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Liver failure

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Liver failure
The liver is the greatest gland in the human body .. where he plays a key and very important role in his life .. no human can live without it .. Due to the importance of knowing the characteristics of this important organ and how to maintain and treat the injury bug .. show the most important causes of liver failure .. but before diving in this area and the big sea .. give a simple profile for this user and this great blessing from God ..
Brief Introduction ..


The liver is the largest organ in the human body .. and its location at the right side top of the body directly under the right ribs and has many functions, and is a maestro of the body is included in the overall balance of the process of the body, it is important how the composition of the blood and convert proteins, fats and eliminate some toxins and secretion of some yeasts, it also produces some physical defenses, which can impair led to the emergence of diseases and various infections, which that makes liquid healer who helps digest food, especially fatty substances .. and it can not take advantage of more food only after the intervention of proper liver work more converts these materials into useful elements for the body. Were it not for this work to become susceptible to the accumulation of waste and toxic substances, and that more intake of chemicals by mouth reduces the degree Tzmmha result of liver work, also is the energy stored in the body, so let all the liver healthy and not sick resulting in bodily proper work ..
Summarize the reasons for the many and complex liver failure as follows ..


Many reasons .. the liver by the very large burden because of the many functions which are carried out within the body .. It is susceptible to many diseases more than other members .. and liver effort and limited power has its cells Taatari some bugs satisfactory reasons or for reasons of age .. and generally causes many and we can not Nhzaretha in genetic or environmental factors ..


There are reasons more prevalent in Western countries, a ..
Related to genetic gene resulting from the imbalance in the secretion of bile in the liver Kaltlev,
And also the narrow congenital bile ducts, which will inevitably lead to the complete failure of the liver function,
Alcoholic liver of the most important types of cystic fibrosis in the West, but not everyone who drinks alcohol hepatitis happening to him but there are those who are weak ability to tolerate alcohol Vengdam develop hepatic inflammation leads with time to liver failure.


But in our areas of Arab ..
Fterdja reasons for failure to environmental pollutants ..
And to the wrong practices Ktaati drugs for a long time,
Also Schistosoma mansoni,


And viral infections of the liver three types (er, lobby, Lucy), which spread in the whole world, and more broadly in the third country in the world and the most dangerous B virus (HCV) and HIV (PE). Sore virus (HCV) is widespread in Egypt by private higher, especially compared to the rest of the world, including African countries. The virus (er) does not cause cirrhosis of the liver and is cured.
But the type (B) is considered the most dangerous type (AC) and due reason for the injury done to the use of contaminated syringes as through blood transfusions derivatives contaminated from the use of contaminated dental instruments also by circumcision in children, which is done by people who are not specialists and use of tools non-sterile, piercing the ears of the girls at the barber health because of the risk of exposing them to infection by viruses, and also births in the Egyptian countryside through (Daya) and use tools are not sterilized properly.
Symptoms and signs:
1 degeneration general health condition of the patient, and it seems the feeling of weakness and fatigue, loss of appetite, wasting, signs of undernutrition.


2 jaundice, which is the essential mark, and here are caused by liver cells inability to deal with the yellow pigment (bilirubin), and increasingly yellowing color increasing the liver breakdown.
3 of the manifestations of liver failure to increase the acceleration of blood in the circulatory system, Wesera pulse, pressure drops, and Ttwathb heart rate, and be warm Matturdh parties, or may livedo and Taatgr fingers if accompanied by rain and crystal spill.
4 fever is common in patients with liver failure, and are caused by microbes from the gut and other leak into the blood, and the inability of the liver dysfunctional refinery for booking bacteria and handling. This fever may be sudden and high, or be insidious inflammation of the peritoneum in cases of dropsy. Then there is another type accompanies cirrhotic patients, and the temperature is high it rose slightly to exceed 38 ° C, but it is continuous and is part of the clinical picture.


5 stinky liver, a distinct change in the breath, sometimes resembles the smell of mice, caused by materials generated from the intestine into the blood and Leaked. This distinctive odor of the signs of liver failure, and may foreshadow the imminent entry into coma.
6 changes, sexual dysfunction endocrine common. In males: the weakness of lust and power, loss of body hair and pubic Kalabt and chin, breast hypertrophy (It may be painful), and the small size of the testis. The females. Vvihn menstrual disorder has been interrupted, breast atrophy, atrophy of the uterus, fertility is usually weak or non-existent.


7 skin changes, most notably redness of the palms, and arterial spiders. The redness of hands, it may be a natural and commonplace among members of some families, as well as frequently appears in pregnant women, and in patients with thyroid gland. And be redness and clear rules in the fingers, especially the thumb and pinky (both sides of the rest).
The arterial spiders, Victher appearance of the face, neck and upper chest, arms, and sometimes take the form of filaments of high red and blue and resemble paper banknotes. We must not confuse them with hairs scattered in the two men, they are from the congestion and varicose veins.
8 disruption of blood clots, the most important elements of fibrinogen and prothrombin, both of which depend on the performance of the liver cells.
9 dropsy.


