Hepatic coma is the most severe stage of encephalopathy associated with cirrhosis of the liver. It is characterized by a severe neurophysiological syndrome that occurs in a person suffering from liver failure. In addition, this condition is accompanied by depression of the nervous system. As practice shows, such a 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.
Prognosis of such a coma is favorable under the condition of timely treatment and a shallow lesion. 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 unfavorable prognosis. Next, find out what symptoms are observed in people against the background of developmentthis pathological condition, as well as find out what first aid should be and how treatment is carried out.
Description of pathology
It should be emphasized that hepatic coma is an extreme stage in cirrhosis of the liver. The development of this pathological condition is associated with various factors. Let's consider the main ones, they, first of all, include the following reasons:
- Presence of liver failure.
- Exposure to dietary protein breakdown products. In this case, we are primarily talking about ammonia.
- The appearance of porto-caval anastomoses, that is, detours for the flow of blood that bypasses the liver, which leads to the fact that many toxic substances are not neutralized in any way, but circulate freely throughout the circulatory system.
Doctors identify the following types of hepatic coma in cirrhosis:
- Coma, which develops due to necrosis of the liver tissues.
- Coma, which is caused by the formation of hepatic or systemic collaterals. At the same time, there is absolutely no neutralization of toxic products.
- Mixed type of coma suggests the presence of both of the above reasons.
On top of that, against the background of cirrhosis, the liver itself ceases to perform its neutralizing function. At the same time, 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 most terrible consequences.
Symptoms preceding coma due to cirrhosis of the liver
Coma usually occurs at a severe stage of the course of a pathology such as cirrhosis of the liver. Usually at this stage, all sorts of violations of various liver functions occur. For example, the synthesis of proteins stops along with the neutralization of toxic substances. In sick people, symptoms may be found in the form of jaundice, high fever, ascites, edema, enlargement of the liver or spleen. Also, patients with this condition may experience increased bleeding with a small punctate rash on the skin throughout the body.
Laboratory findings usually show advanced cirrhosis. For example, the test results reflect a decrease in albumin, cholesterol, prothrombin, and other factors associated with blood clotting are observed. Among other things, in laboratory studies there is an increase in globulin, bilirubin, aminotransferases, and so on. In addition, an increased content of ammonia is found in the blood. Help for hepatic coma should be immediate.
In this condition, patients gradually develop hepatic encephalopathy, which subsequently progresses to coma. The development of encephalopathy is affected by massive bleeding along with poor nutrition, for example, when there is an excessive protein content in food. All sorts of infections, excessive alcohol consumption, and the like can also have an impact. Signs indicating the imminent occurrence of coma against the background of cirrhosis of the liver are the followingfactors:
- The appearance of difficulties with orientation in time and space. At the same time, sometimes a person has difficulty defining his own personality.
- Change in state, ranging from extreme arousal to delusions, depression and drowsiness.
- Noticeable incoordination.
- The appearance of changes on electroencephalography, for example, the occurrence of extremely slow delta waves, the alpha rhythm slows down, and so on.
Symptomatics
Since hepatic coma is associated with brain activity, its symptoms are often confused with other diseases and even with ordinary fatigue, which leads to incorrect treatment and significantly worsens the prognosis.
Clinical symptoms develop gradually:
- The patient is observed to change mood. A person experiences a feeling of anxiety, inexplicable euphoria or longing.
- The patient may begin to have poor orientation in the surrounding space.
- May have problems with sleep and other brain functions.
- Notable symptoms include facial muscle contraction along with prolonged spasms of the masticatory muscles.
- In the initial stages of cirrhosis, a liver odor may be observed, and in addition, jaundice, which is very rarely observed with extensive liver damage. The symptoms of hepatic coma don't stop there.
- Another visual symptom is hemorrhagic syndrome, manifested in petechial hemorrhages, which are especiallyvisible on the cheeks.
- Ascites may be seen in the background of a coma, indicating accumulation of free fluid in the abdominal cavity.
- The final clinical symptoms are convulsive seizures along with a decrease in pressure, lack of motor arousal and a poorly palpable pulse.
Stages of disease
Doctors distinguish three stages of hepatic coma. Specific symptoms depend on these stages, which manifest themselves to a greater or lesser extent:
- The first stage is a precoma; against its background, emotional instability is observed. The patient at the same time begins to complain of profuse sweating and dizziness. This condition lasts up to several days, after which it worsens significantly.
- The second stage is a threatening coma, and in such situations the condition can worsen by the hour. Loss of consciousness is added to the above symptoms along with memory lapses and mood swings. Hand tremor is visually noted. This period lasts up to ten days.
- The third stage of hepatic coma is already a coma. At this point, all symptoms reach their peak. In the event that emergency assistance is not provided, reflexes will be inhibited, the pupils will greatly expand, and at the same time breathing will stop.
