Active liver failure – hepatic encephalopathy – pathophysiology. Diagnostics and treatment Andrzej Gładysz, Monika Pazgan-Simon Medical Science Review - Hepatologia 2005; 5 41-47 aaICID: 16111
IC™ Value: 1.86
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Katedra i Klinika Chorób Zakaźnych,Chorób Wątroby i Nabytych Niedoborów Odpornościowych AM we Wrocławiu
Acute liver failure is a severe, life- threating clinical condition caused by a sudden impairement of liver functions in consequence of hepatocyte damage. The most common causes of acute liver failure are: acetaminophen poisoning, acute liver hepatitis and Wilson’s disease. Acute liver failure has a few forms: fulminant, acute, retarded. The disease is characterized by a cellular dysfunction and multiple organ failure. At the cellular level, all metabolic processes are affected: synthesis and degradation of hydrocarbons, lipids, aminoacids, hormones, detoxication and porphyrin metabolism. In cosequence, systemic disturbances such as cellular oxygen order increase, coagulation and fibrinolysis disturbances, jaundice, renal failure and serious bacterial infections are observed. Encephalopathy develops in many patients, due to the following causes: increased level of ammonia, disturbances of glutaminate metabolism, changes in NMDA and GABA receptor answers, manganese. Cerebral edema, the major death cause, develops in many patients.It occurs due to disturbances of glutamate metabolism, protein kineases – also, the role of protective endogenouse inhibitors: taurine and kynurenic acids is emphasized. Concervative treatment methods includes the use of laxatives, nonprotien diet, lactulose, neomycin, preventive treatment with antibiotics, GABA inhibitors, mannitol, hyperventilation and hypothermia.Liver transplantation is the best treatment option for most patients with acute liver failure.