatitis, poisoning or subacute liver dystrophy.
The chronic form is characteristic of liver cirrhosis and chronic hepatitis. Both forms of failure can result in hepatic coma.
There are different stages: compensated, decompensated, dystrophic and hepatic coma.

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

Causes

The causes of liver failure are divided into hepatogenic and extrahepatic.

Hepatogenic: diseases and phenomena that directly affect liver tissue.
Extrahepatic: processes affecting liver functions indirectly.

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

The main factors provoking this condition:
1. Viral hepatitis
2. Paracetamol poisoning
3. Poisoning with poisons that destroy liver cells ( adulterated alcohol, mushrooms)
4. Wilson-Konovalov disease
5. Liver dystrophy during pregnancy, occurring in acute form.

Signs:

General deterioration in health
Yellowing of sclera, skin
Breath smells like rotten meat
Trembling limbs
Swelling.

What to do?
Go to the hospital immediately.

Diagnostics

1. Questioning the patient about his bad habits, past illnesses the medications he uses.
2. General blood analysis
3. Coagulogram
4. Analysis of urine
5. Blood biochemistry
6. Alpha-fetoprotein test
7. Abdominal ultrasound
8. Abdominal x-ray
9. Radionuclide scanning
10. Electroencephalogram
11. Biopsy of liver tissue.

In children

Despite the fact that this condition is quite rare in children in the first year and a half of life, it ends in death in 50% of cases. And saving the child’s life depends only on the competent and timely actions of parents and doctors.
In newborns under 15 days of age, liver failure is often caused by immaturity in the production of certain enzymes.
In addition, in children 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, and has a headache. Digestion of food is impaired: diarrhea, bloating, vomiting. My stomach hurts, my heart rate is slow.
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. Subsequently, after being discharged home, the child must adhere to a special diet for a long time and take increased doses of vitamins B, A, C, K .

Treatment

Treatment of liver failure of any stage and in patients of any age should be carried out only in a hospital.
It is necessary to maintain the vital functions of the patient’s body and at the same time fight the underlying disease that caused this condition.
If the cause of deficiency is poisoning, toxins are removed from the body using laxatives. Intravenous injections are used to cleanse the body of ammonia. glutamic acid twice or thrice a day for 3 to 4 days.
Glucose and vitamins are also infused AT 12 And AT 6 , cocarboxylase, panangin, lipoic acid.
The use of oxygen installations and oxygen pillows is mandatory.
In chronic forms of insufficiency, drugs are prescribed to alleviate the patient’s condition, the proportion of protein in food is reduced, enemas are indicated to cleanse the intestines, as well as from time to time antibiotics and vitamins IN in the form of injections, vitohepat.

Diet

1. Reduce the protein level in the diet to 30 grams. per day, fats up to 20 - 30 grams, while carbohydrates should be up to 300 grams. In severe conditions, protein is completely excluded, leaving only 5 grams contained in plant products.
2. The basis of the diet - plant food (juices from vegetables and fruits, honey, puree soups, compotes with boiled fruits, rosehip decoction, jelly, jelly).
3. Eat food once every 2 hours in semi-liquid or liquid form.
4. Avoid salt completely.
5. Drink up to 1.5 liters of fluid per day in the absence of edema.

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