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

Causes of liver failure

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

Liver diseases (acute and chronic hepatitis, cirrhosis and echinococcosis, etc.);
diseases associated with obstruction of the bile ducts, leading to hepatic hypertension and the development of dystrophic changes in liver cells;
extrahepatic diseases (cardiovascular and endocrine systems, infectious and autoimmune diseases and etc.);
drug poisoning, 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 a violation of the outflow of bile through the biliary tract due to their blockage, most often by a stone or tumor. As a result of this, one of the most striking manifestations of the disease occurs - jaundice. The severity of this symptom depends on the level of obstruction of the biliary tract. Skin, sclera and mucous membranes may acquire various shades, from pale yellow to orange and greenish. With a long course of the pathological process, jaundice may not be.

Cytolysis syndrome

This syndrome develops when hepatocytes are damaged, as a result of which liver cells cannot perform their function or die. As a result, the blood enters a large number of toxic substances that the liver was supposed to neutralize. Exactly cytolytic syndrome and causes the main symptoms of the disease.

If the death of hepatocytes occurs, the patient begins to worry about fever, weakness, loss and perversion of appetite, nausea, and sometimes vomiting. The liver may increase in size. Patients notice that the stool becomes light or completely discolored. The cardiovascular system suffers, tachycardia appears, 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. There are signs of metabolic disorders, 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, tremor of the limbs and convulsions. Violations in the work of the liver entail a violation of kidney function, as a result of which harmful substances that are normally excreted in the urine accumulate in the body, which contributes to an increase in the symptoms of intoxication. As a result of impaired protein synthesis, anemia can develop.

portal hypertension syndrome

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

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

Treatment of liver failure

A patient with liver failure will be prescribed a number of medications (antibacterial, hepatoprotectors, vitamins, laxatives, and others). It is unlikely that they will be able to get rid of the disease, but they will certainly improve the quality of human 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 advised to follow a protein-restricted diet of 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, until the results of the analysis for the sensitivity of microflora to antibiotics are obtained, broad-spectrum drugs (most often from the group of cephalosporins) are used.
Hypoammoniemic drugs (Ornithine, Hepa-Merz) help reduce the level of ammonia in the body.
Laxatives based on lactulose (Duphalac, Normase) also help reduce the absorption of ammonia in the intestines, as well as suppress the intestinal flora that produces it. With constipation, patients are also given enemas with magnesium sulfate.
Patients may need hormonal and infusion therapy. In case of bleeding, vitamin K (Vikasol) is administered; in case of prolonged or massive bleeding, donor plasma is injected intravenously.
Vitamin therapy and replenishment of microelement deficiency. Vitamins of group B, ascorbic, folic, nicotinic, glutamic, lipoic acids are introduced. To maintain mineral metabolism, it is necessary to introduce calcium, magnesium and phosphorus.
When joining kidney failure patients may need hemodialysis in order to remove ammonia and other toxic substances from the patient's blood, which are normally detoxified by the liver. In stage 3–4 disease, hemodialysis may improve the prognosis for patients.
With severe ascites, paracentesis is performed to evacuate the fluid accumulated in the abdominal cavity.

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

Which doctor to contact

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

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

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

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

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

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

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

Source vseopecheni.ru

signs

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

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

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

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

Source lekmed.ru

Causes

The causes of liver failure may be the following conditions:

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

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

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

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

Extreme effects on the body (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 life of a child depends only on the competent and timely actions of parents and doctors.

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

In addition, in babies, the cause of this condition may be hypoxia and an increased amount of proteins in the body.

Liver failure in children causes a lot of ailments. The child is weak, inactive, sleeps a lot, his head hurts. Digestion of food is disturbed: diarrhea, bloating, vomiting. My stomach hurts, my heart rate is erratic.

If you do not provide urgent help to the baby, he falls into a coma.

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

Source tiensmed.ru

stages

Classify 3 stages of liver failure:

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

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

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

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

End-stage liver failure ends with hepatic coma.

Source curemed.ru

Treatment Methods

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

Strict diet. Protein intake is carefully controlled: an excess of protein can cause brain damage, and a lack of it can lead to weight loss. Sodium intake should be low to avoid accumulation of fluid in the abdomen (ascites).

symptomatic therapy.

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

The surgical method of treatment is liver transplantation.

Source zdorovieinfo.ru

liver-up.com

Causes of liver failure

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

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

Symptoms of liver failure

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

cholestasis syndrome

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

Cytolysis syndrome

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

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

portal hypertension syndrome

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

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

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

Treatment of liver failure

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

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

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

myfamilydoctor.com

About the liver

The liver is the most heavy body that performs many 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 in the process of its own metabolism. So, indirect bilirubin, formed from hemoglobin, is a poison for the brain. The liver binds it with glucuronic acid, and it, becoming less toxic, must 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, carry iron (globin in hemoglobin), perform the process of blood clotting;
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 from 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. At the same time, every minute it performs up to 20 million chemical reactions (detoxification, synthesis of proteins, enzymes, and so on).

The liver is the organ best able to recover. If 25% or more of living cells remain, upon termination of exposure to it toxic factors she can fully restore her volume. But it does not by dividing cells, but by increasing their volume. The rate of regeneration depends on the age of the person (in children - faster), the individual characteristics of his body. No less the ability to recover determines the underlying disease.

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

Forms of liver failure

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

Hepatocellular insufficiency

It occurs when the cells of an organ infect substances that are toxic to them (poisons of fungi, special viruses, poisons from alcohol surrogates). This type of liver failure can be acute, when cells die massively, and chronic, when poisoning occurs gradually, cells die slowly.

