Hepatic coma, also known as hepatic coma or coma hepaticum, represents a disturbance of consciousness – in the form of a coma. The trigger is liver failure. In almost all cases, hepatic coma is fatal.
What is hepatic coma?
If a hepatic coma occurs, the affected person cannot be awakened by external stimuli. The cause of why such a loss of consciousness occurs is liver failure. If there is a lack of detoxification function or death of liver tissue, the organ fails. Initially, hepatic encephalopathy occurs. In this case, so much ammonia is accumulated in the blood that a malfunction occurs and, subsequently, coma. There are two forms: hepatic failure coma and hepatic decay coma. If hepatic liver coma occurs, it ends – in almost all cases – with the death of the patient.
Causes
The causes of why hepatic coma occurs vary. If it is liver decay coma, also known as endogenous hepatic coma, there is death of liver tissue. Endogenous hepatic coma is usually caused by toxic damage to the organ, such as from drugs, chemicals or toxins. Occasionally, hepatitis (type B or D, colloquially known as jaundice) and fatty liver of pregnancy (an extremely rare complication of pregnancy) can also lead to hepatic decomposition coma. If a liver failure coma occurs, there is cirrhosis of the liver. Liver cirrhosis is the final stage of chronic liver disease; the liver tissue has already changed (nodule formation) so that the liver cells can no longer perform their function. This is followed by circulatory disorders and a complete cessation of function of the organ. Cirrhosis of the liver, at least in Europe, is mainly promoted by alcohol abuse; sometimes viral hepatitis can also be responsible for cirrhosis of the liver. However, certain immune and tropical diseases can also trigger cirrhosis. There is an accumulation of toxins, such as ammonia compounds, which cause the organ’s detoxification functions to be impaired. The toxins are subsequently passed on to the affected person’s brain, causing a hepatic coma.
Symptoms, complaints, and signs
Symptoms include unconsciousness, halitosis, areflexia, impaired consciousness, memory impairment, and also incontinence. Depending on the stage, symptoms can vary in severity. While there are hardly any problems with fatigue in the first stage, sleepiness is the biggest problem in the third stage – along with muscle tension.
Diagnosis and course of the disease
The physician makes the diagnosis on the basis of the present complaints, whereby the medical history also plays an essential role. In order for the physician to be convinced that it is indeed a case of hepatic coma, he or she has blood tests performed, whereby the detoxification function of the liver and, subsequently, the ammonia concentration are determined here. Further down the line, an ultrasound of the organ can provide insight into how large the liver already is and sometimes what its composition or structure is. Other procedures, such as a computed tomography (CT) scan, are also used to confirm the diagnosis. Before the affected person loses consciousness, hepatic coma progresses in three stages (I to III), with increasing disturbance of consciousness. In the first stage (stage I), a decrease in intellectual performance is noted. The need for sleep increases. In the second stage (stage II), there is increased fatigue, impaired memory and orientation, and increased muscle tension. Sometimes the affected person also reacts slower to direct speech. In the third stage (stage III), patients can hardly be awakened; when they are alert, they appear disoriented and confused. There is increased muscle tension, and the affected person cannot hold urine or stool. In the fourth stage (stage IV), hepatic coma ensues.
Complications
In most cases, hepatic coma results in the death of the affected person. These can thereby suffer from various complaints and disorders and are thus extremely limited in their everyday life. It comes thereby in most cases to a very bad breath and also to an unconsciousness. The affected persons also suffer from other disorders of consciousness and paralysis.Likewise, incontinence or memory disorders may occur. Patients are extremely tired and fatigued due to hepatic coma. The patient’s ability to cope with stress also decreases significantly as a result of this disease. In many cases, the patient’s relatives also suffer from depression and other psychological complaints and require appropriate treatment. Not in every case does treatment result in a positive course of the disease. In some cases, poisoning can be treated with the help of medication. However, the affected person is then dependent on dialysis. If this is not possible, a liver transplant becomes necessary so that the affected person can continue to survive. In many cases, the life expectancy of the affected person is significantly limited and reduced by the hepatic coma.
When should you see a doctor?
