Liver failure

Liver failure

    * Introduction
    * Causes
    * Symptoms
    * Diagnosis
    * Treatment
    * Measures to prevent
Liver failure occurs when the liver loses its ability to exercise its functions. It is a life-threatening medical condition that requires emergency care. Induficienta liver can develop over several years, chronic liver failure or rapidly in a few days or weeks, acute liver insuficianta.
The most frequent causes of liver failure include: hepatitis B and C, alcohol abuse, malnutrition, liver cirrhosis from any cause, hemochromatosis.
Acute liver failure is determined by other clinical pathological conditions such as acetaminophen abuse, viral hepatitis especially in children, adverse reactions to certain drugs, eating poisonous mushrooms. Many events are due malfunctiei liver. Thus liver can not properly process bilirubin, a product of metabolism of erythrocyte aging and it is not excreted. The result is jaundice. The liver can not synthesize sufficient amount of blood clotting produced by prolonged bleeding wounds and forcing an exaggerated tendency to bruise. Portal hypertension often occurs. This causes accumulation of fluid in the cavity abdominalaascita, hepatic encephalopathy, or both.
A person with liver failure shows jaundice, ascites, encephalopathy and a poor health condition. Other common symptoms involve: fatigue, muscle weakness, nausea and anorexia. In acute liver failure can worsen health in a few days. Doctors can diagnose liver failure Basing on symptoms and physical examination. Evaluate liver function blood tests, which is usually severely impaired.
Treatment depends on the cause and specific symptoms. The urgency of treatment depends on whether the failure is acute or chronic, but the principles are the same. The most important step is identifying the cause of liver failure. The prognosis depends on etiology. Initial treatment is resuscitation. Patients with encephalopathy should be transferred to intensive care monitoring. As the patient developed progressive encephalopathy is required intubation and artificial respiration. Most people tend to develop circulatory dysfunction. Such control is required circulatory fluids, hemodynamic, metabolic parameters and monitoring for possible infection. Maintaining nutrition and prompt recognition of gastrointestinal bleeding are crucial. Coagulation parameters, blood counts and metabolic parameters must be controlled frequently. Serum aminotransferases and bilirubin are measured daily.
Liver transplantation is the definitive treatment that can cure the patient. The prognosis is dependent on the cause of failure. Development of complications is another factor that determines survival.
Pathogenesis
The development of cerebral edema is the major cause of morbidity and mortality in patients with liver failure. The etiology is not fully understood but appears to be multifactorial.
It is considered to be cytotoxic and vasogenica as origin. Cytotoxic edema is a consequence of alterations resulting brain cell swelling osmoreglarii astrocytes. In the brain ammonia is detoxified to glutamine. In hepatic ammonia is not removed by the liver and accumulates in the blood ajungin critical quantities in the brain. Accumulation of glutamine in brain astrocytes cause edema. Another phenomenon involved is increased intracranial blood volume by altering brain self-regulation. Self-regulation is mediated by nitric oxide, which acts as a vasodilator. Cytokines such as IL-1, TNF-alpha and bacterial endotoxins are also involved.
Another consequence of multiorgan failure liver failure is often observed in the context of a circulatory status hiperdinamic mimicking sepsis.
Acute liver failure is most often caused by the abuse of paracetamol. Hepatic metabolism of acetaminophen resulted in a highly toxic metabolite to the liver. It reduces large amounts of hepatic glutathione reserves, sunstanta anti-oxidant which protects the liver tissue oxidation of free oxygen radicals formed during exercise metabolic functions. For drinkers needed a low dose of acetaminophen.