Porto-caval form

It is chronic in most cases. This name suggests that there is high pressure in the portal vein (it is called "vein porte" in Latin), carrying blood to the liver for cleaning. In order not to “flood” the liver with blood, this vein “dumps” blood into the inferior vena cava (it is called the “vein of cava”) through the veins-junctions. These veins exist normally, in case of saving a life with the development of severe hypertension in the portal vein. But if high pressure is maintained in them for a long time, which they are not designed for, gaps of various sizes periodically occur in them, which leads to bleeding: esophagogastric, rectal, retroperitoneal.

Since the blood is dumped around the liver, it turns out that it does not get cleared of toxins. In addition, the portal vein normally provided part of the nutrition of the liver, that is, in the form of porto-caval insufficiency, the liver cells will suffer from hypoxia. The latter will be chronic, since there is still a hepatic artery that brings blood to the liver directly from the aorta.

mixed form

It is also a type of chronic liver failure, which combines both the suffering of liver cells (hepatocellular insufficiency) and the “dumping” of unfiltered blood into the general circulation.

Acute liver failure

When large volumes of liver cells stop functioning all at once, a condition called acute liver failure develops. The symptoms of this condition unfold quickly - from several hours to 2 months, during which bleeding develops, severe intoxication, impaired consciousness to the level of coma, and dysfunction of other organs. 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, this is called fulminant (fulminant) liver failure. Developing due to 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, carried out even before the development of severe bleeding and coma, which is difficult to do. 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 hepatic cell failure. This may occur due to such reasons:

Poisoning with poisonous mushrooms: pale grebes, lines, crosses, heliotrope. The mortality rate for this condition is over 50%.
Taking antipyretic drugs with fever in children 4-12 years old. Particularly dangerous in this regard are acetysalicylic acid ("Aspirin"), products containing salicylates. Less dangerous are paracetamol, ibuprofen (Nurofen), analgin. The disease is called Reye's syndrome or acute hepatic encephalopathy. Mortality in children is 20-30%.
Viruses:
- hepatitis A (only in people over 40 years of age, when Botkin's disease occurred against the background of a disease of the biliary tract);
- hepatitis B - alone or in combination with infection with hepatitis D (hepatitis D virus is defective, it can only enter an organism that already has hepatitis B virus). Fulminant hepatitis B occurs only in people with "strong" immunity, especially young people. Drug addicts, people taking drugs to reduce immune protection(after transplantation, in autoimmune diseases, in the treatment of cancer), 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 the A virus. It is easy for men and women outside the pregnancy period, but it is extremely dangerous for pregnant women, ending in 20% of the fulminant form. Most often - in 21% of cases - this disease develops in the 3rd trimester of pregnancy; dangerous and 1 month after birth;
- yellow fever virus;
- herpetic group viruses (herpes simplex, cytomegalovirus, Epstein-Barr virus, varicella-zoster virus);
Other microbes, not viruses, that can cause a generalized infection of the whole body with liver damage. This is the most diverse bacterial infection (staphylococcal, enterococcal, pneumococcal, streptococcal, salmonella, and so on), as well as rickettsiosis, mycoplasmosis, mixed fungal infections.
Poisoning by alcohol substitutes.
Acute blood poisoning in liver abscesses, purulent inflammation of the intrahepatic bile ducts.
Poisoning with poisons that are toxic to the liver: phosphorus, chlorocarbons and others.
Poisoning with drugs, especially with their overdose. So, you can exceed the maximum dose of Paracetamol, Aminazin, Ketoconazole, Tetracycline, Co-trimoxazole, sulfonamides, drugs for the treatment of tuberculosis, drugs based on male sex hormones.
Acute circulatory disorders in the liver due to embolism of a large branch of the hepatic artery of blood clots, gas, fat.
Severe oncological diseases: hemoblastoses, lymphogranulomatosis, cancer metastases of various localization in the liver.
Diseases of unknown origin: for example, acute fatty liver of pregnancy.
Rupture of an echinococcal cyst in the liver.
Operations on the abdominal organs, in which the blood circulation of the liver was disturbed (for example, a large branch of the hepatic artery was clamped, stitched or cut for a long time).

How does acute liver failure manifest?

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

small acute insufficiency (synonyms: hepatic dysfunction, hepatodepression);
severe liver failure (hepatargia, cholemia).

Both types of the disease manifest themselves in different ways.

Hepatodepression

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

drowsiness;
mild nausea;
decreased appetite.

There is no jaundice, no spontaneous bleeding, no effusion of fluid in the tissue and cavity.

If the cause of hepatodepression was a long-term (more than a day) intractable state of shock, when there is either little blood in the vessels, or they expand too much and cease to normally supply oxygen to the internal organs, renal-hepatic insufficiency develops. This manifests itself:

decrease in the amount of urine;
cloudy urine;
skin itching;
nausea;
loss of 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 final, and most often everything ends within 24 hours. They say about the subfulminant variant when the deployment of symptoms does not last for hours, but for a day or longer.

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

Acute liver failure should be suspected and urgent action should be taken if at least one of the following symptoms is present:

strange behavior;
errors in the performance of the usual work;
constant nausea;
vomiting that is difficult to stop and does not bring relief;
aversion to food;
sleepiness during the day;
acute, severe pain in the right hypochondrium, not associated with food intake, it can decrease or increase on its own, taking no-spa or papaverine does not affect it;
perversion of taste and smell.

