Hepatic coma is the most severe stage of encephalopathy due to cirrhosis. It is characterized by severe neurophysiological syndrome, which occurs in a person suffering from liver failure. In addition, this condition is accompanied by depression of the nervous system. As practice shows, this condition occurs in people as a result of severe intoxication, and in addition, against the background of damage to the integrity of the organ or due to the death of most of its cells due to acute and chronic diseases.
Given timely treatment and a shallow lesion, the prognosis of such a coma is favorable. The chances of recovery are greatly reduced if the patient has chronic kidney failure. Against the background of deep liver damage, the process is irreversible and has an extremely poor prognosis. Next, we find out what symptoms are observed in people against the background of the development of this pathological condition, and also find out what first aid should be and how treatment is carried out.
Pathology Description
It should be emphasized that hepatic coma is an extreme stage in cirrhosis. The development of this pathological condition is associated with various factors. Consider the main of them, they include, first of all, the following reasons:
- The presence of liver failure.
- Exposure to protein breakdown products that come with food. In this case, it is primarily ammonia.
- The appearance of portocaval anastomoses, that is, bypasses for the blood flow passing the liver, which leads to the fact that many toxic substances are not neutralized in any way, but freely circulate throughout the circulatory system.
Doctors distinguish several of the following types of hepatic coma with cirrhosis:
- A coma that develops due to necrosis of the liver tissue.
- Coma, which is caused by the formation of hepatic or systemic collaterals. In this case, there is absolutely no neutralization of toxic products.
- A mixed type of coma suggests the presence of both of the above causes.
In addition to everything, against the background of cirrhosis, the liver itself ceases to fulfill its detoxifying function. In this case, a violation of the portal blood flow leads to vascular changes in the region of the brain.
What are the signs of hepatic coma? This question interests many. It is important to recognize them in a timely manner in order to avoid the worst consequences.
Symptoms preceding coma with cirrhosis
Coma usually occurs at a severe stage of a pathology such as cirrhosis. Usually at this stage, all kinds of violations of various liver functions occur. For example, protein synthesis ceases along with the neutralization of toxic substances. In sick people, symptoms of jaundice, fever, ascites, edema, and an enlarged liver or spleen can be detected. Also, patients with this condition may experience increased bleeding with a small point rash on the skin throughout the body.
Laboratory findings usually show advanced cirrhosis. For example, the results of analyzes reflect a decrease in albumin, cholesterol, prothrombin, and other factors associated with blood coagulation are observed. In addition, in laboratory studies, an increase in globulin, bilirubin, aminotransferases and so on is noted. In addition, an increased content of ammonia is found in the blood. Help with hepatic coma should be immediate.
In this condition, patients develop hepatic encephalopathy, which subsequently progresses to coma. The development of encephalopathy is affected by massive bleeding along with malnutrition, for example, when excessive protein content is present in food. All kinds of infections, excessive alcohol consumption and the like can also have an effect. Signs indicating the imminent occurrence of coma on the background of cirrhosis of the liver are the following factors:
- The emergence of difficulties with orientation in time and space. Moreover, sometimes a person can hardly determine his own personality.
- A change of state, starting from extreme arousal, ending with delusions, depression and drowsiness.
- Marked violation of coordination of movements.
- The appearance of changes in electroencephalography, for example, records the occurrence of extremely slow delta waves, the alpha rhythm slows down, and so on.
Symptomatology
Since hepatic coma is associated with brain activity, its symptoms are often confused with other diseases and even with usual fatigue, which leads to incorrect treatment and significantly worsens the prognosis.
Clinical symptoms develop gradually:
- At the same time, a change in mood is observed in the patient. A person experiences a sense of anxiety, inexplicable euphoria or longing.
- The patient may begin to poorly navigate in the surrounding space.
- There may be problems with sleep and with other functions of the brain.
- Significant symptoms include muscle contraction of the face along with prolonged spasms of the masticatory muscles.
- In the initial stages of cirrhosis, hepatic odor can be observed, and in addition, jaundice, which is very rarely observed with extensive liver damage. Symptoms of hepatic coma do not end there.
- Another visual symptom is hemorrhagic syndrome, which manifests itself in spot hemorrhages, which are especially visible on the cheeks.
- Against the background of a coma, ascites may be observed, indicating the accumulation of free fluid in the abdominal cavity.
- The final clinical symptoms are convulsive seizures along with a decrease in pressure, lack of motor excitement and a poorly palpable pulse.
Stages of the disease
Doctors distinguish three stages of hepatic coma. The specific symptoms that manifest to a greater or lesser extent depend on these stages:
- The first stage is precoma, against its background, emotional instability is observed. At the same time, the patient begins to complain of excessive sweating and dizziness. This condition lasts up to several days, after which it is significantly exacerbated.
- The second stage is a threatening coma, and in such situations, the condition may worsen every hour. To the above symptoms is added loss of consciousness along with memory lapses and sudden mood spikes. Visually marked tremor of the hands. This period lasts up to ten days.
- The third stage of hepatic coma is already a coma. At this point, all the symptoms reach their peak. In the event that you do not provide emergency help, the reflexes will oppress, the pupils will expand greatly, and at the same time breathing will stop.
Possible causes of the development of a pathological condition
Hepatic coma with cirrhosis can occur as a result of the accumulation of toxic substances in the body. The following causes lead to this condition:
- Exposure to external toxic factors, for example, poisoning by arsenic, phosphorus or mushrooms and so on.
- Taking drugs that have a hepatotoxic effect on the liver. It can be drugs like Atofan, Paracetamol, barbiturates and the like.
