liver disease

 Liver failure:

As one of the important organs of the human body, the liver has the functions of synthesis, detoxification, metabolism, secretion, biotransformation and immune defense. It is also called a "processing plant". When multiple factors (such as viruses, alcohol, drugs, etc.) cause severe damage, a large number of liver cells die, leading to severe damage or decompensation of the above functions, and then the coagulation mechanism disorder is mainly manifested by jaundice, hepatic encephalopathy, and ascites A group of clinical syndromes is called liver failure. Clinical symptoms include extreme fatigue, loss of appetite, abdominal distension, nausea, vomiting, and changes in consciousness. Because the disease progresses rapidly, treatment is difficult, medical expenses are high, and the overall prognosis is poor.

Disease classification:

According to histopathological characteristics and disease progression rate, liver failure is divided into acute liver failure (ALF), subacute liver failure (SALF) and chronic acute (subacute) liver failure (acute-on-chronic liver failure, ACLF) ) Four categories and chronic liver failure (chronic liver failure, CLF). See the table below for specific definitions.

Name	Definition
Acute liver failure	Acute onset, liver failure characterized by hepatic encephalopathy above grade II within 2 weeks of onset
Subacute liver failure	The onset is rapid, and clinical manifestations of liver failure appear within 15 days to 26 weeks of onset
Chronic-on-acute (subacute) liver failure	Acute or subacute liver decompensation based on chronic liver disease
Chronic liver failure	On the basis of liver cirrhosis, chronic liver function decompensation with ascites or portal hypertension, coagulation dysfunction and hepatic encephalopathy as the main manifestations caused by progressive decline in liver function

Reason:

liver disease

At present in my country, the main cause of liver failure is still hepatitis virus (mainly hepatitis B virus, accounting for about 80-85%), followed by drugs or hepatotoxic substances (such as alcohol, chemical agents, etc.); while in European and American countries, drugs It is the main cause of acute and subacute liver failure, and alcohol often leads to chronic liver failure. In addition, acute fatty liver during pregnancy, autoimmune liver disease, and parasitic infections can also lead to liver failure.

The etiology of liver failure in children is unknown, and inherited metabolic diseases (including hepatolenticular degeneration, galactosemia, tyrosinemia, Reye's syndrome, neonatal hemochromatosis, α1-antitrypsin deficiency, etc.). Zhu Shishu et al. In the analysis of 120 children with liver failure, in the infant group and the over 1 year old group, the cause of unknown disease was the first, 40.6% and 30.7%, respectively.

The cause of liver failure can be a single factor, such as infection with a certain hepatitis virus, alcoholism, taking a certain drug, etc., or a combination of multiple factors, such as repeated infection with other viruses on the basis of chronic hepatitis, chronic alcoholism Combined virus infection and so on.

Pathophysiology:

Histopathological examination has important value in the diagnosis, classification and prognosis of liver failure. Liver failure (except chronic liver failure) is mainly manifested by varying degrees of liver cell necrosis and residual liver cell regeneration. The location and extent of necrosis vary with the cause and course of the disease. In addition to the uneven distribution of hepatocyte necrosis, chronic liver failure mainly manifests as diffuse liver fibrosis and abnormal nodule formation.

Onset:

The pathogenesis of liver failure is very complex, many factors can influence each other, the specific mechanism is not fully understood. It is currently believed that the mechanism of liver failure mainly includes two aspects: one is the direct damage of liver cells by various factors, such as drugs, viruses, etc., which directly destroy liver cells, leading to liver cell necrosis. Different degrees; the other is immune mechanism, such as immune damage mediated by cytokines or endotoxin.

Clinical manifestations:

Disease symptoms

Extreme fatigue, severe gastrointestinal symptoms (abdominal pain, bloating, nausea, loss of appetite, vomiting), skin and mucous membranes gradually turn yellow, urine gradually darkens, severe coagulopathy (skin and mucous membrane bleeding, nose bleeding, gum bleeding Indigestion) urethral hemorrhage, urethral hemorrhage, etc.) are the main common clinical features, low-grade fever, various complications, etc. may also occur. The specific clinical manifestations vary depending on the classification of liver failure.

(1) Acute liver failure: Acute onset, with hepatic encephalopathy above grade II (manifested as personality changes, abnormal behavior, confusion, confusion, sleep disturbance, decreased orientation and understanding, etc.) within 2 weeks. Beijing You’an Hospital collected data on 50 patients with acute liver failure: 88% of patients experienced high fatigue, 80% of patients experienced severe loss of appetite, 76% of patients experienced nausea and vomiting, and 84% of patients experienced abdominal pain and swelling. Young people under 40 account for 78% of cases. Due to his previous physical fitness and strong tolerance to the disease, he can still work or work in the early stage of the illness. In addition, insufficient knowledge of the disease is also one of the reasons for this disease.

Complication:

Ge Zongcheng et al. A retrospective analysis of 437 patients with liver failure, the incidence of acute liver failure, subacute liver failure, and chronic liver failure were different. The incidence of hepatic encephalopathy was 70.7%, 41.3%, and 37.3%, respectively, and the incidence of ascites was 70.7%, 41.3%, and 37.3%, respectively. The ratios are 51.2%, 58.6% and 88% respectively. The electrolyte imbalance rate was 65.8%, 54.8%, and 81.5%, respectively. The incidence of cerebral edema was 70.7%, 35.6% and 14.7%, respectively. The incidence of hepatorenal syndrome are respectively. 21.9%, 18.3%, 17.5%, spontaneous peritonitis incidence 12.2%, 22.1%, 52.7%, brain herniation incidence 17.1%, 8.6%, 6.5%, upper gastrointestinal bleeding incidence 12.2%, 14.4%, 30.5% . [10]

(1) Hepatic encephalopathy: In liver failure, due to the overall disorder of liver function, neurological syndromes of varying degrees can be caused, mainly manifested as disturbances of consciousness, behavioral disorders and coma, which can eventually lead to death.

(2) Disorders of water-electrolyte acid-base balance: due to severe gastrointestinal symptoms, hyponatremia, hypokalemia, hyperkalemia, and acid-base balance disorders may occur when diuretics are used.

(3) Renal insufficiency: due to insufficient effective circulating blood volume and the influence of endotoxin, functional renal insufficiency can be caused. If it is not corrected in time and effectively, it can lead to organic renal insufficiency and ultimately to renal failure.

(4) Severe nosocomial infections: due to poor immune function, intestinal microecological imbalance, reduced intestinal mucosal barrier function and more aggressive surgery, various nosocomial infections can be combined during hospitalization, which can aggravate the condition, including various fungi And bacteria etc.

(5) Various bleeding caused by coagulation dysfunction: such as epistaxis, mucosal ecchymosis, and even internal bleeding.

(6) Abnormal blood glucose metabolism: Severe hypoglycemia may occur due to loss of appetite and liver glucose metabolism disorders.