Hepatic Coma - Causes, Symptoms, Stages And Prognosis Of Hepatic Coma Treatment

2024 Author: Josephine Shorter | [email protected]. Last modified: 2023-12-16 21:43

Hepatic coma

What is hepatic coma?

Hepatic coma is the final stage of progressive liver failure. Against the background of severe intoxication of the body caused by pathological or mechanical damage, or the death of a significant part of the liver as a result of trauma, necrosis, or during its removal, as a result of acute and chronic liver diseases, symptoms of severe damage to the central nervous system, as well as other organs and systems, appear.

Causes of hepatic coma

Hepatic coma is divided into two types: hepatocellular, which occurs as a result of severe damage to a significant part of the liver cells in viral hepatitis (Botkin's bn), intoxication with chemicals, in case of poisoning with certain types of fungi and in other pathological conditions of the body (diseases of an infectious and non-infectious nature).

A shunt coma or "bypass" develops if the outflow of blood from the intestine does not pass through the liver, but through portocaval anastomoses. Perhaps there is also a mixed version of hepatic coma, in which both the breakdown of liver cells and bypass of the portal system occur.

The main reasons for the development of hepatic coma include: alcohol, drug intoxication, drugs. A shunt coma can be provoked by the intake of food rich in animal proteins. A predisposing factor for the development of hepatic coma is poisoning with ammonium derivatives and aromatic amino acids, the formation of non-toxic products from them occurs in the liver.

Hepatic coma symptoms

Hepatic coma develops gradually: the patient has a feeling of inexplicable anxiety, melancholy, apathy, euphoria. There is a slowdown in thinking, disorientation, sleep disturbance in the form of activity at night and irresistible drowsiness during the day. Shunt coma is characterized by transient disturbances of consciousness. Then the symptoms are aggravated: the consciousness is confused, the patient groans or screams at times, reacts to external stimuli (pain on palpation of the liver). Twitching of the muscles of the face and limbs, trismus (tonic spasm of the chewing muscles) of the jaw is often noted.

In the clinic, there are meningeal symptoms of Kerning and Brudzinsky, a positive symptom of Babinsky, tendon reflexes are increased. Specific symptoms appear: from the mouth "liver" odor, jaundice (may be absent with extensive necrosis of the parenchyma), tremor of the hands.

Hemorrhagic syndrome is expressed by petechial (capillary, point) hemorrhages in the mucous membrane of the oral cavity and gastrointestinal tract.

Free fluid accumulates in the abdominal cavity - edematous ascitic syndrome.

With extensive necrosis of the liver parenchyma, severe pains appear in the right hypochondrium. The respiration of Cheyne-Stokes, Kussmaul develops.

The terminal stage is characterized by liver failure with the addition of infection and the development of sepsis, the level of total bilirubin increases. Following this, a deep coma itself develops. The patient becomes immobile, motor excitement stops, sometimes convulsions are observed, the face is masked. The pupils are dilated, do not react to light.

Areflexia, rigidity of the occipital muscles are noted. Blood pressure is sharply reduced, pulse is threadlike, heart sounds are muffled, tachycardia is increasing. Corneal reflexes go out, sphincter paralysis occurs, and breathing stops.

Stages of hepatic coma

The clinical picture of the development of hepatic coma is presented in three stages: precoma, threatening hepatic coma, and developed hepatic coma.

- Precoma is characterized by disorders of orientation, thinking, sleep disorders (sleepiness during the day and wakefulness at night).

- At the stage of threatening hepatic coma, confusion appears. Attacks of arousal are replaced by drowsiness and depression. There is a disorder of coordination of movements, tremor of the fingers, speech impairment.

- The developed hepatic coma is characterized by a complete lack of consciousness, rigidity of the occipital muscles and muscles of the extremities, pathological reflexes. Jaundice progresses, the "liver" odor increases, the phenomenon of hemorrhagic diathesis. The body temperature rises, sepsis often joins. Oliguria develops and leukocytosis increases.

Hepatic coma treatment prognosis

The outcome of hepatic coma depends on the timeliness and intensity of the treatment initiated. If it is started at the first signs of the disease, then the chances of a favorable outcome of the disease are much greater. The success of the results depends on active complex therapy aimed at combating intoxication and improving the functional capacity of liver cells.

Article author: Mochalov Pavel Alexandrovich | d. m. n. therapist

Education: Moscow Medical Institute. IM Sechenov, specialty - "General Medicine" in 1991, in 1993 "Occupational Diseases", in 1996 "Therapy".