Those symptoms, according to which only in cooperation with a doctor, a catastrophe can be suspected, are:

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

Precoma I (1st stage)

Here behavior is disturbed, 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 can be inverted (drowsiness during the day, insomnia at night), lost on the ground. Relatives may notice in an already yellowed patient new personality traits, aggression, stubbornness, previously unusual for him. At the same time, he understands that the character has changed. Also they say about the fulminant current:

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

Precoma II (2nd stage)

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

Coma I (3rd stage)

Consciousness is absent, a person does not react to a shout, but periodically, without regaining consciousness, he begins to fuss. Are celebrated spontaneous urination and defecation; there are muscle twitches. The pupils are wide, almost do not react to light.

Coma II (4th stage)

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

Other symptoms

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

Jaundice. in yellow the skin and whites of the eyes are stained. Later, you can see that other fluids were stained with bilirubin. So, tears, sputum become yellow. Urine, on the other hand, is dark.
Liver smell from the patient. It is caused by the accumulation of mercaptans in the blood, which were obtained in the large intestine from sulfur-containing amino acids, which were produced by the bacteria located there, but the liver did not neutralize.
Light cal. It is due to the absence of bile acids in it.
Internal and abdominal bleeding. They occur because the liver can no longer synthesize clotting factors. So, uterine, intestinal (black liquid stool), gastric (vomiting brown contents) bleeding. They can appear all together. They can be implicit, so a fecal occult blood test is shaved 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 is manifested by a decrease in the amount of urine, edema. If a person is still conscious at this moment, he complains of thirst and a hoarse voice.

How is the diagnosis made?

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, bilirubin to make this diagnosis. To determine tactics and prognosis, the following surveys are also important:

proteinogram. It defines a reduction total protein and albumin;
biochemical analysis of blood: a decrease in the level of urea in the blood, an increase in creatine phosphokinase. With the addition of renal failure, an increase in the level of creatinine in the blood, 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 three-phase waves appear, in a deep coma brain activity completely missing.

Next, be sure to establish the cause of liver failure. They determine markers of viral hepatitis, antibodies to herpetic group viruses, 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 history from relatives and, if possible, from the person himself: did the person eat mushrooms, how does he feel about alcohol, when did he last use it, does he work in hazardous production.

Treatment of acute liver failure

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

For this, the following drugs are used:

amino acid mixtures without essential amino acids are administered intravenously: Aminosteril N-Hepa, gepaferil;
to replenish the protein, a pharmacy solution of albumin is transfused;
intravenous drip is mandatory to administer drugs: Ornitox (Hepa-Merz), Glutargin;
medications are injected intravenously that block the production of hydrochloric acid by the stomach: Rantak, Contralok, Omez;
inhibitors of proteolytic enzymes are required: Kontrykal, Gordox;
orally (on their own or through a probe), lactulose preparations are administered that neutralize amino acids that are toxic to the brain: Dufalac, Normaze, Laktuvit;
also by mouth (or gastric tube) introduce sorbent preparations that “take away” toxins: Enterosgel, Atoxil, White coal;
for viral hepatitis, glucocorticoid hormones are prescribed: Dexamethasone, Methylprednisolone;
to create the best 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 in one of three ways:

hepatocellular form;
porto-caval form;
mixed insufficiency.

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

Chronic liver failure, unlike acute liver failure, is an irreversible process. Once running, it can only be stopped at the beginning. Further treatment is aimed at maintaining a decent quality of life 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:

reddening 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 coloration of the skin and sclera;
dark urine;
light feces;
heaviness in the right hypochondrium;
loss of appetite;
nausea;
heaviness in the left hypochondrium;
periodic bleeding from the rectum, veins of the esophagus, when vomiting appears with brown contents or black liquid stools;
an increase in 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 is to eliminate the factors that cause the disease. In some cases, such as liver cancer, surgical treatment may be performed. A low-protein diet is prescribed with the amount of carbohydrates 400-500 g / day, and fats - 80-90 g / day, with the exception of alcohol, caffeine, fluid restriction. The daily routine is also changing: now you will need to move enough, but without lifting weights of more than 2 kg and avoiding open sun rays. Persons with chronic liver failure need to get enough sleep, and about taking any medication, even for a cold, consult a hepatologist (almost all drugs pass through the liver).

It is also necessary to prescribe the following medications:

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, a healthy liver would neutralize them). This is Kanamycin, Gentamicin.
Lactulose preparations that bind substances toxic to the brain: Lactuvit, Prelaxan, Dufalac, Lactulose.
To reduce the level of edema and ascites, Veroshpiron is prescribed.
In order to reduce pressure in the portal vein system - Molsidomine, Propranolol, Nebilet.
With blockade of the biliary tract, cholespasmolytics are prescribed. These are Flamin, Buskopan, No-shpa.
With increased bleeding, Vikasol and Etamzilat tablets are used.

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

autoimmune hepatitis;
cirrhosis of the liver;
alveococcosis of the liver;
congenital pathologies of the organ;
tumors that allow you to partially save your own liver.

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Symptoms of the disease

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

Jaundice

The first of the symptoms that is visible to the naked eye. The skin and mucous membranes of the mouth, nose, eyes, genitals acquire yellowish color due to the accumulation of bilirubin and biliverdin in them: from greenish to rich orange hues. Depending on the natural color of the skin, its shade changes, but in people who have a genetically isolated swarthyness, 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 bloodstream due to dysfunction of hepatocytes.

Discoloration of feces

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

urine color

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

itchy skin

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

Gastrointestinal lesion

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

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

Poisoning by internal toxins

The next stages of the disease imply a deterioration in the background of the death of liver cells that do not have time to recover or lyse in the normal way. The decay products of the body's own tissues, which were previously neutralized by the liver, are now accumulated 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

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

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

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

Accumulation of fluid in the abdomen, or ascites.

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

Circulatory disorders

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

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

Enlargement of the spleen.

