Forms of liver failure. Liver failure: stages of the disease, treatment and survival prognosis

Currently, liver failure should be understood as clinical syndrome, resulting from a breakdown in the compensatory capabilities of the liver. In this case, the liver is not able to meet the body's metabolic needs and maintain a constant internal environment.

There's no such thing known species metabolism, which would not be controlled by the liver. In this regard, many emergency conditions manifested and complicated by liver failure. Just 40 years ago, liver failure was not diagnosed and was taken for intoxication, pulmonary failure, cardiovascular failure or other pathological conditions. This circumstance was due to the fact that clinically this pathology does not have pronounced symptoms unique to it.

Causes of liver failure

The following conditions may be the causes of liver failure:

Liver diseases (acute and chronic hepatitis, portal and ciliary cirrhosis of the liver, malignant neoplasms, echinococcus and others);
Obstruction bile ducts, leading to increased pressure of biliary hypertension, which disrupts lymph and blood circulation in the liver and leads to the development dystrophic changes in hepatocytes (liver cells);
Diseases of other organs and systems - heart, blood vessels, endocrine glands, infectious and autoimmune diseases;
Poisoning with hepatotoxic substances ( medicines, poisonous mushrooms, dichloroethane, alcohol substitutes, antibiotics, aminazine, sulfonamides.);
Extreme effects on the body (extensive injuries, burns, traumatic shock, massive blood loss, massive blood transfusions, allergization, septic shock).

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

Symptoms of liver failure

In the clinical picture of liver failure, there are two main points that influence its manifestations.

This cholestasis syndrome– occurs due to intrahepatic bile excretion disorders or extrahepatic blockage of the bile ducts. In this case, jaundice is caused big amount bound bilirubin(one of the indicators biochemical analysis blood).

Hepatocellular failure syndrome. This syndrome occurs when liver cells are unable to perform their function. A number of changes occur in them and the cells are destroyed, as a result of which it enters the blood a large number of intracellular components. It is by them that the severity is judged pathological process in the liver.

The first process causes the appearance of one of the most striking and noticeable symptoms of liver disease - this jaundice. It can have a color of varying intensity from green to orange and depends on the level of obstruction of the biliary tract. There may not be jaundice with a pronounced long-term process, when acute stage slowly becomes chronic.

The second syndrome provides most of the clinical picture. Necrosis of liver tissue leading to cell death causes a serious condition of the patient, severe fever. Due to edema the size of the affected liver increases, appears discolored stool. From the cardiovascular system occurs change in blood circulation. Tachycardia appears and blood pressure rises. It may happen in the future sharp drop blood pressure, due to a decrease in the volume of circulating blood, the liquid part of which will go into the tissue.

In an acute process, when there is a rapid rate of cell death, a number of associated syndromes, since the liver is very closely interconnected with all organs and systems. She has a lot of functions that she performs in Everyday life. The lungs are the first to suffer due to disruption of protein synthetic function. The liquid part of the blood begins to sweat through the walls of the capillaries into the lumen of the alveoli (pulmonary tissue elements), thereby causing gradual pulmonary edema.

The nervous system begins to suffer due to a violation of the cleansing function of the liver, manifested by loss of consciousness, lethargy, drowsiness, nausea and vomiting, and there may also be an opposite reaction in the form of hyperexcitability, tremors of the limbs or convulsions. The relationship between the liver and kidneys leads to a gradual decrease in the filtration capacity of the kidneys, and further contamination of the body with products that should normally be excreted in the urine.

Chronic process that occurs due to continued exposure pathological factor, leads to the formation of more distant and uncorrectable symptoms. Arises portal hypertension syndrome. This is a syndrome characterized by increased blood pressure venous system liver, due to impaired blood circulation through the altered liver tissue. Ascites occurs - accumulation of fluid in the abdominal cavity. All superficial venous plexuses enlarge, forming characteristic symptom"jellyfish" on the patient's stomach. On the chest in the area of the shoulders and nipples appear spider veins. The patient develops anemia due to a violation of the synthetic function of the liver.