- The presence of diseases of the digestive system that cause liver dystrophy, for example, cholestasis or cancer and the like.
- The negative effects of hepatitis B and A.
- The negative effects of infectious mononucleosis and yellow fever virus.
- Exposure to serious stressful situations.
- The presence of burns of a large area.
- Septic abortion.
The causes of hepatic coma may be other.
Types of this pathology
Depending on the factors provoking this pathology, doctors distinguish several of the following types of coma:
- Endogenous type of hepatic coma. In this case, there is a destruction of the cellular structure of the liver and necrosis. As a result, the organ simply stops working, unable to cope with its direct functions and provoking the accumulation of toxic substances in the body.
- The exogenous type is especially characteristic of bleeding in the digestive system.
- The mixed type occurs against the background of necrosis of some liver cells, and, in addition, due to the influx of ammonia during cirrhosis.
- The mineral type of hepatic coma is characterized, as a rule, by hypokalemia and electrolyte balance.
Next, we find out what is usually the prognosis for patients against the background of the development of such a pathological condition in the presence of cirrhosis.
What is the prognosis of hepatic coma for cirrhosis?
The prognosis of cirrhosis is often disappointing, especially when it comes to coma. Treatment in this case may not help. Symptoms of the disease should be established in the first stage of the disease. The most dangerous sign is bleeding, as blood can enter not only the esophagus, but also the abdomen.
The prognosis of hepatic coma directly depends on the regenerative capacity of the organ, which means that the age of the patient plays a large role in a favorable outcome. Also an important factor is the time that has passed since the onset of jaundice to the first symptoms of encephalopathy. The influence is exerted by the progression of neuropsychiatric signs along with many other factors.
In the event that someone was diagnosed with cirrhosis at the last stage, then the chances of survival are low. According to statistics provided by doctors, approximately ninety percent of cases are fatal. In the event that the patient consults a doctor at least in the second stage of the disease, the chances of survival increase.
Consider emergency care for hepatic coma.
What should be first aid for this pathology?
To diagnose this disease, the clinical picture is taken into account, and laboratory and instrumental methods are also used. Mandatory in such cases is the consultation of specialists such as a gastroenterologist and resuscitator. In the event that a person became very ill, and there was a vivid symptomatology of the hepatic coma, the patient must be provided with first aid first aid before the arrival of a qualified specialist. What to do:
- First of all, you need to call an ambulance. It is very important to note the time from the moment the deterioration began to be observed.
- It is required to lay the patient on his side and make sure that he receives a sufficient amount of air.
- Given the fact that this disease is characterized by a disorder of thinking along with inappropriate behavior, it is important to ensure that the patient does not injure himself.
- When vomiting occurs, it is necessary to clean the oral cavity from vomiting.
- The basic principle of emergency care for hepatic coma is the rule - to give the patient a lot of fluid.
Emergency doctors usually conduct an initial assessment of the patient's condition. In that case, if the doctor notices nervous excitement, then the patient will be administered intramuscularly a one percent solution of Diphenhydramine. In the diagnosis of vascular insufficiency, as a rule, injections of Cordiamine and a one percent solution of Mesaton are used.
Medical treatment
Treatment of hepatic coma with cirrhosis involves the following measures within the hospital:
- Bowel cleansing, and if the patient's condition allows, it is advisable to take laxatives or an enema, for which a two percent solution of sodium bicarbonate is used.
- In order to reduce the formation and concentration of toxic components, antibacterial agents are immediately prescribed. As a rule, antibiotics reduce the amount of protein breakdown products along with the vital functions of various bacteria and viruses.
- No less important are hepatoprotectors that protect healthy liver cells and enhance the regenerative ability of this organ.
- In order to relieve muscle stiffness in the treatment of hepatic coma, anticonvulsant drugs are prescribed to patients.
- To regulate nervous excitement, sedatives are prescribed to the patient.
- The patient is also given glucocorticoids and various solutions, for example, such as glucose, sodium chloride and so on. The dosage is individually selected by the doctor.
- In addition, detoxification drugs are used that are injected into the intestines using a probe.
- In the event that the disease was provoked by renal failure, hemodialysis may be required.
- In the case of hypoxia, the patient is additionally given oxygen, which is usually done through the nose.
- Treatment involves the intake of vitamins, and, in addition, various coenzymes, which are very important in order to maintain energy balance.
- In the event that the situation is too neglected, and the patient is in critical condition, then drug therapy is canceled and a special operation involving liver transplantation is performed. Before the operation, the patient's condition is previously stabilized.
In order to treat this pathology, in no case should you resort to the use of folk remedies, as this will only aggravate the condition of the person and miss the precious time necessary for successful treatment.
What preventive measures should be taken?
What needs to be done so that this pathology does not occur? This is a common question, we will understand it in more detail. In order to reduce the risk of hepatic coma on the background of cirrhosis, it is necessary to take into account the following important rules:
- It is necessary to timely treat various liver diseases, and in particular this applies to cirrhosis.
- A person must comply with the adequate intake of medications, which should be prescribed exclusively by a doctor.
- It is very important to refuse to carry out any independent treatment, not only against the background of cirrhosis, but also with other various diseases.
- Very careful contact with various toxic substances, for this it is necessary to use protective clothing, and in addition, apply all kinds of protection methods.
- You should lead a healthy lifestyle in which any bad habits should be excluded.
- You need to change your diet and include in the menu foods rich in vitamins, and in addition, minerals and other substances important to health.
Thus, we can conclude that such a phenomenon as hepatic coma against the background of cirrhosis is a very serious disease and for its successful treatment it is necessary to consult a doctor as soon as possible.