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

Hematemesis

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

Pulmonary edema

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

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

13. Hepatic encephalopathy

The last thing to take a toxic hit is the brain. The nervous system, due to the existence of the blood-brain barrier, is kept to the last, and failures in its work can lead to coma and even death. The 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 decay products and other substances harmful to the body in the blood can cause encephalopathy, and if left untreated, the so-called “hepatic coma”, which will inevitably lead to death.

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 affected by a harmful agent. Cells begin to secrete enzymes that destroy dead hepatocytes and damage healthy ones along the way.
The immune system secretes bodies that attack damaged hepatocytes and completely destroy them.
The process extends to healthy tissues.
With the death of more than 70% of hepatocytes, 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 of their death.

The disease is divided into three stages:

Initial. The compensated stage, which is characterized by an increased fight of the liver with an aggressive agent, whether it be a toxin, a virus, a bacterium, or a mechanical injury. Lasts from several hours to several months, depending on the strength of the damage;
Expressed or decompensated. Characterized by a sudden transition from the initial stage, a jump in temperature, sharp deterioration condition, 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 the severity of symptoms. It is worth dwelling on their description in more detail.

Acute liver failure

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

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

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

Hepatocellular (endogenous) - characterized by massive focal lesion hepatocytes caused by strong toxic effects (for example, poisons, drugs, etc.), acute hepatitis.
kzogennaya - provoked by nutritional deficiency as a result of pathologies of the blood supply. Violation of blood circulation in the liver or pathology of the veins that carry blood to it often occurs with cirrhosis. Blood circulates, bypassing the liver, poisoning all organs and systems of the body.
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, stomach upsets, which doctors do not associate with liver failure.

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

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

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

What can lead to complications in chronic liver failure:

alcohol in any quantity;
Taking medicines in large doses;
Eating a large amount of fatty and protein foods;
stress;
Infections affecting all body systems;
Pregnancy;
General anesthesia for operations.

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

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

Diagnostics

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

Diagnostic methods include:

General analysis blood - it includes the measurement of hemoglobin, leukocytes and erythrocyte sedimentation rate.
Liver blood tests - determination of total bilirubin, the level of transaminases ALT, GGT and AST, thymol test, determination of the De Ritis coefficient. They give an idea about the level of liver tissue damage, the state of the biliary tract.
Biochemical blood test - determination of the amount of glucose, urea, protein, cholesterol, free and bound iron, ammonia in the blood.
Urinalysis - for diagnosis, the color, amount of urobilin and protein are of interest. With liver failure, the indicators increase tenfold, and the color becomes close to the color of dark beer.
A blood test for antibodies to hepatitis viruses - in the presence of antibodies, there is also a virus, which will tell doctors how to deal with this disease. With a weakened immune system, antibodies may not be present. Then a PCR analysis is performed to determine the specific virus.
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 examination methods that clearly show the condition of the liver.
Liver biopsy - taking part of the biomaterial (liver tissue) for research. Allows you to see and evaluate the processes occurring with the liver tissue.

Treatment of acute and chronic forms

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

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

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

Necessary measures for acute liver failure:

Detoxification: the introduction 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 elimination - application of glutamic acid and ornithine
Cauterization of ulcers - in case of hemorrhage of the esophagus, it is necessary to eliminate the bleeding, possibly surgically.
Drugs that help restore the liver: arginine, ornithine, hepatoprotectors (Essentiale, Hepa-Merz, etc.)
Sedatives, painkillers, antispasmodics - to calm the patient.
Ensuring the patency of the biliary tract, possibly with the help of 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.
Compliance with a strict diet throughout the treatment.
Symptomatic correction of metabolism based on individual test results.
Monitoring the state of the liver using instrumental methods.
Cleansing the intestines with enemas, lactulose preparations and drugs that inhibit the activity of microflora.
Conducting courses of intramuscular administration of vitamins to support liver recovery
Reception of hepatoprotectors.
Remember folk methods This disease has no cure!

Radical treatments

Accelerated and costly treatments include hemodialysis, plasmapheresis, and liver transplantation. general characteristics Plasmapheresis and hemodialysis is the purification of the blood from toxins outside the body. Hemodialysis conducts blood through the artificial kidney apparatus, and plasmapheresis drives 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 rather dangerous operation, used only in extreme cases. In order for the liver to take root, a close relationship with a donor is desirable. The operation can end in death for both the donor and the patient. The organ is transferred directly, within a few minutes from the separation from the donor. A transplant is not completely required: a part of the liver is taken, and sutured to the diseased part, with the connection of all vessels and nerve endings. In Russia, such operations are carried out in the most extreme cases.

Diet and daily routine

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

The main goal of the diet is to ensure the intake of essential minerals, vitamins, maintain an optimal water-salt balance and reduce the amount of ammonia released by bacteria.
For this, there is a special diet called “liver”. It is worth noting that you should not arbitrarily change the diet for such ailments - the attending physician will tell you what to eat in your individual case.
The picture shows the recommended unwanted foods 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 rate of healthy person from 120 g when calculating 2.5 g of protein per kilogram of live weight). Note that digestible protein is taken into account, and its amount varies in different protein products. Some patients feel calm when increasing the amount of protein to 60-80 grams per day. Remember, a long-term protein deficiency is fraught with metabolic disorders, hematopoiesis, muscle functionality, so the doctor will gradually bring it back to normal. Protein should be introduced gradually, starting with vegetable protein and over time, in the absence of a negative reaction, give meat and meat products.

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

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

Prevention

Prevention in this case comes down to three main principles:

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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 results from drug poisoning (paracetamol or other hepatotoxic agents).