All these symptoms progress until complete replacement of the liver with connective tissue develops and cirrhosis develops.

Diagnosis of liver failure

There are several stages of this process.

1. Initial compensated. (Characterized by insomnia, behavioral and mood disorders, weakness, fever, rashes on the body. Jaundice intensifies).
2. Severely decompensated. (Increased symptoms of the first stage. Drowsiness. Inappropriate behavior, sometimes aggression, Disorientation. Dizziness, fainting. Slowness and slurred speech. “Flapping tremor”, sweating, liver odor from the mouth).
3. Terminal dystrophic. (Stupor, difficulty waking up. Agitation, anxiety, screams. Confusion. Loss of contact while maintaining adequate reaction for pain).
4. Hepatic coma. (Loss of consciousness. Spontaneous movements and reaction to pain at the beginning of the coma and subsequently disappear. Divergent strabismus. Absence of pupillary reactions. Pathological (plantar) reflexes. Convulsions. Rigidity. EEG - slowing down of the rhythm, decreasing amplitude as the coma deepens).

Diagnosis of liver failure is based on the totality of all the measures that your doctor must take. With severe symptoms and acute condition go to the ambulance medical care if you have had episodes of poisoning. It is necessary to accurately describe the drugs you took or the liquids you drank. The doctor should examine you and pay attention to external symptoms which have already been described previously.

Paraclinical activities include blood sampling to determine such biochemical parameters like ALT and AST, bilirubin, alkaline phosphatase, lactate dehydrogenase (LDH) - these indicators reflect the degree of activity of the process in the liver and the higher they are, the more active the breakdown process in the liver occurs. Ultrasound of the liver can see both acute and chronic processes, describe the size of the liver, its structural and morphological changes.

Additional techniques such as ECG, general analysis blood, general urine analysis, functional tests and indicators of the coagulation and anticoagulation systems will give an idea of the involvement of other organs and tissues in the pathological process.

Treatment of liver failure

Treatment of this process is very complex and lengthy and depends on the severity of the process. The patient's diet reduces total protein intake and table salt. From medications must be appointed immediately antibacterial agents(2-3 generation cephalosporins depending on the expected flora), hepatoprotective drugs Hepa-Merz. The administration of Lactulose reduces the process and amount of absorbed ammonia as a product of the breakdown of protein structures. For mild bleeding, vitamin K (Vikasol), for severe bleeding, it is necessary to prescribe fresh frozen plasma, taking into account the blood type and Rh factor. Vitamin D and folic acid to maintain adequate mineral metabolism under the current conditions. When the severity of the process is relieved, it is necessary to begin to treat the immediate cause that caused the development of failure.

For viral hepatitis, it is necessary to administer interferon (Ribavirin) according to the treatment regimen for viral hepatitis. If the bile duct is obstructed by a stone, it is necessary to surgical intervention. In case of severe ascites syndrome, it is necessary to perform paracentesis to evacuate fluid from the abdominal cavity.

Prevention, prognosis and complications of liver failure

The best way to prevent the development of liver failure is to limit the risk of developing cirrhosis or hepatitis. Here are some tips to help prevent these conditions:

Get vaccinated against hepatitis by administering immunoglobulin type A or B. Follow a proper diet and eat all food groups. Drink alcohol in in moderation. Avoid drinking alcohol while you are taking antibacterial drugs and drugs with increased toxicity. Practice good personal hygiene. Since microorganisms usually spread through dirty hands, remember to wash your hands thoroughly after using the bathroom. Also, wash your hands before touching food. Be careful about blood transfusions and donations. Do not use other people's personal belongings or personal hygiene items, including toothbrushes and razors. If you are planning to get a tattoo or piercing, make sure that the organization that provides these services complies with all measures for processing materials. Be sure to use condoms during sexual intercourse.

