What is hepatic coma in liver cirrhosis? Comatose liver: types and stages, rules of first aid.

Hepatic coma is a severe stage of encephalopathy. As a result of diffuse damage to gland cells, as well as sharp decline its functions characteristic of chronic diseases, pathological process provokes atrophy and death of liver tissue (more than 70%). As a result of such irreversible processes, the liver and its cells atrophy, and if medical care is not provided, the patient’s death occurs.

The causes of this condition are most often chronic viral hepatitis (endogenous hepatic coma). Next dangerous factor is considered to be toxic hepatitis and medicinal hepatitis(shunt exogenous hepatic coma). Encephalopathy develops when chronic hepatitis, cirrhosis, obstructive jaundice, liver oncology, cholangitis. Signs of hepatic coma can also be observed against the background of poisoning with heavy metals and pesticides: arsenic, mushrooms, mercury, lead, phosphorus.

Pathogenesis of hepatic coma

What is hepatic coma, and what are its main risks to human life? Mainly it's defeat nerve cells liver, healthy remaining cells take over all functions, but when the percentage of damage is more than 50%, recovery becomes impossible. In such cases, we are talking about improving the quality of life, without prolonging it.

Pathogenesis is associated with parenchymal insufficiency and a simultaneous violation of its antitoxic function. As a result of this process, the ability to neutralize poisons formed during natural metabolism disappears. Chronic liver diseases lead to the formation of portocaval anastomoses, which in turn provoke a change in blood flow: from the portal vein, bypassing the liver, blood enters the vena cava, aggravating intoxication.

Particularly hazardous toxic components

Ammonia is considered especially dangerous for the liver and its cells. Formed in the colon, ammonia enters the portal vein and is neutralized by the liver (urea is formed). Such toxins are eliminated from the body along with the urethra without causing harm to the entire body. During hepatic coma, the blood accumulates a significant amount of ammonia, toxic products of protein breakdown are also not excreted, and general intoxication of the entire body occurs.

The main effect of toxic ammonia is on the respiratory center, brain and nervous system. The patient experiences characteristic shortness of breath, heavy breathing even in a calm state, swelling and the appearance of yellowness. In the process of reducing the antitoxic function of the liver, an increase in intoxication occurs. Now protein breakdown occurs thanks to intestinal bacteria. However, in the blood and brain the concentration of aromatic amino acids still increases, and the concentration of amino acids decreases.

Phenylalanine, tyrosine and tryptophan compete with neurotransmitters (dopamine, norepinephrine) in the brain, thus disrupting the interaction of brain neurons. Conflict results in oppression nervous system: the patient’s speech is slightly slurred, inhibited, the reaction is slow, pain is reduced or often absent.

Clinical picture and symptoms

Symptoms of liver coma are associated primarily with cerebral manifestations that develop against the background of the toxic effects of the nervous system. The dynamics of the sequence and manifestation of disorders allows us to identify the main stages of hepatic encephalopathy with observation of symptoms:

Minor motor impairment, mild apathy and inhibited perception of reality. At this stage characteristic symptoms are lethargy with inconsistent excitability, attacks of anxiety and even panic in places, followed by euphoria and a surge of strength. Fast fatiguability and severe headache with throbbing attacks. Disturbance of the usual rhythm of sleep: sleep during the day and inability to fall asleep at night, adynamia.

Significant and persistent sleep disturbances, constant desire to sleep and disorientation when awake. Impaired perception of reality and memory depression. Can be frequent attacks aggression and fatigue. Inappropriate behavior is associated with a violent reaction from the nervous system: screaming, hearing loss, panic attacks. Painful palpation, there is a decrease in liver volume, and the patient’s weight decreases.
For this stage, characteristic symptoms are severe disturbances of consciousness, pronounced disorientation (the patient often cannot remember names, names of the city, place of residence), stupor, unclear sluggish and slow speech. Intoxication affects more and more liver and brain cells. There is a general intoxication of the whole body. The condition can be aggravated by alcohol, medications and heavy protein foods. Vomiting with characteristic “coffee grounds”, the appearance of bruises and abrasions, the skin is yellow, dry and cold. Manifestations of tachycardia, pain on palpation.
Last stage is the most difficult clinical condition which only leads to death. The patient loses all skills, there is loss of hearing, voice, and memory. An increase in body temperature to 40 with simultaneous swelling of the entire abdominal area, voluntary defecation and urination, no reaction to any external indicators, or pain. Afterwards the patient falls into a coma, resulting in death.