Possible causes of the development of a pathological condition
Hepatic coma in cirrhosis of the liver may result from the accumulation of toxic substances in the body. The following reasons lead to this state:
- Exposure to external toxic factors, such as poisoning with arsenic, phosphorus or mushrooms, and so on.
- Taking drugs that have a hepatotoxic effect on the liver. These 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 impact of hepatitis B and A viruses.
- The negative impact of infectious mononucleosis and yellow fever virus.
- Exposure to severe stressful situations.
- Presence of large area burns.
- Septic abortions.
There may be other causes of hepatic coma.
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 destruction of the cellular structure of the liver and necrosis. As a result, the body simply stops working, unable to cope with its direct functions and provoking the accumulation of toxic substances in the body.
- Exogenous type is especially characteristic of bleeding in the digestive system.
- Mixed type occurs against the background of necrosis of some liver cells, and, in addition, due to the intake of ammonia in cirrhosis.
- The mineral type of hepatic coma is characterized, as a rule, by hypokalemia and electrolyte balance.
Next, we will find out what is usually the prognosis for patients against the background of the development of suchpathological condition in the presence of cirrhosis.
What is the prognosis for hepatic coma in cirrhosis of the liver?
Prognosis in the presence of cirrhosis of the liver is very often disappointing, especially when it comes to coma. Treatment in this case may not help. Symptoms of the disease should be established at the first stage of the disease. The most dangerous sign is bleeding, as blood can get not only into the esophagus, but also into 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 big role in a favorable outcome. Also an important factor is the time that has passed from the onset of jaundice to the first symptoms of encephalopathy. The progression of neuropsychiatric symptoms along with many other factors has an influence.
In the event that someone with cirrhosis was diagnosed at the last stage, then the chances of survival are low. According to the statistics presented by doctors, approximately ninety percent of cases end in death. In the event that the patient turns to the doctor at least at the second stage of this disease, the chances of survival increase.
Consider emergency care for hepatic coma.
What should be the first aid for this pathology?
To diagnose this disease, the clinical picture is taken into account, and laboratory and instrumental methods are also used. In such cases, it is mandatoryconsultation of such specialists as a gastroenterologist and resuscitator. In the event that a person becomes very ill, and there is a vivid symptomatology of hepatic coma, the patient must be provided with first emergency care even 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 since the deterioration began.
- It is required to lay the patient on his side and make sure that he receives enough air.
- Given that this disease is characterized by thought disorder along with inappropriate behavior, it is important to ensure that the patient does not injure himself in any way.
- When vomiting occurs, clean the mouth from vomit.
- The basic principle of emergency care for hepatic coma is the rule - give the patient plenty of fluids.
Emergency doctors usually conduct an initial assessment of the patient's condition. In the event that the doctor notices nervous excitement, then the patient will be injected intramuscularly with a one percent solution of Dimedrol. When diagnosing vascular insufficiency, as a rule, injections of Kordiamin and a one percent solution of Mezaton are used.
Performing medication
Treatment of hepatic coma in cirrhosis involves the following measures within the hospital:
- Cleansing the intestines, and if the condition allowspatient, 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 activity of various bacteria and viruses.
- No less important are hepatoprotectors that protect he althy liver cells and enhance the regenerative capacity of this organ.
- Anticonvulsant drugs are prescribed to relieve muscle stiffness in the treatment of hepatic coma.
- The patient is given sedative drugs to control nervous excitement.
- The patient is also injected with glucocorticoids and various solutions, for example, such as glucose, sodium chloride, and so on. The dosage is individually selected by the doctor.
- Among other things, detoxification drugs are used, which are injected into the intestines with a tube.
- If the disease was provoked by kidney failure, hemodialysis may be required.
- In case of hypoxia, the patient must be given additional 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 therapycancel and perform a special operation involving liver transplantation. Before the operation, the patient's condition is preliminarily stabilized.
For the treatment of this pathology, in no case should you resort to the use of folk remedies, as this will only aggravate the condition of a person and miss the precious time needed for successful treatment.
What should be preventive measures?
What should be done so that this pathology does not arise? This is a common question, let's look into it in more detail. In order to reduce the risk of hepatic coma on the background of cirrhosis, the following important rules must be considered:
- It is necessary to treat various liver diseases in a timely manner, and especially cirrhosis.
- A person must take adequate medication, which should be prescribed exclusively by a doctor.
- It is very important to refuse any self-treatment, not only against the background of cirrhosis, but also for all kinds of other diseases.
- You should be very careful when coming into contact with various toxic substances, this requires the use of protective clothing, and in addition, use all kinds of protection methods.
- You should lead a he althy lifestyle, in which any bad habits should be excluded.
- You need to change your diet and include foods rich in vitamins, as well as minerals and other substances important for he alth.
So you can dothe conclusion is that such a phenomenon as a hepatic coma on 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.
