Acute liver failure - a disease that progresses rapidly, develops suddenly. She is not preceded by any pathological condition of the organ. Potentially arrester is reversible. Without adequate treatment, encephalopathy of the liver is possible. From the onset of acute renal failure to the development of encephalopathy, 8-26 weeks pass. Hematopoietic cells may also malfunction. In acute renal failure, plasma hemostasis is impaired.
Where did the trouble come from?
The causes of acute liver failure are most often hepatitis. Form A, B, D, and E can lead to such consequences. Another factor is virus infection. Cytomegalovirus, paramyxovirus, causative agents of hemorrhagic fever and some other pathological forms of life can lead to acute renal failure.
There are cases when acute renal failure was observed during drug therapy. The most common cause is paracetamol. It is known from medical statistics that it is this drug with a greater degree of probability than any other that provokes signs of liver failure. Somewhat less often they are observed with the use of drugs based on sulfonamides, as well as statins. There is a risk of liver dysfunction with the use of drugs containing halothane, phenytoin, isoniazid. In practice, there have been situations when acute arrests developed against the background of the consumption of some Chinese herbs. A variety of herbal preparations can potentially provoke such consequences.
What else is possible?
The causes of acute liver failure are poisoning with various hazardous substances. Quite often, the diagnosis is made against the background of α-amanitine entering the body. Its source is the pale toadstool mushroom growing in our country. Among all poisonings, this is what occurs more often than others. Somewhat less common, ARF is observed against the background of ingestion of carbon tetrachloride or other hazardous compounds.
Possible liver failure in children and adults in acute form on the background of hepatic ischemia, shock and hepatitis in an autoimmune form. Occasionally, blood poisoning, diseases of Budd-Chiari, Ray, and Hellp lead to acute renal failure. During the bearing of a child, acute renal failure may be provoked by acute lipid hepatic dystrophy. Another potential cause is the formation of a blood clot in the portal vein.
How to notice?
The main symptom of liver failure in women and men, if the condition develops in an acute form, is encephalopathy. At the initial stage of the progress of the disease, non-specific manifestations of a health disorder first appear. The patient loses his appetite, his stool is broken, rashes appear on the skin, fever. As a rule, the condition is accompanied by an increase in the rhythm of the heartbeat, a decrease in blood pressure. In general, the nonspecific picture is initially similar to septic shock.
An accurate diagnosis against the background of the described symptoms of liver failure is usually possible when encephalopathy develops. The intensity of the state varies significantly from case to case. Another important characteristic symptom is jaundice. In most cases, it develops from the very beginning, but in a certain percentage of patients it follows encephalopathy.
What to look for?
Symptoms of liver failure include hemorrhagic diathesis. This condition does not occur in all patients. Its development allows you to clarify the diagnosis.
As a rule, hemodynamic instability is detected against the background of acute renal failure. Most patients experience hepato-nephrotic syndrome. This means that kidney and liver failure develops. In some cases, the complication of the condition is due to ascites.
In some patients with acute renal failure, seizures characteristic of epilepsy are observed. This phenomenon indicates an increase in pressure inside the skull. In some cases, seizures are a sign of primary brain damage.
Status Progress
In the absence of adequate treatment for symptoms of liver failure in men and women, acute illness occurs naturally. From case to case, its course varies; the dynamics can differ significantly. Not always super-sharp option means the worst forecast. This is often recorded with paracetamol poisoning, but does not mean that the outcome will be catastrophic.
If ARF is not treated, ignore the symptoms; there is a chance of death. In a number of severe cases, acute renal failure requires a liver transplant urgently. Without adequate qualified help, a coma of the liver, swelling of the brain, and insufficient functioning of internal systems and organs are possible. In total, this condition leads to the death of the patient.
Establishing diagnosis
In order to start treatment of liver failure in time, the symptoms that appear in the patient must be clarified in order to formulate the correct diagnosis. Gathering information about the patient, attention should be paid to the drug therapy he is undergoing, as well as to all the medicinal and herbal preparations that the person is taking. We are talking not only about those prescribed by prescription, but also about all others that are freely available from pharmacies, as well as those collected by a person independently. When making a diagnosis, it is necessary to take into account information about previous operations, transfusion.
If the patient ate mushrooms, it is necessary to fix this fact when collecting an anamnesis. Take into account the trips made in the recent past to various countries and regions of the world. Particular attention is paid to those remote from the permanent area of residence. When formulating the anamnesis, the doctor should clarify whether there are persons among the relatives suffering from impaired liver function.