Associated symptoms, in addition to mental disorders, are:

Hand tremors;
Decline muscle tone;
Cramps and nervous tics muscles;
Ataxia;
Rigidity;
The breath smells sweetish, with a characteristic liver odor;
Decreased appetite;
Vomiting, nausea;
Pain in the right hypochondrium (epigastric region);
Decreased performance;
Dizziness and fainting;
Decreased partial memory loss;
Skin itching, redness and swelling in the hypochondrium;
Enlarged pupils, lack of reaction to light;
Frequent hiccups and yawning.

From the chemical diagnostic study, the following are observed:

Bilirubin-enzyme dissociation (decreased transaminase activity);
Reduced blood clotting;
Hypochromic anemia;
Increasing the concentration of biribulin (direct and indirect);
Decrease in prothrombin concentration;
Low levels of albumin, glucose, potassium, cholesterol;
Increase in sulfur-containing amino acids, ammonia;
Decompensated metabolic acidosis.

When diagnosing liver failure, important has a sweetish odor from the mouth. This sign is considered one of the earliest. Already at the first manifestations of liver disease, the smell changes due to changes in metabolism and the accumulation of liver hormones in the blood. As encephalopathy increases, the intensity of the specific odor increases.

Ignoring these symptoms leads to an exacerbation of the disease, which in the future leads to more complex and acute diseases of the nervous system. Against the background of constant intoxication of the body, the patient sharply loses weight, appetite decreases, food intake is often accompanied by the urge to vomit, after almost every intake of liquid and food - nausea, a feeling of fullness and increased pain in the right side. Panic attacks increase, disturbances of consciousness and memory occur, sleep becomes clear and not strong.

At the same time, there is a constant desire to sleep and relax, regardless of the duration of sleep. Timely diagnosis– a chance to avoid the worst outcome.

Therapy and treatment during hepatic coma

Intensive treatment for renal coma mainly involves detoxification, treating the underlying cause. Therapy contains components and techniques drug treatment, which are also used for encephalopathy.

The treatment system for hepatic coma consists of correct diagnosis, establishing a diagnosis, and only then determining the drug effect. In general, the entire treatment complex consists of several stages:

Restoring energy reserves. Since during the development of the disease the patient cannot take the required amount of food, a natural of this disease the process of vomiting and loss of energy reserves of the body. An infusion of 20% glucose solution (8-10 g/kg per daily dose) is prescribed.

In addition, insulin is prescribed. Ringer's solution (5% glucose solution + 1% glutamic acid solution) is prescribed for elimination toxic substances from blood 1 ml per year of life. The total volume of liquid is 100-150 ml/kg. Infusion therapy is carried out with simultaneous administration diuretics.

Reduced intoxication (hyperammonemia). Hepasteril A dropper (1.7 ml/kg per hour) without diagnosis renal failure.
Stabilization of amino acid metabolism. Albumin solutions (Heparil B) and fresh frozen plasma are administered.
Reducing the amount of ammonia in the digestive tract. It is important to adhere to the correct therapeutic diet which consists in the complete exclusion of protein foods: eggs, milk, dairy products, cottage cheese, cheese, legumes, meat, fish. To prevent the septic effect, oral antibiotics are prescribed, which will help reduce the production of intestinal enzymes. Also carried out mandatory cleaning intestinal tract, by administering enemas and gastric lavage.
Anabolic hormones will help normalize the production of liver hormones: Essentiale; Cocarboxylase; Unithiol; Water-soluble vitamins, groups A, C, K, D, E; B vitamins; Fresh liver extracts: preparations Sirepar, Gepalon.
Symptomatic therapy. Sedatives will stabilize the emotional background, cardiovascular medications will maintain normal blood circulation and the functioning of the heart muscle, and Contrikal or Gordox is prescribed to inhibit proteolytic processes.

Dangerous symptoms: if conservative treatment does not work

In cases where there is no effect from conservative therapy, a decision is made to prescribe more radical methods - active detoxification:

Hemosorption;
Lymphosorption;
Plasmapheresis;
Hemodialysis;
Peritoneal/intraintestinal dialysis.

Hepatic coma - dangerous symptom, which requires immediate treatment and hospitalization. Only timely diagnosis and prescription of effective therapy will help cope with dangerous conditions.