Complications of liver failure and prognosis

The infection is big problem. Spontaneous peritonitis occurs in most cases when infectious lesion liver tissue. An opportunistic infection can lead to severe pneumonia.
Bleeding from esophageal varices can be a serious problem.
Hepatic coma forms very quickly, since protein breakdown products (ammonia and metabolites of its own amino acids) are not excreted from the body due to kidney damage and lead to an increase in blood acidity, causing hypoxia of brain tissue.
The main complications that cause death even after transplantation, there are bleeding, sepsis, cerebral edema, renal failure and respiratory failure.

The prognosis depends on the cause of liver failure:

Hepatitis A has good prognosis from 50% to 60% survival rate. It accounts for about 20% of pediatric liver transplants. For Wilson-Konovalov disease liver failure represents an almost inevitable fatal outcome unless transplantation occurs. In the United States in 1995, it was reported that 7% of all liver transplants were for chronic liver failure and that the 1-year survival rate was 63%.

General practitioner Zhumagaziev E.N.

Video about the causes, symptoms and treatment of liver failure

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

Causes of liver failure

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

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

Symptoms of liver failure

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

Cholestasis syndrome

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

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 enters the blood toxic substances, which the liver was supposed to neutralize. Exactly cytolytic syndrome and are caused by the main symptoms of the disease.

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

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

Portal hypertension syndrome

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

In acute liver failure, symptoms increase very quickly, which can lead to the death of the patient. During 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 in to varying degrees. This stage of the disease can last for years.
The decompensated (severe) stage is characterized by an increase in the symptoms of the first stage. Symptoms of the disease increase, patients may behave inappropriately, aggressively, disoriented, speech becomes slurred, slow, and tremor (shaking) of the limbs appears.
The terminal stage (dystrophic) stage is characterized by stupor, the patient can hardly be awakened, and apathy is replaced by excitement. Sometimes patients are completely non-communicative, but the reaction to pain is preserved.
The last stage of liver failure is hepatic coma. Patients are unconscious, there is no reaction to painful stimuli, convulsions and pathological reflexes appear.

Treatment of liver failure

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

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

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

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

Which doctor should I contact?

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

– a pathological symptom complex that develops with changes in the liver parenchyma and is accompanied by a violation of its functions. Acute liver failure is characterized by signs of hepatic encephalopathy (unmotivated weakness, drowsiness, adynamia, agitation), dyspeptic disorders, the appearance and increase of jaundice, edema, ascites, hemorrhagic diathesis; in severe cases – the development of hepatic coma. Diagnosis of acute liver failure is based on clinical data, results of liver tests, acid-base balance, and EEG. Treatment of acute liver failure requires infusion therapy, vitamin therapy, hormone therapy, plasmapheresis, hemodialysis, hemosorption, lymphosorption, oxygen inhalation, hyperbaric oxygen therapy.

Direct triggers for the development of acute liver failure may include the use of alcohol or medications with hepatotoxic effects, anesthesia during operations, surgical interventions(for example, portocaval shunt, laparocentesis for ascites), gastrointestinal bleeding, excess protein in food, renal failure, diarrhea. In patients with existing liver damage (hepatitis, cirrhosis), acute liver failure can be triggered by intercurrent infections, peritonitis, portal vein thrombophlebitis and other conditions.

Pathological changes that develop in the body during acute liver failure are caused by the accumulation in the blood of compounds (ammonia, amino acids, phenols) that have a cerebrotoxic effect, impaired water-electrolyte and acid-base balance, circulatory disorders and other factors. In acute liver failure in to the greatest extent the detoxification function of the liver is impaired, and the participation of the liver in various metabolic processes(protein, carbohydrate, fat, vitamin, electrolyte, etc.).

Classification of acute liver failure

There are three forms of acute liver failure: endogenous (spontaneous), exogenous (induced) and mixed. Functional impairment, which develops with direct damage to the liver parenchyma, is regarded as endogenous. The basis of exogenously caused liver failure is a circulatory disorder in the liver, which leads to the discharge of blood saturated with toxins (primarily ammonia) into the liver. general circle blood circulation In mixed liver failure, both pathological mechanisms take place – endogenous and exogenous.

