Liver brain (liver coma)

Liver brain (liver coma)'s disease overview

Hepatitis , also known as liver coma , is a secondary loss of brain function when the liver cannot remove toxins. from blood. 

The disease causes changes in behavior, mental state and nervous system due to high ammonia concentration in the blood and brain causing too severe liver failure. 

Ammonia is derived from bacteria in the stomach and intestines. Usually the liver will metabolize ammonia. However, for people with liver disease, the concentration of ammonia in the blood is high because the liver does not work effectively, leading to ammonia stored in the blood and to the brain affecting the function of the brain causing symptoms of the disease. P>Is dangerous liver disease?

Hepatic brain disease is a serious complication of cirrhosis, very severe prognosis, 90% death, especially endogenous liver coma. Particularly for external liver coma, if adjusting the favorable factors after 48-72 hours the patient can get out of coma.

Prognosis depends on the favorable factors that cause liver coma and progression of cirrhosis.

Causes of Liver brain (liver coma)'s disease

The causes of external liver coma include:

  • Eat too much protein or excessive protein transmission in patients with long -term venous feeding patients.

    • Severe gastrointestinal bleeding.

  • Using strong diuretic, causing dehydration and hypokalemia.

    • Use liver poison: tetracycline, anti -tuberculosis, sedative, sleeping pills, antihypertensive drugs, nonsteroidal anti -inflammatory drugs

  • Alcohol poisoning

    • After surgery in patients with cirrhosis.

    Infection with liver, bile, kidney, lung, intestines.

  • Against: Due to poke many times or once too much reduces the amount of blood circulation through the liver

    • The causes of endogenous liver coma include:

  • Due to severe and widespread liver damage as in acute hepatitis, hepatitis is poisoned by inorganic phosphorus, tetraclorure de carbone, amanite phalloide, drugs or cancer due to cancer or cancer Liver or end -stage cirrhosis.

    • In addition, any disease that destroys liver cells and causes liver failure can lead to liver coma such as: hepatitis caused by virus (hepatitis B , hepatitis c), autoimmune disease or Reye syndrome.

    Patients with cirrhosis used with sedative or painkillers can also cause hepatic brain disease.

  • In case of too severe liver failure or due to the turning off the owner, the blood from the portal vein to the liver is no longer metabolized by the liver cells, becoming toxins that disrupt metabolic disorders In the tissue especially in the brain. These toxins include ammonia, Mercaptan, Acide Gama Amino Butyrid and aromatic amino acids

    • Symptoms of Liver brain (liver coma)'s disease

    In addition to the symptoms depending on the existing liver disease before the liver coma such as cirrhosis, hepatitis caused by virus, toxic hepatitis, ... The main symptoms include disorientation, dementia , drowsy. Patients may see drowsiness, mood changes, sleep, loss of even coma. Other symptoms include jaundice, language disorders, tremor, emotion, and cannot be moved. There are also symptoms of liver disease such as jaundice, chest bulging, testicular shrinkage, peritoneal effusion, leg edema.

    Liver coma is usually divided into 04 stages:

  • Money for liver: The manifestations of neurological disorders are still very gentle and discreet, need to be examined carefully to detect. 

    • Consciousness disorders: loss of space and time, drowsiness, sleeping.

    Change of personality: Laughing for no reason, irritability.

    Disorders of regulating and movement: manifested through ginger words, writing at first clear, later gradually smaller, lost strokes, difficult to read or doodled, may have vibration marks. 

  • Liver coma 1: The symptoms of liver money more clearly, during this period, the symptom of shaking wings is outstanding. There are also tower symptoms, increased babinski reflexes and increased towering tone, breathing breathing. 
  • Liver coma 2: Real coma with loss of awareness, sensory and movement. 

    • Liver coma 3: Deep coma, can be accompanied by real biomedical disorders, loss of reflexes and babinski.

    People at risk for Liver brain (liver coma)'s disease

    The factors that can increase the risk of liver coma are:

  • Dehydration
  • Eat too much protein

    • Gastrointestinal bleeding

    Infections

    Kidney pathology

  • There is a condition of hypoxemia
  • Using central nervous system inhibitors (such as barbiturat or sedative Benzodiazepine)

    • People with cirrhosis are likely to have 50% of normal people than normal people. 

    Prevention of Liver brain (liver coma)'s disease

    Methods to prevent liver coma include:

  • Patients should regularly have regular health checkups, when there are abnormal signs, they should immediately go to reputable specialized centers for examination. 
  • Consult your doctor before using drugs. Absolutely do not arbitrarily buy oral medications or combine Eastern medicine drugs without the guidance of a doctor.
  • Patients with liver disease should avoid use of stimulants, alcohol, diuretics, sedatives, excess eating.
  • Also avoid constipation by eating fiber -rich foods (vegetables, tubers, fruits, ...).

    • Should be vaccinated periodically to limit infection.

    Diagnostic measures for Liver brain (liver coma)'s disease

    is mainly based on the following main factors:

    Patients with a history of an acute or chronic liver, or after surgery to turn off the owner.

    Clinical examination:

  • There are cognitive disorders: Confusion and coma.

    • There are neurological symptoms such as muscle tone, increased reflexes, wing shaking, babinski, sometimes there are epilepsy symptoms.

  • Breathing with liver smell.

    • Testing:

  • Brain Electrical Map: High voltage, symmetrical, slow Delta wave.
  • Ammonia blood increases
  • Electrolyte disorders and acidosis: blood sodium usually decreases, potassium decreases, calcium is less affected, alkaline reserves increase, pco2 decreases.
  • Cerebrospinal fluid: glutamine, glutamic acid increases.
  • Liver function tests.
  • CT Scan and MRI: There may be brain atrophy or cerebral edema.

    • Differentiate diagnosis with other conditions such as alcoholic, overdose of sedatives, meningitis, hypoglycemia, brain cancer or stroke.

    Liver brain (liver coma)'s disease treatments

    Most patients with liver coma are hospitalized. 

    Treatment principles: Eliminate the promotion factors to get out of the acute phase, prevent recurrence and preserve the remaining parenchyma. 

    In addition to the media for treatment and monitoring, it is applied to the coma, the treatment of liver coma is based on the following theory:

    Determine and treat the cause of onset. Supporting treatment: In order to reduce and eliminate blood ammonia
  • Dietary reduction diet: If a patient with cirrhosis has many liver coma and keeps a poor protein diet, it should be used Combining real protein and animal. 
  • Drugs:

    • Medicines on ammonia metabolism in the small intestine: antibiotics (neomycin, metronidazol), lactulose (reducing blood ammonia due to increased ammilia in feces). 

    Medicines increase ammonia excretion through the kidneys: arginin and ornithin, sodium benzoate. 

    Surgery: If the liver coma occurs in the patient who has turned off the door - the owner must tie the connection, stop the ammonia generation by the colon bacteria by cutting the right and left colon - rectal. 

    Maintain energy and translate based on water and electrolytes.

    Treatment of fake neurotransmitters

    normalization of blood amino acids disordered in liver coma, regulating brain catecholamine deficiency by using L - dopa or dopamine homogeneous substance, bromOriptin. 

    Treatment is based on the hypotheses of benzodiazepine

    flumazenil is the antagonist of benzodiazepine receptors, the drug occupied the benzodiazepine receptor of endogenous substances from food or synthesized in the brain.

    Liver transplant

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