Therapeutic target Avoidance of complications Therapy recommendations Therapy for liver failure varies according to the exact cause, the form of liver failure and other concomitant diseases, and the age of the affected individual. Therapeutic measures range from pharmacotherapy to liver transplantation (LTx). Diseases Acute hepatitis B See under hepatitis B/pharmacotherapy. Herpes simplex hepatitis Antiviral therapy … Hepatic Insufficiency: Drug Therapy
Obligatory medical device diagnostics. Abdominal ultrasonography (ultrasound examination of the abdominal organs) – for basic diagnostics. Optional medical device diagnostics – depending on the results of the history, physical examination and obligatory laboratory parameters – for differential diagnostic clarification. Doppler sonography (ultrasound examination that can dynamically visualize fluid flows (especially blood flow)) of the portal … Hepatic Insufficiency: Diagnostic Tests
To prevent liver failure, attention must be paid to reducing individual risk factors. Behavioral risk factors Consumption of stimulants Alcohol Drug use Ecstasy (also XTC and others) – collective name for a variety of phenylethylamines. Cocaine Drugs (hepatotoxic) Allopurinol Analgesics (incl. NSAIDs) Acetylsalicylic acid (ASA), diclofenac, ibuprofen, indometacin, metamizole, acetaminophen* (paracetamol), sulindac* Non-alcoholic fatty liver … Hepatic Insufficiency: Prevention
The following symptoms and complaints may indicate liver insufficiency (liver failure): Leading symptoms Hepatic encephalopathy (HE, synonyms: portosystemic encephalopathy, hepatoportal encephalopathy, minimal encephalopathy; it is a potentially reversible brain dysfunction that results from inadequate detoxification function of the liver) Impaired consciousness Euphoria, depression Insomnia (sleep disorders) Confusion Icterus (jaundice) Foetor hepaticus – specific breath odor … Hepatic Insufficiency: Symptoms, Complaints, Signs
Pathogenesis (development of disease) Liver failure (liver insufficiency) can be divided into the following forms: Acute liver failure (ALV; ALF), causes: Acute viral hepatitis (HBV) or other hepatotropic viruses (EBV, CMV, HSV). Toxic induced ALV (due toe.g. ethyl toxic liver cirrhosis. i.e. due toalcohol abuse). Cryptogenic ALV (30-50% of the cause of acute liver failure … Hepatic Insufficiency: Causes
General measures Alcohol abstinence (complete abstinence from alcohol). Review of permanent medication due topossible effect on the existing disease. Avoidance of drug use Avoidance of environmental pollution: Tuber leaf fungus intoxication (amanitins). Ecstasy (collective name for a variety of phenylethylamines). Carbon tetrachloride Operative therapy Liver transplantation (LTx; = causal therapy for irreversible acute or chronic … Hepatic Insufficiency: Therapy
Medical history (history of illness) represents an important component in the diagnosis of liver failure. Family history Is there a history of frequent liver disease in your family? Social history Current medical history/systemic history (somatic and psychological complaints). Do you suffer from any brain dysfunction? Disturbance of consciousness* Euphoria, depression* Insomnia (sleep disorders) Confusion* Have … Hepatic Insufficiency: Medical History
Endocrine, nutritional, and metabolic diseases (E00-E90). Alpha-1-antitrypsin deficiency (AATD; α1-antitrypsin deficiency; synonyms: Laurell-Eriksson syndrome, protease inhibitor deficiency, AAT deficiency) – relatively common genetic disorder with autosomal recessive inheritance in which too little alpha-1-antitrypsin is produced because of a polymorphism (occurrence of multiple gene variants). A deficiency of protease inhibitors is manifested by a lack of … Hepatic Insufficiency: Or something else? Differential Diagnosis
The following are the most important diseases or complications that may be contributed to by liver insufficiency: Blood, blood-forming organs – Immune system (D50-D90). Bleeding, unspecified Coagulopathy (blood clot disorder) [INR > 1.5] Endocrine, nutritional, and metabolic diseases (E00-E90). Hypoalbuminemia/hypalbuminemia (decreased concentration of the plasma protein albumin in blood plasma) with ascites (abdominal fluid). Hypoglycemia … Hepatic Insufficiency: Complications
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; further: Inspection (viewing). Skin, mucous membranes, oral cavity, and sclera (white part of the eye) [jaundice (jaundice); foetor hepaticus (specific breath odor (of raw liver)); flapping tremor (flutter tremor; coarse hand tremor)] … Hepatic Insufficiency: Examination
1st order laboratory parameters – obligatory laboratory tests. Small blood count Inflammatory parameters – CRP (C-reactive protein). Electrolytes – sodium, potassium, calcium, etc. Blood gas analysis (BGA) with lactate determination. Serum globulins Serum albumin – important protein (protein) [albumin ↓, as a sign of liver synthesis disorder]. Liver parameters – alanine aminotransferase (ALT, GPT), aspartate … Hepatic Insufficiency: Lab Test