Based on the severity of functional liver disorders, three degrees of hepatopathy are distinguished. For hepatopathy mild degree There are no clinical manifestations of liver damage. Laboratory tests detect moderate functional disorders(increased enzymes, bilirubinemia, increased transaminase levels, etc.).

Hepatopathy medium degree characterized by the appearance of clinical symptoms: hepatomegaly, liver pain, attacks of hepatic colic, jaundice skin and sclera, phenomena of hemorrhagic diathesis. Hyperbilirubinemia, hypoproteinemia, and dysproteinemia increase in the blood.

Severe hepatopathy corresponds to the stage of acute liver failure. The above-mentioned manifestations are accompanied by symptoms of hepatic encephalopathy and hepatic coma, which develop against the background of severe impairment of liver function.

Symptoms of acute liver failure

The clinical stage of acute liver failure (hepatic encephalopathy) is characterized by drowsiness, which can be replaced by agitation, adynamia, and progressive weakness. Dyspeptic disorders are noted: nausea, loss of appetite, vomiting, diarrhea. Swelling, phenomena of hemorrhagic diathesis, jaundice, intoxication, ascites, and fever increase.

In the precomatous period they develop neuropsychiatric disorders: dizziness, slow speech and thinking, sleep disorders, auditory and visual hallucinations, confusion, finger tremor, motor agitation. Bleeding from the nose, gums, and varicose veins of the esophagus may occur.

Harbingers of an approaching hepatic coma are pain in the hypochondrium, the appearance of a “liver” odor from the mouth, and a decrease in the size of the liver. Actually hepatic coma is characterized by loss of consciousness; convulsions, hypothermia, arrhythmia, the appearance of pathological reflexes, multiple organ failure.

Diagnosis of acute liver failure

Recognition of acute liver failure is carried out taking into account symptoms, results of studies of biochemical parameters (including liver tests), acid-base balance, instrumental studies(electroencephalography).

Laboratory signs of acute liver failure are anemia, thrombocytopenia, hyperbilirubinemia (bilirubin levels can increase 5 times or more), increased activity of serum transaminases. In the terminal stage of acute liver failure, hypocholesterolemia, hypoalbuminemia, a decrease in PTI and other coagulation factors, hypoglycemia, hypokalemia are expressed, and a violation of the acid-base state is noted.

An EEG study, depending on the stage of acute liver failure, reveals a disturbance (irregularity, slowing or disappearance) of the alpha rhythm, dominance of theta and delta waves.

Treatment of acute liver failure

A central place in the treatment of acute liver failure is occupied by infusion therapy aimed at detoxification, improvement of microcirculation, metabolism, correction of electrolyte disturbances, and restoration of acid-base balance. In acute liver failure it is indicated intravenous administration solutions of glucose, albumin, dextran, rheopolyglucin, sorbitol, mannitol, etc. When a large volume of fluid is administered, diuretics are used to prevent edema of the brain and lungs.

Vitamins are prescribed ( ascorbic acid, thiamine, riboflavin, pyridoxine hydrochloride, cyanocobalamin, nicotinamide). At hemorrhagic syndrome administration of solutions of vikasol, aminocaproic acid, sodium ethamsylate is indicated; in case of deficiency of coagulation factors and signs of disseminated intravascular coagulation syndrome, large volumes of plasma are transfused. The progression of acute liver failure requires the use of glucocorticoid hormones (prednisolone), antibiotics (aminoglycosides, cephalosporins).

For detoxification purposes, hemosorption, lymphosorption, and hemodialysis are used. To stimulate immunological activity, ultraviolet irradiation of the blood is used, and to combat hypoxia, hyperbaric oxygenation and oxygen inhalation are used.

Forecast and prevention of acute liver failure

Timely intensive therapy acute liver failure significantly improves the prognosis. With deep hepatic coma they develop irreversible changes leading to the death of the patient.

Prevention of acute liver failure requires adequate treatment primary diseases liver, excluding the effects of hepatotoxic or cerebrotoxic substances, provoking factors.