At least 3% of all visits to the inpatient department intensive care, is associated with a severe form of liver tissue dysfunction, when massive death of its cells—hepatocytes—occurs. One of the most important organs digestive system a person no longer copes with its functional purpose, the blood is not cleansed of toxins, splitting fatty acids, and also other vital signs stop flowing important processes. Against this background, acute liver failure, intoxication of the body and the patient falls into a coma.

According to its etiology, it is this type coma is no different from other types of human vegetative state. The centers of the cerebral cortex, as well as the central nervous system, are in a depressed state and do not respond to external and internal stimuli. Congenital and acquired reflexes are completely absent.

The only peculiarity of this type of coma is that it occurs after the liver tissue ceases functional activity.

It is important to understand that hepatic coma is not independent disease. This is a specific state of the body, which already acts as negative consequences And severe complications as a result of an existing liver disease that has not received drug treatment. Patients in this category throughout long period didn't take any time therapeutic measures to stabilize your health.

Children under 10 years of age, as well as adults over 40 years of age, are at risk of morbidity. Survival rate in acute phase the development of a comatose state is at an average level and largely depends on what exactly provoked the failure of the liver, how timely the person applied for qualified help to a health care institution, as well as from individual qualities and the patient's vital resources. Of 5 patients admitted to intensive care with a diagnosis of hepatic coma, 1 person consistently dies.

Causes of pathology

The onset of a coma is always associated with poisoning of the blood, lymphatic fluid and all body tissues with toxic substances that have accumulated as a result of the absence of signs of liver function, as one of the organs of the digestive system responsible for cleansing the body of toxins. Causal factors that cause hepatic coma are the presence of the following diseases in a person.

Viral or bacterial infection

At least 60% of all cases mass death liver cells hepatocytes is due to the fact that the patient is diagnosed with a concomitant illness such as viral hepatitis. Microorganisms of this strain invade the liver cells, deplete them and lead to the cessation of its vital activity.

It is extremely difficult to bring a patient with hepatitis out of a comatose state, since viral activity does not stop, but only worsens in its manifestation. At the same time, doctors also have to deal with the consequences of intoxication of the body. If the cause of the disease is precisely the presence of this factor, then the likelihood of death is extremely high.

Excess protein

At long-term use dishes containing a large amount of protein foods of plant and animal origin, the tissues of all organs, and especially the liver, are saturated with toxic products of protein breakdown.

Similar condition quite often diagnosed in people who abuse protein diets, or are meat lovers, eating it daily, several times a day and in large quantities.

Oncological process

A person’s hereditary or acquired tendency to develop cancerous tumors in the liver tissue can also cause the gradual degeneration of hepatocytes into a malignant substrate. In such cases, after hospitalization of the patient and a series of diagnostic measures it is established that he has stage 1-2, and sometimes even stage 3 cancer.

Chronic renal failure

The work of the liver and kidneys is closely interconnected, since both perform the function of cleansing the body of poisons and toxic substances. In addition, the kidneys also ensure the excretion of urea beyond excretory system. If activity of this body is reduced, then in this case the nitrogenous substances that make up urine accumulate in the liver and, after reaching a critical concentration, provoke extensive poisoning of the body.

Impaired circulation of fluids

Maintaining a sedentary and sedentary lifestyle, the presence of diseases such as thrombosis great vessels, heart failure, lead to a decrease in the circulatory activity of blood and lymph. In this regard, a stagnation effect occurs and during hematopoiesis, which occurs after eating, the liver receives increased stress, which, with a systematic effect, leads to the development of liver failure.

Chronic intoxication

Constant exposure on the human digestive system such external stimuli as unsatisfactory condition environment in terms of ecology, consumption large quantity alcoholic beverages, drugs, food products containing salts heavy metals and toxins, smoking, drinking contaminated water, leads to the gradual accumulation harmful substances in organ tissues, its poisoning and death of hepatocytes.

In such conditions, hepatic coma in liver cirrhosis is quite common. Especially if the patient has been abusing alcohol for a long period of time. Systematic use of medications has an equally destructive effect, so treatment with medications should also be measured and controlled.

Types of hepatic coma

In order to make it easier to identify the cause of the development of the disease and formulate a unified therapeutic set of measures aimed at removing the patient from pathological condition who is classified into the following types:

It is possible to determine what type of renal coma a particular patient has only with the help of complex diagnostics body and blood tests. After this, a long process of blood detoxification begins, as well as restoration of the functioning of the liver as an independent digestive organ.

