Acute liver failure is a disease that progresses rapidly, develops suddenly. It is not preceded by any pathological condition of the organ. Potentially, AKI is reversible. Without adequate treatment, liver encephalopathy is possible. From the onset of acute renal failure to the development of encephalopathy, 8-26 weeks pass. It is also possible disruption of the hematopoietic cells. With acute renal failure, plasma hemostasis is disrupted.
Where did the trouble come from?
Causes of acute liver failure - most often hepatitis. Forms A, B, D, E can lead to such consequences. Another factor is virus infection. Cytomegalovirus, paramyxovirus, pathogens 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 against the background of drug therapy. The most common cause is taking paracetamol. From medical statistics it is known that this drug is more likely tothan any other, 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 when using products containing halothane, phenytoin, isoniazid. In practice, there were situations when acute renal failure developed against the background of the use of certain Chinese herbs. A variety of herbal preparations can potentially provoke such consequences.
What else is possible?
The causes of acute liver failure are poisoning by various hazardous substances. Quite often, the diagnosis is made against the background of ingestion of α-amanitin. Its source is the pale grebe mushroom growing in our country. Among all poisonings, this is the most common. Somewhat less often, acute renal failure is observed against the background of ingestion of carbon tetrachloride or other dangerous compounds.
Possible liver failure in children and adults in acute form on the background of hepatic ischemia, shock and hepatitis in an autoimmune form. Sometimes blood poisoning, Budd-Chiari, Rey, Hellp diseases lead to acute renal failure. During childbearing, acute renal failure can be provoked by acute lipid hepatic dystrophy. Another potential cause is the formation of a thrombus 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 disease progress, first appearnon-specific manifestations of he alth problems. The patient loses his appetite, the stool is disturbed, rashes appear on the skin, fever. As a rule, the condition is accompanied by an increase in the heart rate, a decrease in blood pressure. In general, the non-specific picture is initially similar to septic shock.
Accurate diagnosis against the background of the described symptoms of liver failure is usually possible when encephalopathy develops. The intensity of the condition 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 out for?
The symptoms of liver failure include hemorrhagic diathesis. This condition does not occur in all patients. Its development makes it possible to clarify the diagnosis.
As a rule, hemodynamic instability is detected against the background of acute renal failure. Most patients experience hepatonephrotic syndrome. This means that kidney and liver failure develops. In some cases, the complication of the condition is explained by ascites.
Some patients with acute renal failure have seizures characteristic of epilepsy. This phenomenon indicates an increase in pressure inside the skull. In some cases, seizures are a sign of a primary brain lesion.
Status Progress
In the absence of adequate treatment for symptoms of liver failure in men, women, acute illnessflows naturally. From case to case, its course varies, the dynamics can differ significantly. Not always a super-acute option means the worst prognosis. This is quite often recorded with paracetamol poisoning, but does not mean that the outcome will be catastrophic.
If AKI is not treated, ignore the symptoms, there is a chance of death. In some severe cases of acute renal failure, a liver transplant is urgently required. Without adequate qualified assistance, a coma of the liver, swelling of the brain, and failure of internal systems and organs are possible. In total, this condition leads to the death of the patient.
Diagnosis
In order to start the treatment of liver failure in time, the symptoms that appear in the patient must be clarified in order to formulate the correct diagnosis. When gathering information about a patient, consideration should be given to the medication the patient is undergoing, as well as any medications and herbal preparations the person is taking. We are talking not only about those that are prescribed by prescription, but also all the others that are freely dispensed from pharmacies, as well as collected by a person on their own. When making a diagnosis, it is necessary to take into account information about previous operations, transfusions.
If the patient ate mushrooms, it is necessary to record this fact when taking an anamnesis. Take into account recent travel to various countries and regions of the world. Particular attention is paid to those remote from the permanent area of \u200b\u200bresidence. When formulating an anamnesis, the doctor should clarify whether among the relatives there are persons suffering fromliver disorders.
If acute liver failure is suspected in men, women, the doctor sends the patient for tests. You will have to do a set of procedures. They study the blood, reveal the content in the plasma of various electrolytes, creatinine, glucose. It is necessary to check the main body fluid for lactate, albumin, enzyme activity.
