Liver failure and hepatic coma are severe syndromes resulting from severe impairment of liver function. Also called liver failure. In general, the liver is an organ with a large reserve capacity and can maintain life even if 2/3 of it is removed. However, if the liver is damaged beyond this limit, symptoms of decompensation and irreversible progression appear. In other words, jaundice, multiple hemorrhagic predisposition, etc. occur, and the most important symptom is hepatic coma.
Hepatic encephalopathy, also known as hepatic encephalopathy, is a condition in which patients with hepatic dysfunction experience impaired consciousness or behavioral changes. It occurs because ammonia, amines, lower fatty acids, etc. increase in the blood due to extensive necrosis of the liver, functional disorder, blood flow disorder or portal vein short circuit, resulting in poisoning of brain nerve cells.
Severe hepatic impairment is thought to be caused by an increase in aromatic amino acids in the blood due to a disorder in the ammonia metabolism process, resulting in a decrease in branched amino acids. Hepatic coma is classified into stages 1 to 4 depending on the severity of symptoms. Stage 4 of hepatic coma is in a coma, sometimes responding to painful stimuli, but gradually becomes unresponsive and falls into a deep coma.
For the treatment of hepatic coma, corticosteroid administration, plasma exchange, glucagon and insulin therapy, and liver transplantation are attempted for acute liver failure such as toxic or fulminant hepatitis, but the prognosis is extremely poor and the fatality rate is very high.
Treatment of chronic hepatic coma seen in the late stages of liver cirrhosis includes enema, protein restriction, and administration of lactulose. In addition, factors that induce or promote hepatic coma, such as respiratory alkalosis, hyponatremia, hypokalemia, anemia, and infectious hypoglycemia, should be corrected, while sedatives, sleeping pills, and diuretics should be stopped.
There is no known prophylactic method for liver failure. However, it is necessary to be careful not to get viral liver disease and alcoholic liver disease, which can be underlying diseases of liver failure, and to receive medical treatment from a doctor periodically to slow down the progression of the disease. In addition, thorough monitoring and prompt treatment for hepatic coma, esophageal variceal bleeding, and peritonitis accompanying liver failure will be able to prevent disease progression.
Hyunsik Kim Seongji Hospital internal medicine specialist wonjutoday@hanmail.net
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2023-05-22 00:39:10
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