Liver failure
Introduction
Introduction As one of the important organs of the human body, the liver is also known as the processing factory because of its functions of synthesis, detoxification, metabolism, secretion, biotransformation and immune defense. When caused by a variety of factors (such as viruses, alcohol, drugs, etc.) causing serious damage, resulting in a large number of hepatocyte necrosis, resulting in serious disruption or decompensation of the above functions, and then the occurrence of coagulation disorders and jaundice, hepatic encephalopathy, ascites A group of clinical syndromes that are primarily manifested, called liver failure. Clinically, the main symptoms are extreme fatigue, loss of appetite, abdominal distension, nausea, vomiting, and mental changes. Due to the rapid progress of the disease, the difficulty of treatment, the medical expenses are expensive, and the overall prognosis is poor.
Cause
Cause
Causes:
1. At present, the main cause of liver failure in China is still hepatitis virus (mainly hepatitis B virus, accounting for 80-85%), followed by drugs or hepatotoxic substances (such as alcohol, chemical agents, etc.). In Europe and the United States, drugs are the main cause of acute and subacute liver failure, and alcohol often leads to chronic liver failure. In addition, acute fatty liver, autoimmune liver disease, parasitic infections, etc. can also lead to liver failure.
2, the cause of childhood liver failure is unclear, genetic metabolic diseases (including Wilson's disease, galactosemia, tyrosinemia, Reye syndrome, neonatal hemochromatosis, 1-antitrypsin deficiency Wait).
3, the cause of liver failure can be a single factor, such as infection with a certain hepatitis virus, alcoholism, taking a certain drug, etc., can also be caused by a combination of factors, such as overlapping with other viruses on the basis of chronic hepatitis, chronic Alcoholism is based on a combination of viral infections.
Examine
an examination
Related inspection
Liver function test liver ultrasound examination liver ascites examination liver palpation liver, gallbladder, spleen CT examination
1. Whole blood cell analysis: Classification of white blood cells, hemoglobin, platelets, and white blood cells: to know whether there is hypersplenism and infection.
2, urine specific gravity, PH value, urinary bilirubin, urinary bilirubin, etc.: Indirectly judge the type of jaundice, preliminary judgment of the body's metabolic status.
3, regular + occult blood stool traits, cells and occult blood: to understand whether there is gastrointestinal bleeding.
4, liver function ALT, AST, TBIL, ALB, CHE, CHO, PALB: understand the degree of liver damage and liver combined reserve capacity.
5, blood biochemistry and blood glucose K, Na, Cl, Bun, Cr, Glu: understand electrolytes, kidney function and blood sugar levels.
6, blood gas analysis PH, PCO2, PO2, HCO3, etc.: to understand the body's acid-base balance.
7, blood ammonia blood NH3: combined with physical examination to assess the presence of hepatic encephalopathy.
8, ultrasound or CT, nuclear magnetic abdominal organs BUS or CT, nuclear magnetic: evaluation of liver size, degree of injury and blood vessels, bile duct diameter, while excluding malignant obstructive lesions.
9, electronic gastroscope or upper gastrointestinal angiography or barium meal: understanding of esophageal varices, gastric mucosa, especially the history of chronic liver disease and long-term alcoholics.
Diagnosis
Differential diagnosis
In 2006, the Chinese Medical Association Infectious Diseases Liver Failure and Artificial Liver Group, the Chinese Medical Association Liver Diseases Branch, the Liver Failure and Artificial Liver Group issued the "Guidelines for the Diagnosis and Treatment of Liver Failure" for various causes (virus, drugs, alcohol, etc.) Caused by liver failure, diagnostic criteria:
(1) Acute liver failure: acute onset, hepatic encephalopathy with degree II or above within 2 weeks, jaundice can be less than 10 times the upper limit of normal value. In the short term, jaundice is progressively deepened, and physical examination or ultrasound indicates that the liver is progressively reduced.
(2) Subacute liver failure: The onset is more urgent, the onset period is from 15 days to 26 weeks, and the jaundice is rapidly deepened, requiring more than 10 times the upper limit of normal value or 17.1umol/L per day.
(3) Slow plus acute (subacute) liver failure: On the basis of chronic liver disease, the above-mentioned acute (subacute) liver function decompensation performance occurs in a short period of time, and the test TBIL171umol/L, and PTA40%.
(4) Chronic liver failure: On the basis of cirrhosis, progressive liver function decline and decompensation. The main points of diagnosis are: 1 There is ascites or other portal hypertension (blood reduction, gastrointestinal bleeding, etc.). 2 may have hepatic encephalopathy. 3 serum total bilirubin increased (can be less than 10 times the upper limit of normal), albumin decreased significantly. 4 There must be coagulopathy, PTA 40%.