As part of the diagnostics, the patient's blood group is identified, the gas composition of the blood, the content of medicinal compounds in it are checked. They do tests to detect the content of toxic substances, viruses. If the patient is a woman in the reproductive period, it is necessary to check the fact of conceiving a child.
Features of analyzes
If acute liver failure is suspected, it is necessary, first of all, to do a blood test. The activity of aminotransferases above the norm indicates AKI. If the indicator exceeds 2,000 IU / l, we can talk about ischemia or poisoning of liver cells. Hypoglycemia is usually observed in AKI, so it is important to regularly take readings to control glycemia. An increase in the content of ammonia in the circulatory system is possible. You can determine it by samples of fluid obtained from the artery.
Against the background of acute renal failure, the content of lactates increases. Rarely, thrombocytopenia is seen. Some other deviations are also 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 lack of workkidneys, there is an increase in creatinine levels.
Checking status: what else can help?
To clarify kidney failure, it is necessary to do tests that allow visualizing 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 acute renal failure, hepatic steatosis, Budd-Chiari disease, or the presence of metastases. A study using a similar technology of the brain allows us to exclude neurological disorders, thereby confirming acute renal failure.
From the first to the third stage of encephalopathy can be diagnosed if the patient is directed to the EEG. The state will be indicated by three-phase waves. The fourth stage of the state will express itself in 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 are observed. If a percutaneous biopsy is prohibited for some reason, a transvenous biopsy should be done. This is possible, for example, in violation of hemostasis.
How can I help?
Treatment of acute liver failure is possible only in the intensive care unit. It is necessary to constantly keep under control the indicators of metabolism, hemodynamics, as well as to monitor the imbalance of water and electrolytes. Infection is possible - it is important to control this fact and monitor the developmentstates. The best option for treating acute liver failure is to refer the patient to a specialized clinic, where the person is immediately put on the list of those in need of an urgent 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 is imposed on products that contain glutamine. The energy value is calculated based on body weight: 30 kcal per kilogram. Obtained values - calculation for 24 hours.
Measures must be taken to prevent hemorrhagic gastropathy.
In acute renal failure, antibiotics and agents that stop the activity of fungal colonies are prescribed. It is possible to use broad-spectrum drugs. Before starting therapy, tests are done to determine the sensitivity of dangerous life forms to a particular variant. It is taken into account that gram-positive life forms usually dominate in the first week, which is replaced by gram-negative ones by the second week. If the stages of liver failure quickly replace each other, the disease progresses, there is reduced pressure, encephalopathy develops quickly, if it is not possible to use antibiotics, the patient is shown to constantly diagnose the presence of infectious foci. To do this, organic liquids are taken for analysis, X-rays are taken.
Features of drug therapy
With acute renal failure, it is necessary to take drugs to prevent swelling of the brain. Used for epileptic seizures"Phenytoin". The drug is injected into a vein. Dosage - 15-15 mg per kilogram. The maximum dose is 50 mg/kg. Maintenance amounts - 100 mg. There are eight-hour intervals between procedures. Phenytoin is not used as a prophylaxis.
To alleviate the patient's condition, it is necessary to properly lay down. The head and torso are raised at an angle of 30°.
It is necessary to regularly measure the pressure inside the skull. It is important to take steps to prevent overhydration.
Vitamin K is used subcutaneously. The dosage is from 5 mg to twice as much. In the presence of bleeding, fresh frozen plasma or recombinant factor is required before surgery.
In severe thrombocytopenia, infusion of platelet concentrate is indicated.
What else do you need?
With acute renal failure, blood flow disturbances, kidney failure are possible. To relieve symptoms, it is necessary to take measures to maintain a stable volume of blood inside the vessels. To do this, you can enter colloidal solutions. The pressure is on average maintained in the arteries at the level of 50-60 units. If there are indications, drugs are used to narrow the vessels. With acute renal failure, it is allowed to use adrenaline, dopamine. In some cases, norepinephrine is indicated. It is possible to install a catheter in the pulmonary artery to monitor the patient's condition. If there are indications for this, the patient is referred for substitution therapy.
OPN is accompanied by a metabolic disorder. Biochemical parameters are importantconstantly monitor, if violations are detected, compensate for them. With acute renal failure, the likelihood of hypoglycemia is especially high. It will require the introduction of glucose to correct it.