Prognosis - how long do people live with hepatic coma and what can be done?

The further fate of the patient largely depends on skillful actions medical personnel, the severity of intoxication of the body, as well as what exactly provoked the occurrence of this pathological condition of the body. The probability of death is extremely high, and on average, every fifth patient who enters a comatose state never comes out of it, and doctors 1-3 days later drug therapy death is diagnosed.

It is believed that if coma is caused by short-term exposure to heavy metal salts, poisons, chemical substances toxic effect, and before that the person led a completely decent lifestyle and did not influence negative influence on the organs of the digestive system, then in this case it is possible full recovery organism with a standard life expectancy, but subject to strict diet. It's about about gentle nutrition, when the patient completely excludes alcohol, fatty, smoked, salted, pickled and fried foods from his future life.

Hepatic coma, complicated by cirrhosis of the liver with signs of full-fledged foci of necrosis, gives little chance of long life. The probability that such a patient will survive is no more than 25%. After returning to consciousness, patients in this category live no longer than 2-3 years. Then in their abdominal cavity fluid begins to accumulate, and foci of necrosis with bright pronounced signs total decay of organ tissue. Complicated forms of the disease with initial stage encephalopathy indicate that the life expectancy of such a patient will not exceed 1 year.

Diseases of this organ can provoke a serious condition - hepatic coma. It has several stages and can be caused for various reasons and lead to severe consequences, even death. Our article will tell you more about this disease.

Definition and code according to ICD-10

Regulatory document defining the international classification medical diagnoses ICD-10 regulates the following liver diseases.

ICD code – 10:

K 72 - , not classified elsewhere.
By 72.0 - acute and subacute liver failure.
K 72.1 - chronic liver failure.
K 72.9 - liver failure unaccounted for.

The disease develops against the background of general intoxication of the body. Phenol, ammonia, sulfur-containing amino acids and low molecular weight fatty acids accumulate in the body. They have a toxic effect on the brain, which increases when the water-electrolyte balance is disturbed.

Forms

Liver dysfunction can be of various types. In total, three variants of hepatic coma have been identified, which can lead to serious consequences.

What types of coma are there:

Endogenous, in which disturbances can be caused viral forms hepatitis, dystrophic and destructive processes in the organ with cirrhosis, as well as replacement of healthy liver tissue with tumor or scars. It is very painful and progresses quickly, with pain felt in the area of the affected organ, hemorrhoidal disorders, jaundice and itching of the skin and a severe “liver” odor from the mouth. Psychosomatic disorders often manifest themselves, periods of increased activity alternate with complete loss of strength, depression and excessive fatigue.
Exogenous hepatic coma occurs more often with chronic organ dysfunction, cirrhosis and chronic renal failure. This form of the disease lacks a characteristic odor and psychosomatic symptoms. The disease is relatively painless and without pronounced symptoms. The problem can be identified by identifying portal vein hypertension.
Mixed forms are characterized by symptoms of endogenous and exogenous forms of hepatic coma. In this case, along with necrotic processes in organ tissue, problems of hematopoietic function are diagnosed, and symptoms may include various manifestations previous forms of the disease.

Stages of the disease

Depending on the severity of the patient’s condition, there are three stages of this disease. In this case, the central nervous system is affected, functions are disrupted brain activity, accompanying symptoms are observed.

The disease has the following stages:

Precursor or antecedent phase. The patient is emotionally unstable, mood swings are very abrupt and do not depend on external influences. Aggression and sleep disturbances (drowsiness during the day, insomnia at night) may occur. It is difficult to concentrate on any issue, consciousness is clouded, mental activity is inhibited. Frequent symptoms: tremors of the limbs, severe headache, nausea, vomiting, hiccups, increased sweating, dizziness.
Excitement phase or threatening coma. Strong emotional upsurge, aggressiveness, anxiety. Mental activity is practically absent, movements are mechanical and without a specific purpose. Disorientation in time and surroundings often occurs. Painful sensations dulled, reactions only to external stimuli.
Complete or deep coma. Complete absence of consciousness, emotions and reactions to stimuli. The breathing rate may change (up to a complete stop), blood circulation slows down. Level blood pressure reduced, sphincter paralysis occurs, corneal reflexes go out.

Causes

Hepatic coma develops against the background of existing chronic diseases and pathologies of the liver, as well as due to toxic effects.