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

Symptoms

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

weight loss;
feeling full after eating;
poor 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 a chronic disease. In addition, the patient's consciousness is disturbed, so contact with him is impossible. These symptoms appear between 4 and 26 weeks from 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 has begun to give severe symptoms, the patient should reduce the amount of protein. The diet should be high enough in calories (35-40 kcal per 1 kg of weight) and be based on pasta, cereals and vegetables.

The study shows that it is advisable to combine proteins derived from dairy and herbal products(about 40 g per day) with nutritious amino acids. Such amino acids can be found in many plants (more on that 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 tremor), 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, it is impossible to consume the daily norm of protein at one meal - divide it into 5-6 servings.

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

Treatment

In order to at least partially restore the functioning of the liver, 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

Among the people, the treatment of kidney failure with radish is very popular. 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 run it through a juicer. You will get about a liter of juice. It must 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 put it in the refrigerator too.

The treatment looks like this: every morning on an empty stomach, take a tablespoon of juice. Then, after breakfast, eat a teaspoon of radish pulp with honey. This should 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 a rosehip infusion with lemon juice. It is prepared like this: put a handful of dry berries in a thermos, pour a liter of boiling water and insist the drug all night. Strain in the morning. This will be your daily intake of the drink. Every time after eating, drink a glass of infusion, adding a tablespoon of lemon juice to it. During the day you need to drink all the drug. Treatment course continue until the symptoms of the disease disappear or at least decrease.

Burdock-based remedy

And now we will tell you how to treat acute liver failure with burdock. This remedy has helped many people to improve the functioning of this organ and get rid of discomfort in the stomach.
So, take half a kilo 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 it in a tablespoon twice a day on an empty stomach. Soon, liver failure will stop bothering you, or its symptoms will decrease significantly.

Chinese remedy

IN Ancient China used 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, chop a small ginseng root (the size of a finger) with a knife. Mix the ingredients and pour 500 ml of medical alcohol. Leave the mixture for 10 days in a warm place. After the tincture is ready, start taking it in a teaspoon, eating honey. The course of treatment is one month. Such courses can be repeated 3-4 times a year.

Fragrant woodruff

With the help of woodruff fragrant, acute liver failure is treated in remission (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 grass 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 repeat the course. To restore liver function, it will take from 3 to 10 such therapeutic courses.

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

Herbal preparations

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

Rosehip (fruits) - 30 g;
Wintergreen grass - 20 g;
Nettle leaves - 20 g.

For 3 tablespoons of the mixture, take 1 cup of boiling water. The remedy should be infused for half an hour, then it must be filtered and taken in half a glass twice a day.

Ancient Russian healers treated the liver with such a collection:

Yarrow grass - 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 the infusion three times a day. The course of treatment should last at least 2 months.

The following collection helps with liver failure:

Yarrow grass - 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. Thoroughly mix the herbs, brew 2 teaspoons of the mixture in a glass of boiling water, leave for 30 minutes in a sealed container, then strain. Drink 2 - 3 times a day for a glass of medicine in between meals.

Liver failure is a medical term for a set of symptoms that develop as a result of destruction of the liver parenchyma and a violation of its basic functions. This pathological condition manifested by intoxication of the body, since the liver ceases to perform a detoxifying 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 region of the right hypochondrium. In our body, this organ performs more than 500 essential functions. We list the main ones:

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

The liver is the main filter of our body.

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

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

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

Types and forms of liver failure

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

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

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

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

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

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

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

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

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

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

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

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

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

Diagnostic methods

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

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

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

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

Treatment

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 prescribed a specific diet, with restriction of salt and protein, which he must adhere to until full recovery. Therapeutic measures include detoxification of the body, the use of medications, the action of which is aimed at improving blood circulation, normalizing electrolyte processes, as well as achieving acid-base balance.

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

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

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

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

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

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

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

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

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

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

Diet and nutritional habits

In the treatment of liver failure Special attention 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 nutrition- you need to eat little by little, but often (5-6 times a day);
in the diet it is necessary to increase the amount of fiber and eat more fresh fruits and vegetables;
the diet should include a small amount of easily digestible carbohydrates (honey, sweet fruits and berries), as well as foods high in useful vitamins and minerals;
daily calorie content diet - at least 1500 kcal, while you should cook delicious dishes, as many patients have a lack of appetite.

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

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

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

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

With the deterioration of the environment due to human activities, the spread of viral hepatitis and other infections, alcoholism and drug addiction, the deterioration of food quality, 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 falls down at the same time and in large quantities, the liver may not be able to cope, and then the risk of developing liver failure develops, which, in turn, can lead to irreversible processes in the body and to the death of the patient.

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

Some statistics!

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

Interesting Facts!

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

Liver anatomy

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

Characteristics of the liver:

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

Distinguish liver surface:

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

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,
tail share.

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

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

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

Liver regeneration

The liver is an organ that can completely restore its structure after damage, that is, it is able to regenerate. 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: in children this period is 2-4 weeks, and in the elderly - from 1 month. The speed and volume of regeneration also depends on individual characteristics and the disease that caused its damage.

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

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

The structure of the liver

Serous membrane- peritoneum.
fibrous sheath- a capsule from which thin branches of connective tissue pass. They divide the parenchyma (part of an organ that contains special functioning structures or an organ without membranes) of the liver into lobules.
Liver lobules- the structural and functional unit of the liver, its size is about 1 mm, there are about half a million of them in the liver.
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 located in hepatic beams - in two layers. The hepatocyte is located between the bile canaliculi and the intralobular capillary.
Bile ducts- located between the hepatic beams, along them bile from hepatocytes enters the bile ducts.
intralobular capillaries or sinusoids- blood vessels through which chemical compounds enter the hepatocytes and processed substances leave them.