AKI, accompanied by active infectious foci, is often a reason 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 hepatocellular insufficiency, insufficiency of the liver in an acute form, in some cases it is necessary to undergo 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 meet the generally accepted conditions for referral to surgical interventions.
Transplantation is necessary if the liver is damaged due to excessive intake of paracetamol, if the acidity of the blood in the artery is less than 7.3 units. They are referred for surgery if encephalopathy is simultaneously established at the third stage or the fourth, while the prothrombin time is more than 100 s, 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 three of the following criteria is possible:
- under ten, over forty;
- duration of jaundice to the stage of encephalopathy - more than a week;
- prothrombin time over 50 s;
- bilirubin above 18 mg/dl;
- hepatitis or drug idiosyncrasy.
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
AKI, accompanied by the third stage of encephalopathy, on average in every third patient leads to swelling of the brain, increased pressure inside the skull. With encephalopathy of the next level, the probability of such complications is estimated at 80%. The cause of death in the predominant percentage of cases is herniation 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, the introduction of "Mannitol" in the amount of 0.5-1 g per kilogram of weight is indicated. Repeat injections as needed. It is important to control the quality of the plasma. Intubation is indicated for level 3-4 encephalopathy.
If "Mannitol" does not show the desired effect, hyperventilation, barbiturate coma is possible. Hormonal anti-inflammatory drugs are ineffective. It is recommended to use a catheter to check the pressure inside the skull. It is desirable 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, the blood can be cleansed of toxic components, allergic substances. This is where hormonal filtration takes place.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. The 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 glycogen storage depot.
At the stage of intrauterine development, the liver is a hematopoietic organ. In an adult, this element of the body is one of the most important in the hemostasis system.
The liver produces active components necessary for life support, biochemical reactions. It is involved in the processing of vitamin compounds, and also helps to accumulate nutrients, and their excess - to remove from the body.
If the liver begins to malfunction, it negatively affects the whole body.
Insufficiency: features of the condition
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 functions of the central nervous system, encephalopathy is diagnosed.
OPN, CRF appears if liver cells die. The functionality of the organ is weakened, the blood is not cleared of toxins, poisons are carried throughout the body. Soon it affects the state of the central nervous system. It is these processes that are responsible for the symptoms described above.
Acute and chronic: violationsliver activity
The acute form of disorders occurs when a strong negative effect on the body. The chronicle develops slowly, steadily progressing over time. Often, violations are observed against the background of cirrhosis, tumor processes, and other diseases that negatively affect the functioning of the liver.
Based on the severity, we can talk about the initial stage of PN - it has practically no symptoms, but the liver does not show an adequate reaction if poisons penetrate the blood. The second stage is decompensated, when you can notice the symptoms of PN. The patient loses his appetite, suffers from edema, nausea. Often pulls into sleep, the skin on the face turns yellow. Possible acidosis. Removal of a liver test shows the inadequacy of the indicators. The third stage is the terminal one. Violations are serious, the liver, kidneys, central nervous system, metabolism suffer, the body is depleted. Jaundice becomes especially pronounced, the patient is constantly sick. Against the background of the terminal stage, there is a high probability of liver coma, which can provoke a fatal outcome.
Liver Encephalopathy
Often, MO leads to the development of such a condition. It expresses itself with sharp mood swings, convulsions and anxiety, the inability to coordinate their movements. In many patients, consciousness is confused and cognitive functions are impaired. Memory suffers, intellect and quick wits decrease. To determine hepatic encephalopathy, the patient is sent for a special test.
How to warn?
To reduce the risk of PN, it is necessary to lead a he althy lifestyle and carefully avoid infection, and in case of infection– immediately begin adequate treatment under the supervision of a qualified doctor.
Since PN is possible when the liver is poisoned with toxins, it is necessary to avoid situations in which toxic substances can enter the body. Mushroom pickers should be especially careful.
It is important to treat any diseases that involve liver functions in a timely manner, resorting to traditional medicine.
One of the most common causes of cirrhosis leading to PN is alcohol abuse. You can minimize the risks for yourself if you refuse alcoholic beverages.