The main reasons are:

Viral hepatitis of groups A, B, C, D, E, G.
Viral liver diseases, including herpes, Infectious mononucleosis, Coxsackie's disease, measles, .
Vasiliev-Weil disease (icteric leptospirosis).
Liver damage due to fungal or microplasma infection.
Severe intoxication with toxic substances.

Threatening factors include the use of alcohol and psychotropic substances, the inclusion in the diet of excessive amounts of protein foods, as well as wild mushrooms.

Pathogenesis

The processes of pathogenesis have not been fully studied. It is known that in this condition the functioning of neurotransmitter systems is disrupted, and an excess of breakdown products (nitrogen compounds, fatty acids and neurotransmitters) negatively affects the functioning of the brain and central nervous system.

Symptoms

Depending on the causes and severity of the disorders, the symptoms of the disease may vary. It is also worth taking into account the individual characteristics of the patient, which also determine the severity of the lesion and the prognosis of treatment.

The main symptoms are:

Feelings of anxiety, thinking disorders.
Problems sleeping at night, sleepiness during the day.
Muscle cramps and increased tone.
Yellowing of the skin.
Accumulation of fluid in the abdominal cavity (ascites).
Bleeding, the appearance of hematomas.
Soreness in the liver area.
Increased body temperature, chills and fever.
Tachycardia, decreased blood pressure.
Tremor of the extremities, usually the fingers.

In various stages, there may be increased mental agitation, aggression and sudden mood changes. In addition, strong bad smell from the mouth, digestive disorders (prolonged vomiting, constipation or diarrhea), sphincter paralysis.

Complications

Progressive liver failure affects general state patient, threatening his life. This disease has no complications as such, because hepatic coma in itself is a very serious condition, leading to irreversible processes in the body.

Diagnostics

The disease is determined by.

These include bilirubinemia (increased concentration of bile pigment), azotemia (excess normal indicators nitrogenous products), reducing the level of prothrombin, cholesterol and glucose.

Urine becomes richly yellow in color, bile acids and urobilin can be found in it, feces become discolored.

Urgent Care

If sharp deterioration health incident occurred outside the walls of a medical institution, the patient must be placed on his side, ensuring normal air flow, and an ambulance must be urgently called.

Before the doctors arrive, you should not change position, shake or move the patient. Such conditions require immediate hospitalization, and already in the hospital the active struggle for the patient's life.

What can be done in the hospital:

Administer a glucose solution with panangin to improve brain activity.
Complex saline solution and insulin in severe catatonic states.
On the first day, an increased dose of prednisolone is prescribed to relieve the toxic effect on the organ.
Stimulation of liver activity is carried out using intravenous or intramuscular solution nicotinic acid, riboflavin, thiamine chloride and pyridoxine.

First aid consists of reducing symptoms of intoxication, stabilizing respiratory function, hydration electrolyte balance and protein metabolism. Until the condition is stabilized and in order to prevent a deep coma, the patient is in the intensive care unit.

Treatment

Further treatment measures are agreed upon with the attending physician. The prognosis and chances of recovery depend on many factors, including the presence concomitant diseases, age and degree of organ damage.

The following methods are commonly used:

Diet and limiting the amount of protein consumed.
Reception antibacterial agents, reducing activity intestinal flora and the formation of waste products.
Maintenance therapy consists of using glucose solution, saline solution, and glucocorticoids.
To reduce ammonia levels, you need to take glutamic acid and arginine.
Excessive psychosomatic symptoms corrected with special antipsychotics.
In case of dysfunction respiratory system, the patient is connected to an oxygen mask.

In case of diagnosis " toxic poisoning", all activities should be aimed at detoxifying the body. The doctor may suggest a blood transfusion, as well as hemodialysis, if kidney failure is added to the main symptoms.

How long does hepatic coma last?

Even the most highly qualified doctor will not be able to give accurate forecasts. It will be extremely difficult to revive a patient in a state of complete coma, so it is best to seek help from early stages illness.

The recovery rate is significantly influenced by accurate diagnosis and elimination of the cause, but in more than 15% of cases it cannot be determined.

Prognosis and prevention

The chances of recovery in patients who have suffered a hepatic coma are extremely low.

Basically, this is no more than 20% of survivors at the precoma stage, less than 10% in the threatening phase and approximately 1% in a deep coma. Even such disappointing forecasts are not always possible, and only with timely and competent treatment.

Irreversible processes that occur in the body under the influence of decay products, as well as suppression of functions or complete failure of an organ, affect the activity of the central nervous system and brain.