Blood vessels of the liver

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

Biliary vessels of the liver

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

The composition of bile

A huge amount of bile is secreted per day by the liver - up to 1 liter, at least half a liter.

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

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

Bile happens:

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

What is included 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 intestine under the action of intestinal microflora).
Bile acids are formed from cholesterol in hepatocytes. In bile they are in the form of salts and anions. The role of bile acids is great in the digestion of fats and the absorption of fatty acids and triglycerides in the intestine. Part of the bile acids is absorbed in the intestine back into the blood, and again enter the liver.

Bile pigments:
- bilirubin
- biliverdin.
Bile pigments are formed from hemoglobin in the spleen and in Kupffer cells. Any erythrocyte is formed in the red bone marrow (erythropoiesis) and destroyed in the spleen, and a small part of them in the liver. Erythrocytes contain hemoglobin, which carries oxygen atoms and carbon dioxide, that is, it carries out gas exchange in tissues. After the destruction of the erythrocyte, there is a question about the utilization of hemoglobin. Bile pigments are intermediate products of the breakdown of hemoglobin; they are excreted from the body with the help of bile.
These pigments color bile yellow, green and brown colors. And also, after binding with oxygen, it slightly stains urine (urobilinogen) and feces (stercobilinogen).

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

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

Ions:
- sodium,
- calcium,
- potassium,
- chlorine,
- bicarbonates
Ions enter the bloodstream and liver along with food. Their main role is to improve the permeability of cell walls, and ions are part of the micelles in 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.

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

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

Causes and pathogenesis of liver failure

The mechanism of development of liver failure in stages

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

Causes of liver failure

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. Work with toxins, poisons, chemicals, heavy metals, paints and varnishes and so on. Taking many drugs (especially long-term): non-steroidal anti-inflammatory drugs(paracetamol, analgin, nimesulide and others), antibiotics and antivirals(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 drugs, precursors (ingredients for the synthesis of drugs) and psychotropic drugs. Diseases of the biliary system: cholecystitis, biliary dyskinesia, cholelithiasis. Frequent consumption of 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 grebe, fly agaric and others). Common infectious diseases(sepsis, HIV, influenza and others). Autoimmune diseases - diseases in which the immune system perceives its own as someone else's, affecting its own cells. Congenital pathologies of the liver(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 load factors on the liver, especially dietary disorders.	The process of development of cirrhosis of the liver is long sometimes last for years. Under the influence of hepatotoxic factors, partial destruction of hepatocytes constantly occurs, but due to the regenerative function of the liver, hepatocytes are partially restored. With prolonged, ongoing exposure to toxic factors, when autoimmune processes are connected, the gene material of the 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.
Dystrophy liver (hepatosis): Parenchymal fatty degeneration liver	overeating fats and carbohydrates, diseases of the gastrointestinal tract, malnutrition, starvation, anorexia, bulimia, eating badger, bear, dog, camel fat and so on.	The intake of excess fat into the liver (also increased content in the liver of carbohydrates, increased glycogen consumption) or difficulty in the release of fats from the liver (lack of proteins, violation of the enzymatic work of the liver) 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 proteinaceous dystrophy of the liver	violation of protein metabolism, 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 dystrophy of the liver: 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 still 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. In this case, 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 drop 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, the development of cirrhosis of the liver is possible. Hyaline can also destroy the wall of the hepatocyte, leading to its necrosis. In any case, sooner or later liver failure develops.
Parenchymal carbohydrate degeneration of the liver	violation of glycogen metabolism, 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. With the development carbohydrate dystrophy glycogen does not accumulate in the cytoplasm, but in the nucleus of the hepatocyte. At the same time, hepatocytes significantly increase in size. With a long process, the death of hepatocytes occurs or connective tissue develops (liver cirrhosis). Outcome - liver failure.
Liver mesenchymal dystrophy or liver amyloidosis	chronic infectious diseases (tuberculosis, syphilis, osteomyelitis and others), diseases immune system, genetic predisposition to the formation of amyloid.	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. Sealed vessels of the liver cannot fully function, 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 defeat of hepatocytes is played by immunity. If in viral hepatitis A and E immunity promotes 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 if other hepatotoxic factors are eliminated, otherwise chronic hepatitis, necrosis or cirrhosis of the liver develops, and the outcome is liver failure. With viral hepatitis C (specialists 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.

It 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 an incompatible blood type,
surgical operations in the abdominal cavity.

Types of liver failure

Distinguish between acute and chronic liver failure.

Acute liver failure

- a type of liver failure that develops as a result of rapid damage to the liver. The clinical picture of this syndrome develops very quickly (from several hours to 8 weeks) and also quickly leads to hepatic encephalopathy and coma.

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

Causes that can lead to acute liver failure:

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

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

After the development of acute liver failure, all toxins that come from the environment or are formed as a result of metabolism have Negative influence to cells throughout the body. With brain damage, hepatic encephalopathy occurs, then coma and death of the patient.

