liver insufficiency
Introduction
Introduction Hepatic insufficiency refers to severe damage to liver cells caused by certain causes, which may cause damage to the liver's morphological structure and cause serious disorders such as secretion, synthesis, metabolism, detoxification, immune function, etc., jaundice, bleeding tendency, serious infection, hepatorenal syndrome Pathological processes or clinical syndromes of clinical manifestations such as hepatic encephalopathy. The liver is the main place for many drug metabolism. After the drug enters the human body, it is usually metabolized and excreted by the liver and kidney. Therefore, it is necessary to reduce the amount of medication and the number of medications used, especially when using drugs with hepatotoxicity.
Cause
Cause
There are many reasons for liver dysfunction, which can be summarized as the following categories:
Infection
Parasites (Schistosomiasis, Clonorchis sinensis, Amoeba), Leptospira, bacteria, and viruses can cause liver damage; especially viruses are most common (such as viral hepatitis).
2. Chemical poisoning
For example, carbon tetrachloride, chloroform, phosphorus, antimony, arsenic, etc., can often destroy the enzyme system of liver cells, cause metabolic disorders, or inhibit the oxidative phosphorylation process, reduce ATP production, leading to degeneration and necrosis of hepatocytes; For example, chlorpromazine, salicylic acid, isoniazid, certain iodine drugs, and antibiotics (such as tetracycline), even at therapeutic doses, can cause liver damage in a few people, which may be related to allergies.
3. Immune dysfunction
Liver disease can cause abnormal immune response, and abnormal immune response is one of the important causes of liver damage. For example, humoral immunity and cellular immunity caused by hepatitis B virus can damage liver cells; hepatitis B virus surface antigen (HBsAg), core antigen (HBcAg), and e antigen (HBeAg) can bind to the surface of liver cells and change liver. The antigenicity of the cell membrane causes autoimmunity. Another example is primary biliary cirrhosis. The patient's blood contains various antibodies (anti-small bile duct antibodies, anti-mitochondrial antibodies, anti-smooth muscle antibodies, anti-nuclear antibodies, etc.), and may also be an autoimmune disease.
4. Undernutrition
In the absence of choline or methionine, it can cause liver fatty changes. This is because the transport of intrahepatic fat must first be converted to phospholipids (primarily lecithin), which is an essential component of lecithin. Methionine supplies a methyl group that synthesizes choline. When these substances are deficient, the removal of fat from the liver is blocked, causing fatty changes in the liver.
5. Biliary obstruction
Biliary obstruction (such as stones, tumors, mites, etc.) causes cholestasis. If the time is too long, hepatic cells may be caused by the damage of hepatocytes caused by retained bile and hepatic ischemia caused by intrahepatic dilated bile duct compression. Denaturation and necrosis.
6. Blood circulation disorders
Such as chronic heart failure, causing liver congestion and hypoxia.
7. Tumor
Such as liver cancer damage to liver tissue.
8. Genetic defects
Some liver diseases are genetic diseases caused by genetic defects. For example, due to the inability of the liver to synthesize ceruloplasmin, copper metabolism is impeded, causing hepatolenticular degeneration; in the liver cells, there is a lack of 1-phosphoglucose galactosidase, and 1-galactose is not converted to 1-phosphate. Glucose accumulates, damages liver cells, and causes cirrhosis.
Examine
an examination
Related inspection
Liver prothrombinase test reflects liver storage function test liver fibrosis index check serum alanine aminotransferase hepatitis A antibody
First, changes in material metabolism
In the case of liver dysfunction, changes in metabolism are multifaceted, including proteins, lipids, sugar, and vitamins. It also reflects changes in plasma protein, cholesterol and blood sugar levels in the blood.
(1) Changes in protein metabolism
The main manifestation is the change in plasma protein content.
(two) changes in plasma cholesterol levels
1. Simple biliary obstruction, blocked cholesterol discharge, total plasma cholesterol increased significantly, and cholesterol esters accounted for a normal percentage of total cholesterol.
2. The liver cells are damaged, the cholesterol ester production is reduced, the plasma cholesterol ester content is decreased, the percentage in the total cholesterol is decreased, and the total plasma cholesterol is decreased or in the normal range.
3. Hepatocyte damage accompanied by biliary obstruction (such as jaundice hepatitis accompanied by small bile duct obstruction), total plasma cholesterol can be increased, but the percentage of cholesterol ester in total cholesterol is reduced.
(three) changes in blood sugar
Second, changes in serum enzymes
The liver is the most active organ of matter metabolism, and the enzyme content is extremely rich. Hepatocyte damage or liver dysfunction can also reflect changes in some enzymes in the serum, some increase, and some decrease. Clinically, changes in certain enzymes in serum are often used to measure liver function and to understand the degree of damage to liver cells or blockage of the biliary system.
(1) Some serum enzymes are elevated
(B) some serum enzymes are reduced
Third, changes in biological transformation and excretion function
(1) Detoxification function is reduced
(two) low extinction of hormones
(three) reduced drainage function
Fourth, hepatic encephalopathy (hepatic coma)
Diagnosis
Differential diagnosis
Identification:
Most liver diseases have symptoms of jaundice, which is caused by the fact that the liver cannot continue to excrete bilirubin. (In metabolism and a number of functions play a major role, including glycogen storage, decomposition of red blood cells, plasma protein synthesis and detoxification.) When the patient has elevated alanine aminotransferase, it indicates that the liver cells have substantial damage, The use of drugs with greater hepatotoxicity may aggravate liver damage. When the liver is insufficiency, the drug metabolism is inevitably affected, the biotransformation of the drug is slowed down, and the free drug in the blood is increased, thereby affecting the use effect of the drug and increasing the toxicity.
In the narrow sense, liver dysfunction refers to the extremely serious metabolic disorder manifested in the end stage of liver disease. Patients may have a series of clinical syndromes such as jaundice and ascites. In fact, the current liver function dysfunction in the drug manual refers to the abnormal liver function, that is, the symptoms of transaminase and bilirubin in patients with liver disease.