The liver plays a role in the human body important role. It participates in all metabolic processes, produces liver bile for normal digestion. Also, the liver performs the functions of cleansing the body of toxins, poisons, and heavy metals. Every day the organ passes through itself up to one hundred liters of blood, cleansing it.

If the liver stops performing one of its functions, the functioning of the entire body is disrupted. This condition is called liver failure. In this case, liver failure is accompanied metabolic disorders, dysfunction of the central nervous system, intoxication. Acute failure without proper medical attention leads to hepatic coma.

What it is?

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

Classification

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

Hepatocellular failure. This form is also called endogenous, and develops when an organ is poisoned by toxic substances. As a result of the development of this form of the disease, rapid death of liver cells begins.
Exogenous form of liver failure. This is a dysfunction of blood circulation in the organ. That is, the liver stops functioning as it should and blood does not pass through the liver, which means it is not cleared of toxins, which further poison all organs.
Mixed form. These are disturbances in the functioning of hepatocytes and disruptions in blood circulation in the hepatic vessels.

Diagnostics

Currently using following methods diagnostics of cellular liver failure, allowing to create a holistic picture:

Collecting an anamnesis in order to clarify the facts of the patient’s alcohol abuse, whether he is a drug addict, whether he has had viral hepatitis or not, whether the body’s metabolism is disturbed, whether there are chronic liver diseases and malignant tumors, what medications are in this moment accepts whether he suffers from swelling of the extremities.
Ultrasound of the organ, which allows you to most accurately assess its condition.
Biochemical blood test aimed at identifying higher level bilirubin, decreased protein levels, coagulation pathologies, electrolyte disturbances and other indicators.
An electroencephalography method used to detect disturbances in the amplitude of the brain rhythm.
A biopsy is a method of determining the cause of the disease and the current indicators of the organ.
MRI, revealing the degree of changes in liver tissue.

Fulminant liver failure is determined based on the following: clinical manifestations, such as jaundice, a significant reduction in liver size, encephalopathy and biochemical parameters determined by a blood test.

Acute liver failure

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

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

Causes of acute liver failure

Poisoning with alcohol substitutes.
Poisoning with poisons that are toxic to the liver: phosphorus, chlorocarbons and others.
Poisoning with poisonous mushrooms: toadstools, stitches, crosses, heliotrope. The mortality rate for this condition is more than 50%.
Taking antipyretic drugs for fever in children 4-12 years old. Particularly dangerous in this regard are acetisalicylic acid (“Aspirin”) and products containing salicylates. Less dangerous are paracetamol, ibuprofen (Nurofen), and analgin. The disease is called Reye's syndrome or acute hepatic encephalopathy. The mortality rate for children is 20-30%.
Viruses, E, as well as viruses of the herpetic group ( herpes simplex, cytomegalovirus, Epstein-Barr virus, – varicella-zoster virus).
Other microbes, not viruses, that can cause a generalized infection of the entire body with liver damage. This is a wide variety of bacterial infections (staphylococcal, enterococcal, pneumococcal, streptococcal, salmonella, and so on), as well as rickettsiosis, mycoplasmosis, and mixed fungal infections.
Acute blood poisoning due to liver abscesses, purulent inflammation intrahepatic bile ducts.
Acute circulatory disorder in the liver due to embolism of a large branch of the hepatic artery of blood clots, gas, fat.
Diseases of unknown origin: for example, acute fatty hepatosis of pregnancy.
Gap hydatid cyst in the liver.
Severe course of oncological diseases: hemoblastosis, lymphogranulomatosis, cancer metastases various localizations to the liver.
Poisoning with drugs, especially in case of overdose. Yes, you can exceed maximum dose Paracetamol, Aminazine, Ketoconazole, Tetracycline, Co-trimoxazole, sulfonamides, drugs for the treatment of tuberculosis, drugs based on male sex hormones.
Surgeries on the abdominal organs in which the blood circulation of the liver is disrupted (for example, for a long time it is pinched, stitched or cut large branch hepatic artery).