If there is a suspicion of acute liver failure in men and women, the doctor directs the patient for analysis. Have to do a set of procedures. They study the blood, reveal the plasma content of various electrolytes, creatinine, glucose. It is necessary to check the basic body fluid for the content of lactate, albumin, enzyme activity.
As part of the diagnosis, the patient's blood group is revealed, the gas composition of the blood, the content of medicinal compounds in it are checked. Analyzes are done to detect the content of toxic substances, viruses. If the patient is a woman in the reproductive period, it is necessary to verify the fact of conception of the child.
Analysis Features
If you suspect acute liver failure, it is necessary, first of all, to do a blood test. On ARF indicates above normal activity of aminotransferases. If the indicator exceeds 2,000 units / liter, we can talk about ischemia or poisoning of liver cells. Hypoglycemia is usually observed with acute renal failure, so it is important to regularly take indicators to control glycemia. Possible increase in ammonia in the circulatory system. It can be determined by samples of fluid obtained from an artery.
Against the background of acute renal failure, the content of lactates increases. Thrombocytopenia is rarely detected. Some other deviations are possible, determined by the characteristics of a particular case of liver failure. Much depends on the severity of the condition, the presence of additional complications. If the disease is accompanied by kidney failure, there is an increase in creatinine.
Status check: what else will help?
To clarify renal failure, it is necessary to make analyzes to visualize the work of internal systems and organs. The most effective and informative method is computed tomography. Such a study helps to clarify whether there is an acute renal failure, hepatic steatosis, Budd-Chiari disease or the presence of metastases. A study using a similar technology of the brain eliminates neurological disorders, thereby confirming the acute renal failure.
From the first to the third stage of encephalopathy, you can diagnose if you refer the patient to EEG. Three-phase waves will indicate the state. The fourth stage of the state will express itself as delta waves.
Additionally, a liver biopsy is prescribed. Such a study helps to clarify why acute liver failure is observed, whether there are metastases, tumor processes, hepatitis, or other disorders that provoke signs of acute renal failure. If a transdermal biopsy is prohibited for some reason, a transvenous one must be done. This is possible, for example, in violation of hemostasis.
How to help?
The treatment of acute liver failure is possible only in the intensive therapeutic unit. It is necessary to constantly monitor the indicators of metabolism, hemodynamics, as well as monitor imbalances in water and electrolytes. Perhaps infection - it is important to control this fact and monitor the development of the condition. The best option for the treatment of acute liver failure is to refer the patient to a specialized clinic, where the person is immediately put on the list of people who need an emergency liver transplant.
Nutrition for acute renal failure involves the use of a nasogastric tube. The patient is shown about 60 g of protein food per day. The ban applies to products that contain glutamine. The energy value is calculated based on body weight: 30 kcal per kilogram. The values obtained are calculated for 24 hours.
Measures must be taken to prevent hemorrhagic gastropathy.
In acute renal failure, antibiotics and drugs that stop the activity of fungal colonies are prescribed. Perhaps the use of drugs with a wide spectrum of action. Before starting therapy, tests are done to identify the sensitivity of dangerous life forms to a specific option. They take into account that gram-positive life forms usually prevail in the first week, which is replaced by gram-negative by the second week. If the stages of liver failure quickly replace each other, the disease progresses, low blood pressure is observed, encephalopathy develops quickly, if it is not possible to use antibiotics, the patient is constantly shown to diagnose the presence of infectious foci. For this, organic liquids are taken for analysis, an x-ray is taken.
Features of drug therapy
In acute renal failure, medications must be taken to prevent cerebral edema. For an epileptic seizure, Phenytoin is used. The drug is injected into a vein. Dosage - 15-15 mg per kilogram. The maximum dose is 50 mg / kg. Supporting amounts are 100 mg. Between the procedures make eight-hour intervals. As a prophylaxis, “Phenytoin” is not used.
To alleviate the condition of the patient, it is necessary to correctly lay. The head and body are raised at an angle of 30 °.
It is necessary to regularly take pressure readings inside the skull. It is important to take measures to prevent overhydration.
Vitamin K is used subcutaneously. Dosage - from 5 mg to twice as much volume. In the presence of bleeding, freshly frozen plasma or a recombined factor is required before surgery.
In severe thrombocytopenia, an infusion of platelet concentrate is indicated.
What else is needed?
With acute renal failure, there may be impaired blood flow, kidney failure. To stop the symptoms, measures must be taken to maintain a stable volume of blood inside the vessels. For this, colloidal solutions can be administered. The pressure on average is maintained in the arteries at the level of 50-60 units. If there is evidence, use drugs to narrow the vessels. With acute renal failure, adrenaline and dopamine are allowed. In some cases, it is indicated to administer norepinephrine. A catheter can be inserted into the pulmonary artery to monitor the patient's condition. If there is evidence for this, the patient is referred for replacement therapy.