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

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

Chronic liver failure

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 in acute liver failure, there are forms:

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

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

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

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

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

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

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

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

Criteria	Acute liver failure	Chronic liver failure
Development timeline	From a few days to 8 weeks.	From 2 months to several years.
Development mechanism	It 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, the liver is able to partially compensate for its functions. It can also develop with a gradual violation of blood circulation.
The 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 acute liver failure, in which portal hypertension is not a mandatory symptom.
The severity of the current	The course of the disease is extremely severe, more severe than in chronic liver failure.	The course is severe, in the initial stages an asymptomatic course is possible.
Forecast	The prognosis is unfavorable, hepatic encephalopathy often develops, and then coma. 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	Origin mechanism
cholestasis syndrome	Jaundice	Staining of the skin and visible mucous membranes in yellow shades: from green and lemon to orange. In swarthy people, jaundice can be noticeable only on the mucous membranes, especially on the sclera of the eyeballs.	Cholestasis syndrome associated with a violation of the outflow of bile from the liver. This is due to compression of the biliary tract and the inability of damaged hepatocytes to excrete bile. At the same time, the breakdown product of hemoglobin, bilirubin, is not excreted with bile and feces. In the blood, there is a large amount of bile pigments (bilirubin and biliverdin), which provide staining of all tissues in the color of bile. But the feces lose their staining with stercobilin. The kidneys try to remove excess bilirubin from the blood, while there is an increased content of bile pigments in the urine, and as a result, its more intense staining. An increased amount of bilirubin also has a toxic-allergic effect on the skin, which contributes to the development of itching.
	Discoloration of feces	Kal acquires light color up to white and beige.
	Darkening of the urine	The color of urine becomes darker, it is compared with shades of dark beer.
	Itching of the skin	A patient with cholestasis is accompanied by itching throughout the body, while there may not be a rash.
	Pain in the right hypochondrium	Not an obligatory symptom in liver failure. Pain can appear after eating, are aching or spasmodic in nature.	Pain in the right hypochondrium occurs due to obstruction of the bile ducts. At the same time, bile bursts the bile ducts and compresses the lobular nerves.
Dyspeptic disorders	Nausea, vomiting, stool disturbance, loss and perversion of appetite.	Nausea and vomiting are associated with food intake, are intermittent or constant. Disorders of the stool in the form of diarrhea, more than 3 times a day. Appetite is poor, up to refusing to eat. Some patients have a desire to try inedible (earth, chalk, hair, incompatible foods, etc.).	Digestive disorders are associated with the inability of the liver to participate in the digestion of fats. A decrease in appetite can also be a sign of damage to the nervous system and intoxication, which develops against the background of liver necrosis.
Intoxication symptoms	Fever, 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 chain the patient to bed. 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.
Changing the size of the liver	Liver enlargement (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.
Changing the size of the liver	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, resembling 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 promotes fluid drainage in soft tissues.
	Vascular asterisks	Vascular asterisks are an expansion of blood vessels, they look like jellyfish. Appear on the front wall of the abdomen and on the shoulders.	Spider veins are dilated vessels that branch off 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 the disturbed blood circulation.
	Splenomegaly - enlargement of the spleen	This symptom can be determined by palpation of the abdomen and instrumental research methods.	Splenomegaly develops due to circulatory disorders in the spleen, which is the blood depot. It is supplied with blood from the system of portal and inferior vena cava. When the pressure in these vessels increases, more blood is deposited in the spleen. Also, the spleen takes over 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 the remains of blood are detected only in the feces (melena). It is either acute or chronic. The amount of blood loss also varies from person to person. must be differentiated from pulmonary hemorrhage when the secreted blood is bright scarlet, with air bubbles. Aspiration of blood is dangerous (blood entering the lungs - suffocation).	The veins of the esophagus dilate against the background of portal hypertension. Constantly and for a long time dilated vessels lose their mobility and permeability, and therefore bleeding occurs from them. Bleeding also contributes to a violation of blood clotting (associated with impaired liver function, one of which is the synthesis of certain clotting factors).
Hepatic encephalopathy	Violation of the nervous system	Dizziness, lethargy, sleep disturbance, confusion or loss of consciousness inattention, memory loss, lethargy, "Blurring the 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 with bloody sputum with blisters.	Appearance pulmonary symptoms associated with increased pulmonary edema. Pulmonary edema - blood filling of the pulmonary vessels. This is due to a violation of protein metabolism as a result of liver damage. Blood begins to simply sweat through the walls of blood 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.	An increase in blood pressure over 140/90 mm Hg. Art. Arterial hypertension will soon be replaced by hypotension, a decrease in pressure below 90/60 mm Hg. 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).	Violation of the general circulation is 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 lowers blood pressure. With these changes in the bloodstream, the work of the heart is also associated, arrhythmia appears.
Amyotrophy	muscle weakness	Muscles decrease in size, become flabby, 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.
Blood clotting 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 the bleeding is extremely difficult to stop.

Also, with liver failure, anemia, pulmonary heart failure, acute or chronic renal failure, intestinal paresis can develop. Absolutely all organs and systems of the body suffer.
In hepatic insufficiency, a specific hepatic odor from the mouth is characteristic.

Photo of a patient with jaundice.

Acute liver failure, features of the clinical course

Stages of acute liver failure:

Latent stage of hepatic encephalopathy - at this stage, patients have no complaints, and there are no pronounced symptoms of liver damage. Changes can only be detected by examination.
I stage of hepatic encephalopathy - precoma. At the same time, symptoms of liver failure increase: syndromes of cholestasis, portal hypertension, intoxication symptoms, the first symptoms of damage to the nervous system appear in the form of its inhibition.
II stage of hepatic encephalopathy - precoma. At this stage, the patient's condition is aggravated, symptoms of hepatic encephalopathy increase, inhibition is replaced by excitation of the nervous system, and a few pathological reflexes appear. Symptoms of blood clotting disorders become more pronounced, intoxication increases, the liver sharply decreases in size, it cannot be detected on palpation (symptom of "empty hypochondrium"). At this stage, a liver smell from the mouth appears.
Coma- loss of consciousness, the patient shows reflexes only to stronger stimuli, signs of multiple organ failure appear (simultaneous course of 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, multiple organ failure develops. In most cases, this is an irreversible process, the death of the patient 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 cirrhosis of the liver with 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, 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 coordination of movement. There is a liver smell from the mouth. At this stage, short-term memory loss is possible. At this stage, the liver only partially performs its functions.
III stage - a significant decrease in the functionality of the liver. Previously appeared symptoms become more pronounced. There are manifestations of cholestasis and portal hypertension, blood clotting disorders, aggravation of the state of the nervous system (severe weakness, impaired speech).
IV stage (hepatic coma) - the liver completely dies and does not function at all. There is a loss of consciousness, a decrease in reflexes, then their absence. Brain edema develops. Multiple organ failure is on the rise. Most often, this is an irreversible process, the patient dies.