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

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

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

Acute liver failure involves the following symptoms:

Nausea, vomiting, a sharp decline body weight, fever, severe weakness and fatigue with the slightest physical exertion;
Jaundice (yellowing of the skin, mucous membranes due to increased bilirubin levels), severe itching;
"Liver" odor from the mouth (reminiscent of rotten meat);
(accumulation of fluid in the abdominal cavity), swelling of the extremities;
Tremor or shaking upper limbs(involuntary flapping of arms);
Bleeding from gastrointestinal tract, injection sites, nosebleeds;
Decreased blood pressure, disorder heart rate(different types);
Hypoglycemia (low blood glucose levels).

In most cases, hepatorenal syndrome (hepatic-renal failure) develops. The reason may be the impact poisonous products metabolism that is not properly excreted from the body, or a sharp drop in blood pressure.

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

Treatment of acute liver failure

Acute liver failure requires treatment emergency care. The patient should be immediately hospitalized medical institution. Treatment is carried out for the underlying disease and any resulting disorders. It consists of the following activities:

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

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

Chronic liver failure

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

As with acute liver failure, the following forms are distinguished:

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

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

In the presence of additional hepatotoxic factors, decompensation occurs (loss of the ability to regenerate hepatocytes), and hepatic encephalopathy may develop, followed by coma and death.

Symptoms of chronic liver failure

Chronic liver failure is characterized by a gradual, step-by-step increase in symptoms. And no matter how long the disease exists at the initial stage, sooner or later it will begin to progress.

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

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

Clinical blood test - an increase in the number of leukocytes, as well as a decrease in the number of red blood cells, platelets and a decrease in hemoglobin levels can be determined;
Biochemical blood test - pay attention to the levels of bilirubin, ALaT and ACaT, alkaline phosphatase, creatinine;
Coagulogram - decrease in blood prothrombin index;
Ultrasound of the abdominal organs - allows the doctor to assess the condition of the liver parenchyma and the size of the liver.

Treatment of chronic liver failure

Treatment of liver failure involves eliminating the factors causing disease. In some cases, such as liver cancer, it may be surgery. A low-protein diet is prescribed with an amount of carbohydrates of 400-500 g/day, and fats of 80-90 g/day, excluding alcohol, caffeine, and limiting fluids.

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

The following medications are also required:

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

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

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

The prognosis is unfavorable. In 50-80% of cases of hepatic encephalopathy, the patient's death occurs. In case of compensated chronic liver failure, liver restoration is possible only if all hepatotoxic factors are eliminated and adequate therapy is carried out. Often chronic liver failure in its initial stages It is asymptomatic and the diagnosis can be made only on the basis of data from targeted examinations. This is the reason for untimely diagnosis and treatment of the disease, which significantly reduces the chances of recovery.

Diet and nutritional habits

In the treatment of liver failure Special attention is given proper nutrition. Principles dietary nutrition with this pathology are as follows:

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

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

– spicy or chronic syndrome, developing when one or more liver functions are impaired, accompanied by metabolic disorders, intoxication, disturbances in the central nervous system and the development of hepatic coma. The disease occurs with symptoms of hepatic cell failure (jaundice, hemorrhagic, dyspeptic, edematous-ascitic syndromes, fever, weight loss) and hepatic encephalopathy ( emotional lability, apathy, speech disorders, hand tremors, ataxia). Extreme degree liver failure is the development of hepatic coma. Liver failure is detected based on biochemical blood parameters, EEG, and hepatoscintigraphy. Treatment of liver failure is aimed at eliminating intoxication, normalizing electrolyte disturbances, and restoring acid-base balance.

Liver failure can develop by an endogenous, exogenous or mixed mechanism. Endogenous failure is based on the death of hepatocytes and the exclusion of over 80% of the liver parenchyma from functioning, which is usually observed in acute viral hepatitis, toxic damage liver. The development of exogenous liver failure is associated with impaired hepatic blood flow, which leads to the flow of blood saturated with toxic substances from portal vein immediately into the general circle, bypassing the liver. The exogenous mechanism often occurs during shunting procedures for portal hypertension and liver cirrhosis. Mixed liver failure occurs when both pathogenetic mechanisms– endogenous and exogenous.