It is extremely difficult to bring a person out of a deep coma, and the most successful treatment method is this moment is a donor liver transplant and long-term drug therapy.

There are no preventive measures against this disease. To maintain the health of this organ, you must follow general recommendations: refuse and take, observe moderation in diet, and also regularly subject the body to feasible physical activity.

All problems and identified diseases must be treated in time and regularly examined if possible. Hepatic coma, regardless of its forms and stages, causes irreparable harm to health and significantly reduces the quality and life expectancy, so its symptoms should never be ignored.

Hepatic coma is a pathological condition that occurs due to a high concentration of toxic substances in the body and leads to complete inhibition of the central nervous system. As a rule, the prognosis in this case is disappointing, since this condition provokes internal bleeding. The pathogenesis of the disease indicates irreversible processes.

Despite the fact that hepatic coma that occurs with cirrhosis of the liver is an extreme degree of neglect of the disease, it also occurs in several stages, each of which is characterized by its own symptoms:

precoma - nausea, loss of appetite, pain in the abdomen, impaired thinking and disorientation in space appear. Upon careful examination, a slight yellowing of the skin may be noted. A person can remain in this state from several weeks to several months;
threatening coma - stage further development and worsening of the disease. The disturbance in thinking is accompanied by difficulty speaking, tremors of the limbs, constant drowsiness and irritability, loss of consciousness may occur. The yellowness of the skin of the entire body increases. In this state, in the absence of medical intervention, a person can remain for no more than 3–5 days. Your health suddenly deteriorates and medical attention is required;
deep coma - characterized by a person's immersion in unconsciousness. Holds on heat body, muscle rigidity gradually worsens, although reflexes to strong stimuli still remain.

Knowing the symptoms of a developing coma with cirrhosis of the liver, it is important to record the appearance of the first of them and immediately contact specialists.

Early detection of signs of pathology increases the chances of recovery, while ignoring these symptoms often leads to rapid death.

Causes of hepatic coma

Among the main conditions that cause the development of hepatic coma are:

intoxication of the body due to overuse alcohol or poisoning with heavy chemicals;
some infectious or viral diseases, for example, hepatitis C;
drug use or drug intoxication;
the presence of benign or malignant tumors in the liver area.

Doctors call another cause of hepatic coma severe form jaundice or complications after it. This cause is often observed in young patients under the age of 10 years.

Types of hepatic coma

Doctors distinguish four types of hepatic coma depending on what diseases cause this pathology:

endogenous - characterized by necrosis of hepatocytes in the liver and occurs against the background of diseases such as cirrhosis, hepatitis, poisoning with toxic substances;
exogenous - develops against the background of cirrhosis complicated by hypertension;
mixed - combines the first two types;
false - characterized by a lack of potassium in the body against the background of developing cirrhosis of the liver.

The type of pathology can be identified based on test results. Diagnostics are carried out to determine the degree of neglect of the problem, as well as to determine the optimal methods of treating hepatic coma.

Usually, biochemical analysis blood allows you to see a complete clinical picture, on the basis of which conclusions can be drawn. In addition, ultrasound of the liver and abdominal organs, electroencephalogram, and MRI are also used.

First aid for hepatic coma

Pathology can only be treated by medical institution under the supervision and control of qualified doctors. Timely contact with a specialist increases the chances of preserving the life and health of the patient.

Having noticed the first signs of the development of hepatic coma, it is important to immediately call emergency doctors, and before they arrive, provide the person with pre-medical care. Most effective actions are the following steps:

lay him on his side and ensure sufficient oxygen supply;
If vomiting occurs, ensure that the vomit does not remain in the oral cavity and did not enter the respiratory tract;
give as much fluid as possible to drink;
try to calm down and reduce increased excitability;
When a disorder of thinking and behavior manifests itself, make sure that the person does not injure himself.

It is important to record the time when symptoms of hepatic coma began to appear. In addition, to correctly understand the clinical picture, the specialist will need to know how the attack manifested itself and how the signs of pathology grew.

It is absolutely impossible to treat hepatic coma at home or hope that the problem will go away on its own. The onset of the second and third stages of this condition ends quickly in 85% of cases. fatal Therefore, a person’s life depends on the speed of reaction and the effectiveness of the therapy used.

Features of the treatment of hepatic coma

The main direction of treatment of the pathological condition is the use of drug therapy. Medications are divided into several main groups depending on their purpose.

