Hepatic coma represents the final stage in the progression of liver failure.The development of failure, possible cirrhosis of the liver.
The development of this disorder occurs on the background of the emergence of severe intoxication of the organism, provoked by patisserie and mechanical damage. In addition, the development of the breach occurs as a result of the death of a large part of the liver in case of injury, necrosis or partial removal during surgery. Hepatic coma can arise in the process of progression of acute and chronic ailments. The result of the progression of coma observed symptoms of damage to the Central nervous system of the body.
The reasons for the development of hepatic coma
Hepatic coma is of two kinds:
- hepatocellular form;
- shunt form.
Hepatocellular form a coma is a form of patyrusiu caused severe damage to a large part of the cells of the liver tissue during the development of hepatitis or intoxication with chemical substances. In addition, Patrusheva can occur in mushroom poisoning or development of diseases with an infectious character.
Shunt (or “roundabout”) coma develops as a result of disruption of the normal outflow of blood from the bowels, when the blood is not circulating through the cells of the liver tissue, and follows through portocaval anastomoses.
Beside these two varieties of hepatic coma there are also combined hepatic coma, in which there is, along with the collapse of the cellular structures of the liver tissue, shunting of the portal system.
The main reasons for the development of such patyrusiu as hepatic coma:
- the abuse of alcohol;
- drug poisoning;
- the use of drugs.
The development of shunt coma is able to trigger ingestion of food products rich in proteins of animal origin.
The main factor predisposing to the development of hepatic coma, may be poisoning with ammonia and its derivatives and aromatic amino acids, since formation of these compounds non-toxic products is carried out by the liver cells.
The symptoms of the disease
The development of hepatic coma is gradual. There is a sense of anxiety, a feeling of sadness, apathy and euphoria. In the process of development of coma appear symptoms such as slowing of thought processes, disorientation, impairment of function of sleep (in the form of manifestation of activity at night and the occurrence of daytime sleepiness). Shunt for hepatic coma is characterized by the appearance of transient impaired consciousness.
With the further development of hepatic coma, the patient’s condition begins to worsen, appear the following symptoms:
- the mind starts to get confused;
- the patient periodically starts to moan or shout;
- patient reacts to external irritating effects (pain appear when performing palpation);
- there is a twitching of the muscles of the face and extremities;
- the occurrence of spasm of the muscles of the jaw.
The development of hemorrhagic syndrome characterized by the occurrence of hemorrhages in the mucosa of the mouth and of the gastrointestinal mucosa.
Hepatic coma is characterized by the development of meningeal symptoms Kerning and Brudzinskogo, enhanced tendon reflexes.
In the process of development of hepatic coma to develop specific symptoms, such as:
- the appearance of hepatic smell from the mouth;
- hand tremor.
One of the specific symptoms that occur in a coma, the appearance of free fluid in the abdominal cavity, the so-called otern-astiticeski syndrome.
End-stage coma characterized by development of renal failure with the accession of infection and development of sepsis. In the body there is an increase of bilirubin level. In the process of progression of this stage comes a deep coma.
The main signs of the onset of deep coma the following:
- the patient becomes stationary;
- stop motor excitation;
- the skin become maskoobraznoe;
- pupils cease to respond to light stimulation.
In addition, the development of patyrusiu arise areflexia, muscle tension neck. There is a drop in blood pressure, pulse becomes thready, increased pulse, revealed paralysis of the sphincters, occurs stop breathing.
Treatment and prognosis of hepatic coma
If evidence is revealed precome required to sharply restrict the use of food protein products. In the daily diet of this component should not exceed 50 g, and in the case of continuing the development of the disease should completely abandon the consumption of foods with protein. Treatment patyrusiu is in the initial phase in the daily conduct of the process of bowel cleansing using enemas and laxatives. In addition, treatment of disease requires the introduction into the body using a probe of antibiotics, which can suppress the microflora in the gut.
Treatment of coma requires the use of vitamin therapy. In addition, the treatment involves use of cocarboxylase, drugs, potassium, glucose, it is additionally required to spend copious parenteral administration of fluids.
Treatment of comatose state is carried out by using arginine and glutamic acid, which can neutralize ammonia, concentrated in the blood. With the development of psychomotor stimulation treatment of the disease is performed with use of haloperidol. In the case of development in the body of a pronounced metabolic acidosis the treatment is done by injection of sodium bicarbonate solution with concentration of the latter equal to 4%. In severe metabolic alkalosis the treatment is conducted by injecting a large amount of potassium in the body.
In the process of conducting medical procedures used glucocorticosteroid medications in large doses. During treatment it is forbidden to use diuretics. With the development of hepatocellular kom applies an exchange transfusion, which can be up to 5-6 liters per day. Requires timely peritoneal or extracorporeal dialysis.
The prognosis of hepatic coma
The forecast is of great importance for persons who have severe forms of coma. These patient are characterized by a very high degree of mortality, which is about 80% of the total number of cases of coma. The prognosis of the disease depends on the timeliness of treatment and the ability of liver tissue to regenerate. To make the forecast of development of coma, you need to consider many factors such as the age of the person, the time period from the first manifestations of jaundice until the first signs of development of the comatose state, the intensity of the psycho-neurological failures.
With timely treatment the prognosis for the disease is favorable, but if in the anamnesis there is failure, the prognosis is considered unfavorable.
The patient and his relatives are interested in the question about how many live patients with this diagnosis. Clearly this question can not be answered due to the fact that in the course of the disease is influenced by many factors.