10 doused the brain Hepatic Encephalopathy Hepatic these neuropsychiatric changes severity varies from simple mental disorders, a deep coma that may lead to death. Diseases early signs in the patient: sleep disorder, Vaiglb him sleep during the day but he loses sleep at night, slow to speak and slow movement in general, personal change, such as anxiety or depression, or indifference to, or difficulty thinking or tumble writing. Twitching body (Parkinson’s) one of the important signs, it seems clear in the hands, arms Alambsoutin Vkonhma bird wings batters. The coma They degrees, the simplest confusion and conduct disorder and confusion confusion, and lethargy, drowsiness drowsiness, then stunned and the disruption of speech stupor, though the patient is still responding to commands speaker, and finally deep coma that are not in response to the deep unresponsive coma. In chronic liver disease Kaltlev signs of nervous system injuries Kalshll bottom muscle spasm appear.


This psychological changes and nervousness may occur in acute liver Kalalthab Madahm disease, any sudden and severe brunt fulminant hepatic failure (Table 1) and the die (Taatnkerz) Khalaiaalqaibd comprehensive Motta and crumble functions within two weeks of its inception, it is more like a full removal of the liver, or the psychological changes occur and nervousness in chronic diseases Kaltlev, especially if the veins side conductive widened between the portal vein and vena cava (table 2). The closest explanation for such changes is leaking harmful substance finds its way from the intestine to the blood, liver Tsog and up to the brain Vtvsd performance (Figure 1). This article arises from the act of gut bacteria. Most probably they ammonia (ammonia). There are of course other possibilities Kalominac, amino acids and acid (GABA). (Gamma aminobutyric acid) and there is also a chemical imbalance that can affect the liver cells and cells of the body in general, the acid balance disorder. And alkali, or Alaketrulyat disorder Kalsodiom, potassium, or low blood sugar. These disturbances have sometimes directly causes Kagaye, diarrhea or diuretic drugs, or fever, or bleeding, or excessive eating proteins such as meat, or wine, or severe constipation. These direct causes are corrected, and an important part of treatment.
How and diagnostics ..


As we mentioned earlier the symptoms of liver failure and clinical signs, especially the brain and poured hepatitis and hepatic coma. And means of diagnosis depends on the different causes and sources, Kthalal chemical blood (sugar level, and the level of ammonia, and the proportion of Alaketrulyat Kalsodiom and potassium), and analysis of cerebrospinal fluid CSF, and the protein content may go up but the number of abnormal cells.
It is the most important means of diagnostic ECG brain EEG for patients with liver failure, and it decreases the number of vibrations of the natural rhythm known as «Alpha alpha» and is 8-13 pulse per second, and up in the state of coma to less than 4 pulses per second, a rhythm «delta delta» ( Figure 2) and this change starts in the frontal lobe or middle of the brain on both sides and then extends to the back, drawing electrical brain is of great value for the diagnosis and follow-up treatment, but the changes that we have described may occur in other diseases Kedzmm urea uremia and low blood sugar.
There are also modern methods of imaging the brain ray computer CT CT and magnetic resonance MR and it shows or Dima brain cerebral edema in some cases, or atrophy of the cerebral cortex, so eager are some specialized centers to measure the pressure inside the skull and monitored constantly, and work to lower it if the rose (Balmanatol and other means).


the cure ..
Direct causes liver failure and hepatic coma mentioned earlier, much of which is uncorrectable. Bleeding from the gastrointestinal tract, fever, vomiting, diarrhea, abuse of diuretics, excessive eating proteins or abuse alcohol or constipation … etc.
The underlying reasons vary depending on the disease. There are, for example, hepatitis Madahm, in which the liver breaks down comprehensive and sudden collapse, due to hepatic viruses or harmful effects of certain medications, or pre-eclampsia. Such cases should be handled with the utmost attention and continuous follow-up, preferably placed in intensive care centers, because they are in spite of the seriousness of a full recovery in many of them.
The chronic liver disease, cirrhosis, and mostly, they have a comfort food Almnspain, and most of these patients are allowed to moderate activity and diet provides about 2,500 calories per day.


As for proteins, there is no need for the ban as long as the patient is not suffering from a coma or introductions, and has to have 50-60 g protein per day. Alcohol is forbidden at all. Vitamins may sometimes help if signs of shortages emerged. But many of the drugs market «that liver sloths active» or «protected from toxins», most of them useless, and some might hurt, especially if it contains a high proportion of choline or methionine. Hypnotics and sedatives nerves improves avoided unless necessary, and sexual stimuli useless.