First of all, the body must be cleansed of toxins and toxic substances. To cleanse the intestines, enemas or laxatives are used, and a solution of glucose, vitamins and lipoic acid is injected intravenously into the patient.
Antibacterial medications also help prevent the buildup of toxins in the body.
Antibiotics prevent the occurrence of infectious complications.
To stop necrotic processes in liver cells, Prednisolone is used.
To replenish the amount of electrolytes in the blood, such ready-made solutions, such as Disol, Trisol and Ringer's solution.
An important factor in the treatment process is diet, if the patient can eat on his own. The diet is set in such a way as to exclude foods that contribute to the formation of ammonia in the body. If the patient is in a coma and is unable to eat, he is given an intravenous injection of glucose solution with the addition of required quantity insulin.

Most effective method treatment that increases the likelihood of recovery and leading a normal lifestyle in the future is a transplant healthy liver. The operation is complex surgical intervention and requires careful preparation. In this case, the patient's condition must be stable.

Hepatic coma is a complex and intractable condition that occurs as a result of the development of cirrhosis of the liver. The prognosis and effectiveness of treatment directly depend on the speed of treatment medical care. In the early stages, the pathology can be recognized and stopped, thereby saving the patient’s life.

Today, about three percent of patients are admitted to the intensive care unit. Every patient who comes to the clinic with a hepatic coma is sick with something. Thirty percent of such people have not yet reached the age of forty, and only one in five people survives after treatment for hepatic coma. Most deaths were recorded among patients under ten years of age and over forty years of age.

Hepatic coma and its symptoms

Hepatic coma is the most severe stage of hepatic encephalopathy. The cause of its development is diffuse liver damage and sharp violation vital organ functions. Typically, this condition is caused by symptoms of acute and chronic diseases such as viral hepatitis, liver cirrhosis, severe obstructive jaundice, malignant tumor, poisoning with poisons and alcohol. The anatomical and physiological characteristics of the liver change noticeably. Hepatocytes die, the gland itself changes in size

Cirrhosis of the liver leads to impairment metabolic processes, although it is not dangerous. But if there is an increase pathological changes, the organs stop coping with the task assigned to them, and coma develops. The first symptoms of hepatic coma are manifested by changes in the person’s psycho-emotional sphere. The patient's mood changes sharply, excessive, unreasonable joy appears, during the day the patient increasingly tends to sleep, and at night he is overcome by insomnia.

It is important to know: Before the patient develops coma, signs of precoma appear. This state lasts for a certain period of time and gradually leads the body to a comatose state.

Precoma of hepatic pathology is manifested by the following symptoms:

pain;
nausea, vomiting, bloating;
change in skin tone;
the patient's face takes on a reddish color;
the tongue turns crimson.

On the patient's body different places hemorrhages appear. There is bleeding from the nose, uterus and organs.

Precoma turns into coma. This is manifested by the following symptoms:

a person ceases to navigate, cannot understand where he is and what time it is;
the patient's mouth smells of liver;
urination decreases;
the face becomes sharper;
breathing uses muscles;
the temperature drops;
the tone of the eyeballs decreases;
blood pressure decreases;
the pulse is difficult to palpate;
the patient loses consciousness.

Causes of hepatic coma

The main reason why hepatic coma develops in liver cirrhosis is toxin poisoning. Liver disorders occur because a person:

drank alcohol for a long time;
took medications for a long time;
performed operations;
suffered from viral and infectious pathologies;
suffered shock, abortion, stress.

A comatose state negatively affects brain function. The metabolic rate decreases during hepatic coma, toxins enter directly into the blood, move directly to the brain, and provoke the occurrence of cerebral edema. As a result, the prognosis may be sad.

Hepatic coma - treatment

Liver pathology is usually treated in the intensive care unit, regardless of the stage of the disease, and is treated in intensive care unit, this is not affected by the stage of development of the disease. Every two hours, doctors monitor the level of substances in the blood. If symptoms of a precomatose state appear, the patient must be laid down and his head raised. Special solutions are injected intravenously to replenish blood volume, equalize electrolytes, and blood pH.

Important: The patient is not able to feed himself, so amino acids, glucose, and fat emulsions are infused intravenously.

In addition, through enemas, the patient’s body is cleansed of toxins. If the level of oxygen in the blood is low, additional oxygen therapy is prescribed. To help the liver start working again, doctors prescribe a course of glucocorticosteroids.