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 sooner or later will lead to hepatic encephalopathy and coma.

Diagnosis of liver failure

Examination of the patient by a general practitioner, hepatologist or gastroenterologist, 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, visible mucous membranes.

Laboratory methods for studying the state of the liver

Laboratory diagnostics allows assessing the functional state of the liver, 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 the indicators of bile pigments - 50-100 times or more, up to 1000 µmol / l. Hepatic encephalopathy occurs when the level of bilirubin 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 transaminase, the more pronounced the process of hepatic tissue necrosis. In liver failure, transaminases increase tenfold. With complete destruction of the liver, a sharp decline transaminases.
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 coefficient 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 IU / l for women, 10 - 71 IU / 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 the diagnosis of 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, the breakdown products of protein.
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 U/L for women and up to 270 U/L for men			In liver failure, there is an increase in activity alkaline phosphatase 3 - 10 times due to cholestasis syndrome, the inner membranes of the biliary tract are a source of alkaline phosphatase.
blood ammonia	11-32 µmol/l			With liver failure, the content of ammonia nitrogen in the blood increases up to 2 times, with an increase in hepatic encephalopathy, the level of ammonia increases.
fibrinogen	2 - 4 g/l			There is a decrease in the level of fibrinogen due to a violation of its formation in the liver. Fibrinogen is a blood coagulation factor, its deficiency in combination with a lack of other factors leads to the development of hemorrhagic syndrome.

Hemoglobin	120 - 140 g/l			With liver failure, there is always a decrease in hemoglobin less than 90 g / l. This is due to violations of 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 an 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 the 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 the urine			The appearance of protein in the urine is associated with a violation of protein metabolism, may indicate the development of renal failure.

Sterkobilin	Normally, stercobilin is present in feces, it contributes to the coloring of feces in yellow-brown colors.			The absence of stercobilin in the feces is associated with a violation of the outflow of bile.
hidden blood	Normally there should be no occult 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 to viral hepatitis indicate an acute or chronic process.

*All indicators 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 formations, the state of the vessels of the liver, 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 as indicated.

Treatment of acute liver failure

Basic principles of therapy for acute liver failure:

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

Stages of intensive care for acute liver failure

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

Treatment of chronic liver failure

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

The main drugs used in chronic liver failure

Type of drugs	Representatives	Mechanism of action	How it is applied
Lactulose	Dufalac, Normase, Good luck, Portolac	Lactulose changes the acidity of the intestine, thereby inhibiting the pathogenic intestinal microflora that releases nitrogen. Nitrogen is absorbed into the blood and combines with the hydrogen atoms of water to form ammonia. A damaged liver is not able to form urea from this ammonia, ammonia intoxication occurs.	30 - 50 ml 3 times a day with meals. Lactulose can be used for a long time.
Broad spectrum antibiotics	Neomycin most well established in the treatment of liver failure.	Antibiotics are needed to suppress the intestinal microflora that releases ammonia. You can use any antibacterial drugs, 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.	Inside, 1 g 2-3 times a day. The course of treatment is long from 1 month to 1 year.
	Ornithine (ornicetil)		Inside the granules, 3 g, dilute 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 contributes to the replenishment of the necessary energy reserves.	Up to 200 - 500 ml per day of each of the solutions intravenously drip. 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% (phys. solution), Ringer's solution, Lakt	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 the control of the level of potassium in the blood, as its excess can lead to heart failure.	10 ml of a 4% solution diluted in 200 ml of any liquid for infusion.
vitamins	Vitamin C	Many vitamins are antioxidants, improve the condition of the vascular wall, 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, improves their regeneration.	Solution for injection - 5 ml 2-4 times a day, diluted in physical. solution or glucose. After 10 days of injections, you can switch to Essentiale tablets. For oral administration: 1st month - 600 mg (2 capsules of 300 mg) 2-3 times a day with meals. Further - 300 mg (1 capsule) 2-3 times a day. The course of treatment - from 2-3 months.
Hepatoprotectors	Heptral	Contains amino acids that improve liver regeneration, contribute to the neutralization of bile acids.	1 tablet for every 20 kg of the patient's weight in the morning between meals.

Indications for extracorporeal treatments

Extracorporeal methods- Methods of treatment outside the body of the patient. 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 driven through the filters, freeing it from toxins.

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

Indications:

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

Indications for liver transplant

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

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

Principles of diet therapy for liver failure:

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

Daily regime:

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

Take care of your health!

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

Classification

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

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

Causes

Causes of liver failure are divided into hepatogenic and extrahepatic.

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

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

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

Signs:

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

What to do?
Urgently go to the hospital.

Diagnostics

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

In children

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

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

Treatment

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

Diet

1. The level of protein in the diet is reduced to 30 gr. per day, fats up to 20 - 30 gr., while carbohydrates should be up to 300 gr. 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 broth, jelly, jelly).
3. Eat food once every 2 hours in a 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 every three days you can add 10 grams. protein to reach age norm. Protein should be increased by introducing cottage cheese, kefir, yogurt into the diet. You can slowly increase the fat content. At the same time, the basis of the diet is easily digestible carbohydrates ( honey, sugar, jam, jelly, jelly, fruits).