There are three stages in the development of liver failure: initial (compensated), severe (decompensated), terminal dystrophic and hepatic coma. In turn, hepatic coma also unfolds sequentially and includes the phases of precoma, threatening coma and clinically pronounced coma.

Causes of liver failure

Next most common etiological factors liver failure are drugs and toxins. Thus, massive damage to the liver parenchyma can be caused by an overdose of paracetamol, analgesics, sedatives, diuretics. The strongest toxins causing phenomena liver failure, include the poison of toadstool (amanitoxin), mycotoxin of fungi of the genus Aspergillus (aflatoxin), chemical compounds(carbon tetrachloride, yellow phosphorus, etc.).

In some cases, liver failure may be caused by liver hypoperfusion, which occurs due to veno-occlusive disease, chronic heart failure, Budd-Chiari syndrome, and profuse bleeding. Liver failure can develop with massive infiltration of the liver tumor cells lymphoma, metastasis of lung cancer, pancreatic cancer.

TO rare reasons liver failure is classified as acute fatty degeneration liver, autoimmune hepatitis, erythropoietic protoporphyria, galactosemia, tyrosinemia, etc. In some cases, the development of liver failure is associated with surgical interventions (portocaval shunting, transjugular intrahepatic portosystemic shunting, liver resection) or blunt liver trauma.

Factors provoking failure compensatory mechanisms and development of liver failure, disorders may occur electrolyte balance(hypokalemia), vomiting, diarrhea, intercurrent infections, alcohol abuse, gastrointestinal bleeding, laparocentesis, excessive consumption protein foods, etc.

Symptoms of liver failure

The clinical picture of liver failure includes the syndromes of hepatic cell failure, hepatic encephalopathy and hepatic coma. In the stage of hepatic cell failure, jaundice, telangiectasia, edema, ascites, hemorrhagic diathesis, dyspepsia, abdominal pain, fever, weight loss appear and progress. In chronic liver failure, they develop endocrine disorders, accompanied by decreased libido, infertility, testicular atrophy, gynecomastia, alopecia, atrophy of the uterus and mammary glands. Disruption of metabolic processes in the liver is characterized by the appearance of liver odor from the mouth. Laboratory tests at this stage of liver failure reveal an increase in the level of bilirubin, ammonia and phenols in the blood serum, and hypocholesterolemia.

Treatment of liver failure

In case of liver failure, a diet with strict restriction or exclusion of protein is prescribed; at the precoma stage, tube or parenteral nutrition is provided.

Treatment of liver failure includes measures for detoxification, improvement of microcirculation, normalization of electrolyte disturbances and acid-base balance. For this purpose, large volumes of 5% glucose solution, cocarboxylase, panangin, vitamins B6, B12, essentiale, lipoic acid. To eliminate ammonia intoxication and bind the ammonia formed in the body, a solution of glutamic acid or ornitsetil is prescribed.

To reduce the absorption of toxic substances, the intestines are cleansed using laxatives and enemas; short courses of broad-spectrum antibiotics and lactulose are prescribed, which suppress the processes of putrefaction in the intestines.

With the development of hepatic cell coma, the administration of prednisolone is indicated; In order to combat hypoxia, it is advisable to carry out oxygen inhalations and hyperbaric oxygenation.

For complex therapy For liver failure, hemosorption, hemodialysis, and ultraviolet irradiation of blood are used.

Prognosis and prevention of liver failure

With timely intensive treatment of liver failure, liver dysfunction is reversible, the prognosis is favorable. Hepatic encephalopathy in 80-90% progresses to the terminal stage of liver failure - hepatic coma. In deep coma, death most often occurs.

To prevent liver failure it is necessary timely therapy liver diseases, exclusion of hepatotoxic effects, drug overdoses, alcohol poisoning.