In hepatic coma, and pre-coma, we must prevent the protein is strictly full of food, Nawwadh calories needed by stomach tube or intravenously. Constipation sworn enemy, wash colon rectal injection, we give the patient oral medication to Aktauluz (and likeness for Aktewol), which softens the intestine and prevents the formation of ammonia. For the same purpose, to give oral or gastric tube drug neomycin (4 g per day), an antibiotic cleanses the intestine from the bacteria which produces ammonia, it can be replaced crestomycin drug or drug metronidazole.
There is a precedent attempts to absorb the ammonia from the blood drug «Glutamine», but did not prove good.
Two drugs now and try out others to protect the brain from the harmful consequences associated with coma: The first drug is «bromocriptine» which helps in providing dopaminergic compounds needed to perform the functions of the brain. The second drug is «Flomazinal» which protects the brain from Abannsudaaziban compounds that may lead to coma.


The sharp coma caused by liver Madahm and the accompanying destruction of the collapse of the failure, they have extraordinary measures, because the problem is not limited to just the coma, but also the loss of all functions of the liver Chairperson of the imbalance of body fluids and Ketrulyath, and the disruption of the acid and alkali balance and imbalance in blood sugar, and the breakdown of blood clots and complications of severe bleeding, kidney failure and its complications, and the collapse of the blood and breath session, infection of different microbes and difficult to control, etc …


So we always prefer the transfer of such patients to intensive care departments, where constant medical supervision and accurate tests are available, and where the various solutions and blood products and rare devices available. And sometimes we resort to change the patient’s blood and replace a complete change by pure blood, or purify the blood of the patient from toxic substances Bamrarh in the system of the liver Liver support systems, support systems,
It is on three types: –


1 biological system, try the fifties of this century, and it tells (perfused) the patient’s blood outside the body in an animal or human liver, or in segments or Jnasat homogenates of tissues, but the results were not encouraging for the difficulty and lack of usefulness.
2 artificial system, based on the principle of adsorption adsorption in a column of active charcoal, or on the principle of dialysis in a dialysis membrane polymer semi port as in kidney dialysis. Despite the success of these artificial means to remove some of the toxins, but the clinical usefulness has not succeeded in prolonging the patient’s life.
3 artificial biological system (bioartificial liver (BAL) (Fig. 3) combines the advantages of the two systems, and which separates the plasma from the blood outside the body, and then is told through a column of coal, then through the so-called reactor biological (bioreactor)? It is a pipe hollow stuffed cells, liver taken from a dog or a pig. such cells can be saved and cooled and stored for long periods of uses clinical, and these systems experimented Albioastnaaah first in experimental animals – dogs, liver failure with severe failure Baagafar blood ischemia, Vtokdt feasibility of these systems as ammonia decreased the ratio of lactate in the blood, and increased glucose, as prothrombin ratio improved and stabilized blood dynamics. then these systems tested in a limited number of patients with liver disease and the result so far is encouraging. in Los Angeles, where lead researcher «Demetriou Demetriou» his team in these studies, he found improvement significantly in patients poured brain hepatitis, clinically and chemically, as they prepare a system of BAL this bridge crosses the patient critical stage even stand a chance of laying a new liver to him, or until the patient is able to restore the growth of cells in the liver of God and enough planting exorbitant expenses and potential problems.


Finally, there is encouraging attempts to culturing human liver cells, it is known that the liver cells and natural does not fall rapidly in cell cultures plants, but the kind of tumor hepatic human Alorome human hepatoblastoma possible culturing cells in the former biological reactor described, which produces about 200 g of cells, which are quantity needed for this purpose, since it is known that acute liver failure needs to be at least 15% of the normal liver mass (1200-1500 g) to maintain the functions necessary. Try this device permission extracorporeal liver assist device (ELAD) (Fig. 4) in dogs disarmament, including the liver, or offered for liver failure acute massive dose of the bar Asatamol, install the success of the device, as ammonia has decreased in the blood, and the back of the human albumin in the dog’s blood, and if possible to avoid the appearance of the brain and poured for 48 hours.
Then try the device in humans patients: the first of them 68-year-old woman infected with acute liver failure of unknown etiology, she regained her mind and liver function after six days during the use of the machine, but she died four days later from Tafnah shock Septic shock. The second patient is a 12-year-old and an infection and acute hepatic failure, treated with the device for a period of 58 hours, liver function returned to normal and she recovered. Then use the device in seven patients with acute liver failure periods vary from one day to six, and the result so far are encouraging (see Sussman & Kelly, in Houston USA).)


In Japan, where he is not allowed planting liver and transferred from the donor human moral reasons, there are attempts to transfer the hepatic cells from a part of the liver and transplanted into the spleen self-seed hepatocyte autotransplantation in patients with cirrhosis of the liver, and the results so far are tentative (see: Mito, M. & kusano, M .: Hepatocyte transplantation in man. see also: `Cell Transplntation 2 (1993). (66-74). as a liver transplant as a treatment for landing failure acute liver Deluxe figures for success ranging from 50-85%

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