If there is noticeable bad breath or changes in body odor, a doctor should be consulted. If there is a feeling of illness, general malaise or peculiarities of the skin appearance, a visit to the doctor is advisable. In case of disturbances of consciousness, impairment of memory or loss of acquired knowledge as well as skills, a doctor is needed. A decrease in memory is always a warning sign of the organism, which should be clarified. In case of a loss of natural reflex activity, the affected person needs medical assistance. An increased need for sleep, sudden tiredness, sluggishness or listlessness are signs of existing disorders that should be investigated. Regular check-ups and preventive examinations by a doctor are generally recommended. If limitations in performance occur for no apparent reason, or if there are emotional changes or persistent muscle tension, a doctor is needed. A visit to the doctor should be initiated if incontinence occurs. If the excretions cannot be repeatedly regulated by willpower, a doctor should be consulted. If existing symptoms spread or increase in intensity, a physician should be told of the observations. Because hepatic coma is a condition in which the patient is unresponsive, persons present should administer first aid and call an emergency physician as soon as loss of consciousness becomes apparent.
Treatment and therapy
If hepatic coma occurs, the patient is immediately taken to the intensive care unit. There is an acute risk of death. However, because hepatic coma is a symptom, the causative disease that led to the condition is treated first and foremost. Only if the doctors treat the underlying disease can the patient come out of the coma. If viral hepatitis is present, antiviral therapies – in the form of drugs – are administered. If poisoning, for example by fungi, is the reason for the liver coma, drugs are also administered. Due to the fact that the liver, even with damage of around 90 percent, can still recover on its own, doctors often rely on so-called liver dialysis. This gives the damaged organ the time it needs to regenerate. Such dialysis can also be used to bridge the time needed for a liver transplant. In many cases, liver dialysis is the only treatment option to treat hepatic coma.
Outlook and prognosis
The prognosis of hepatic coma is unfavorable. Most people die because of the adverse health effects. In about 90 percent of those affected, the course of the disease reveals a fatal outcome. Liver function is impaired and the organism is no longer able to detoxify sufficiently. Ultimately, organ failure threatens and with it the death of the affected person. Without medical care, there is no prospect of alleviating the symptoms. Moreover, there are no self-help measures that can bring about an improvement in liver function. In some patients, organ transplantation succeeds or relief of symptoms can be achieved by liver dialysis. Dialysis provides the human organism with time to activate a regeneration process. In basically healthy people with a stable immune system, improvement can be documented in this way. Organ transplantation is associated with numerous risks and side effects.In addition to the actual operation, the difficulty lies in the acceptance of the donor organ by the weakened and diseased organism. Rejection reactions to the new liver are often apparent, which contributes to an additional deterioration of the overall situation. If the survival of the affected person can be ensured, lifelong impairments are to be expected. Susceptibility to disease is increased, and regular checkups are necessary.
Prevention
Hepatic coma can be prevented, provided potential causes-such as viral hepatitis or alcohol abuse-are avoided by a relatively healthy lifestyle. If alcohol dependence already exists, it is advisable to undergo therapy so that further liver damage can be prevented. Hepatitis is mainly transmitted through unprotected sexual intercourse. Protected sex or hygienic behavior, since the virus is also transmitted through direct blood contact, reduces the risk of infection. There is also the possibility of a vaccination against hepatitis B. Liver coma is a highly dangerous, life-threatening condition that, without therapy – and accordingly, follow-up care – is generally fatal.
Follow-up care
Accordingly, follow-up care for hepatic coma should also be continued by intensive medical care, if possible. Primarily, this focuses on addressing the underlying cause that led to the condition in the long term and, ideally, eliminating it altogether. If the liver is severely impaired in function to the point that liver failure is inevitable, liver transplantation is required. After treatment of acute hepatic coma, liver dialysis should therefore be carried out as a bridging measure between intensive medical therapy and liver transplantation. In any case, alcohol, nicotine and other drugs should be completely avoided. Although this can no longer repair irreversible damage, it can prevent it from progressing further. A healthy lifestyle and diet, as well as regular medical check-ups, are also part of comprehensive aftercare. If there is an initial stage of liver coma, further treatment with medication can also inhibit the progression of the condition. Last but not least, psychological follow-up should also be considered, as the loss of cognitive abilities as a result of the condition can also cause mental problems.
Here’s what you can do yourself
With a diagnosis of hepatic coma, the sufferer is left with few to no options to help themselves in their daily lives. This disease offers no alternatives to medical treatment. The sufferer should see a team of experts at the first sign of discomfort and rely on medical care. The instructions of the medical team must be followed. Depending on the stage of the coma, the sufferer may no longer be responsive and therefore unable to perform independent activities. Relatives should be fully informed about the illness and its consequences. If they need emotional support in coping with the situation, it is advisable to consult a therapist. In an initial phase of the disease, the affected person suffers from a decrease in performance and an increased need for sleep. As far as it is possible for him in this condition, the lifestyle should be optimized. This includes the complete avoidance of toxins and harmful substances as well as a healthy diet. