What is hepatocellular failure syndrome

Hepatocellular failure syndrome is a serious organ pathology. It develops against the background of various violations of hepatic activity, accompanied by metabolic disorders, acute generalized intoxication of the body, dysfunctions in the work of the central nervous system and the progression of encephalopathy and hepatic coma.

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What is hepatocellular failure syndrome

Hepatocellular failure syndrome is a pathology that is formed as a result of dysfunctions of the organ’s compensatory capacity. The result is the inability of the liver to provide a full metabolic process.

The problem with such a disease is that it does not have pronounced clinical manifestations characteristic only of it. Therefore, the syndromes of liver damage are often diagnosed when the disease progresses to an advanced stage.

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Classification

The classification of pathology is as follows:

  • acute form of liver failure,
  • chronic form of liver failure.

The timing of the development of each form is also different. The exacerbation stage develops several weeks after the defeat of hepatocytes. The predisposing factors for the development of an acute form of the disease are various toxic organ damage – viral hepatitis, alcohol or drug damage. But the chronic phase of the disease develops slowly, it is usually triggered by chronic organ diseases – cirrhosis, tumor, fibrosis.

There are three degrees of development of pathology: early, severe and terminal dystrophic. The last stage in the development of the disease is clinical hepatic coma.

Causes

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There are a large number of different reasons that can provoke the further development of the pathological process. Among them, various organ diseases can be distinguished – the presence of cirrhosis, hepatitis, tumor-like processes.

Another reason is the development of obstructive changes in the bile ducts. In this condition, the compression of bile increases, against the background of which there are disturbances in the outflow of blood and lymphatic fluid, as a result, dystrophic changes in the liver cells.

Various dysfunctions in other organs and systems can affect the development of insufficiency: diseases of the heart apparatus and the vascular system, malfunctions of the organs of the endocrine system, diseases of infectious and autoimmune genesis.

The gradual development of the syndrome can be caused by intoxication of the body with medications (for example, antibacterial drugs that are taken for a long time and uncontrollably by the patient), poisonous mushrooms, dichloroethane, clandestinely made alcoholic beverages.

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Another cause of such a disease can be a serious effect on the body (for example, with extensive burns, trauma, with massive loss of blood fluid, septic shock).

Regardless of how the provoking factor causes the development of pathology, the outcome will be the same – irreversible changes in the structure of hepatocytes. Since they are very susceptible to oxygen deficiency, the disease progresses rapidly.

Clinical signs

During an acute process, which is accompanied by a rapid rate of destruction of hepatocytes, a large number of pronounced clinical signs appear that cannot go unnoticed by a person. There is puffiness in the lungs, the central nervous system suffers, since the cleansing function of the body’s natural filter is impaired.

Symptoms of a negative effect on the central nervous system are: lethargy, constant drowsiness, bouts of nausea, or, on the contrary, asthenic manifestations: excessive irritability, hyperexcitability, trembling hands, or even seizures. Additionally, renal dysfunction occurs.

Diagnosis and laboratory signs

Diagnosis of clinical patients with liver diseases is usually carried out even when the pathological processes are in a serious stage of their development. Liver failure is manifested by the following main symptoms.

Cholestasis – develops due to dysfunctions in the outflow of bile or as a result of blockage of the gallbladder channels. Symptoms of this condition are soreness in the right side, nausea, discomfort or heaviness in the epigastrium, upset of the intestinal tract. A pronounced sign of a developing ailment is the yellowness of the epidermal layer.

Such signs are due to the release of bilirubin into the blood fluid, this can also be seen from the results of biochemical analyzes of blood fluid.

Hepatocellular failure. This condition develops when the hepatocytes are no longer able to perform their usual functions. After a series of negative changes, a gradual destruction of cells occurs, due to which a large number of intracellular compounds are released into the blood fluid. It is by the indicators of the level of these structures that doctors talk about how pronounced the pathological process is in the tissues of the organ.

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In hepatocellular failure, changes in the organ are irreversible. With necrotic tissue lesions and death of hepatocytes, the symptoms are pronounced. The patient develops hyperthermia, its indicators sharply become febrile.

The liver is swollen and enlarged. Stool becomes almost colorless. The mode of blood circulation changes, this is manifested by tachycardia, hypertension, or a sharp drop down in systolic and diastolic blood pressure indicators.

Diagnosis of liver failure involves its own examination methods. The diagnosis of cellular insufficiency is made on the basis of all test results, laboratory and instrumental. First, the doctor collects anamnestic data to find out the possible cause of the pathology.

Next, laboratory tests are assigned: biochemical parameters of the kidneys and liver, determination of the degree of activity of negative changes in the tissues of the organ. With such a violation, the blood fluid clotting rate, the erythrocyte sedimentation rate also make it possible to determine whether neighboring organs are involved in pathological processes.

Mandatory instrumental diagnostic methods are: ultrasound, computed tomography, magnetic resonance imaging, electrocardiogram.

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Hepatic (production) hyperazotemia

This condition is characterized by an increase in the concentration of nitrogenous compounds in the blood fluid – urea, creatinine.

Hepatic hyperazotemia develops as a result of deterioration of blood microcirculation, with severe hepatic failure. The treatment is carried out by a hepatologist after a preliminary diagnosis.

Lack of synthetic liver function

In the liver, the synthesis of various high molecular weight protein structures occurs. Their main task is the outflow of bilirubin, the breakdown of hormonal substances and components of medications.

With violations in the synthesis of proteins, the corresponding symptoms occur – ascites, edema. In addition, the synthesis of bile is disrupted, negative changes occur in the hematopoietic system (blood can coagulate poorly).

Characteristic biochemical changes

When studying biochemical parameters, the following changes are found:

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  • the amount of urea increases,
  • the concentration of bilirubin increases,
  • there is an increased level of cholesterol,
  • erythrocyte sedimentation rate decreases

Disease in children and pregnant women

Acute liver failure in children is rare. But this condition is more dangerous than for adults, since the cells quickly die, the child may simply not have time to get first aid. Diagnostics is carried out by the same methods as for adults, the treatment is also not much different.

During pregnancy, the organ experiences a double load, so many diseases can be exacerbated. This is accompanied by painful sensations in the right abdomen, nausea, and yellowness of the skin. In this case, only a specialist is involved in the treatment.

Treatment

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Liver failure requires prompt and timely therapy. How long the treatment will be, directly depends on what stage the pathological process is in.

Emergency care for acute liver failure consists in the use of antibacterial medications, hepatoprotective drugs, lactulose, vitamins.

If the cause is hepatitis of viral genesis, the administration of specific interferons is prescribed. If calculi in the gallbladder ducts are the cause, therapy is performed to eliminate them. In the presence of severe ascites, doctors prescribe a procedure to remove secretions from the cavity. Predicting a successful outcome directly depends on how timely the therapeutic intervention is.

Diet

In this condition, therapy primarily involves diet. It is important to reduce your intake of protein and salt. It is also recommended to exclude the consumption of fried, fatty, spicy, smoked foods. Alcoholic drinks are completely excluded.

It is important to observe the drinking regime – drinking at least two liters of clean water per day.

As a preventive measure for the development of pathology, doctors advise: get vaccinated against hepatitis, eat right, do not abuse alcohol, take hepatoprotectors, if there is a need for treatment with antibacterial drugs, carefully follow all the rules of personal hygiene, do not use other people’s hygiene products.

Complications and negative consequences

One of the most dangerous consequences is the infectious process – peritonitis. This condition develops with severe tissue damage. Another complication is the development of bleeding from the esophagus. Other dangerous consequences include: hepatic coma, death, sepsis, brain damage.

Prediction of this disease directly depends on the stage at which the pathology is detected and how timely the treatment is started.

Tatyana Jakowenko

Editor-in-chief of the Detonic online magazine, cardiologist Yakovenko-Plahotnaya Tatyana. Author of more than 950 scientific articles, including in foreign medical journals. He has been working as a cardiologist in a clinical hospital for over 12 years. He owns modern methods of diagnosis and treatment of cardiovascular diseases and implements them in his professional activities. For example, it uses methods of resuscitation of the heart, decoding of ECG, functional tests, cyclic ergometry and knows echocardiography very well.

For 10 years, she has been an active participant in numerous medical symposia and workshops for doctors - families, therapists and cardiologists. He has many publications on a healthy lifestyle, diagnosis and treatment of heart and vascular diseases.

He regularly monitors new publications of European and American cardiology journals, writes scientific articles, prepares reports at scientific conferences and participates in European cardiology congresses.

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