ARF is accompanied by metabolic disorders. It is important to constantly monitor biochemical parameters; to identify violations, to compensate for them. In acute renal failure, hypoglycemia is particularly likely. To correct it, the introduction of glucose will be required.
ARF, accompanied by active infectious foci, is often an occasion to diagnose pneumonia. Foci in the urinary system, blood poisoning and peritonitis caused by pathological bacteria are possible. In the third, fourth stage of acute renal failure, it is imperative to use antibiotics.
Operation!
In case of hepato-cellular insufficiency, insufficiency of the liver in acute form, in some cases it is necessary to perform a liver transplant operation. To determine the relevance of such an intervention, it is first necessary to analyze the patient's condition in order to satisfy the generally accepted conditions for referral to surgical measures.
Transplantation is necessary if the liver is affected due to excessive intake of paracetamol, if the blood acidity in the artery is less than 7.3 units. They are referred for surgery if encephalopathy is simultaneously established in the third or fourth stage, while the prothrombin time is more than 100 s, and the creatinine level exceeds 3.4 mg / dl.
Transplantation is indicated if hepatic damage is accompanied by a prothrombin time of more than 100 s. A combination of the three criteria of the following is possible:
- age younger than ten, older than forty;
- the duration of jaundice to the stage of encephalopathy is more than a week;
- prothrombin time greater than 50 s;
- bilirubin above 18 mg / dl;
- hepatitis or idiosyncrasy for medicines.
Transplantation must be carried out within two days from the moment of contacting a specialized clinic. In this case, the probability of saving the patient is quite high.
Possible complications
ARF, accompanied by the third stage of encephalopathy, on average in every third patient leads to cerebral edema, increased pressure inside the skull. With encephalopathy of the next level, the likelihood of such complications is estimated at 80%. The cause of death in the predominant percentage of cases is a wedge of the brain stem.
To prevent such consequences, it is necessary to provide the patient with the opportunity to lie at a thirty-degree angle. Of the drugs shown the introduction of "Mannitol" in an amount of 0.5-1 g per kilogram of weight. The injections are repeated as needed. It is important to control plasma quality. With encephalopathy level 3-4, intubation is indicated.
If Mannitol does not show the desired effect, hyperventilation, barbiturate coma is possible. Hormonal anti-inflammatory is ineffective. It is recommended to use a catheter to check the pressure inside the skull. It is advisable to maintain parameters at the level of 20-25 units.
The liver and its functions
This organ is extremely important for the normal functioning of the human body. Thanks to the liver, blood can be cleansed of toxic components, allergic substances. Here there is a filtration from hormonal substances, mediators. The work of the liver is an element of the functioning of the digestive system. Without it, the production of bile, the enzymes necessary for the digestion of food, is impossible. Organ is important for energy metabolism, metabolism. Amines, fatty acids, and other substances are transformed in the liver, which makes it possible to obtain glucose, which is so important for human existence. The liver is a depot of glycogen storage.
At the stage of intrauterine development, the liver is a blood-forming organ. In an adult, this element of the body is one of the most important in the hemostatic system.
Active components necessary for life support and biochemical reactions are produced in the liver. It is involved in the processing of vitamin compounds, and also helps to accumulate useful substances, and their excess - to remove from the body.
If the liver starts to malfunction, it negatively affects the whole body as a whole.
Failure: state features
Acute, chronic liver failure is observed when, for various reasons, the organ cannot function adequately. This is usually due to tissue damage. Violations adversely affect the functioning of the brain, central nervous system, other systems and organs. In violation of the central nervous system, encephalopathy is diagnosed.
Acute renal failure, chronic renal failure appears if the liver cells die. The functionality of the organ is weakened, the blood is not cleansed of toxins, poisons are carried throughout the body. Soon, this affects the state of the central nervous system. It is these processes that cause the symptoms described above.
Acute and chronic: impaired liver function
The acute form of disorders occurs with a strong negative effect on the organ. The chronicle develops slowly, and progresses steadily over time. Often, violations are observed against a background of cirrhosis, tumor processes, other diseases that adversely affect the liver.
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How to warn?
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It is important to treat any diseases involving liver function in a timely manner, using traditional medicine methods.
One of the most common causes of cirrhosis leading to PN is alcohol abuse. You can minimize the risks for yourself if you give up alcohol.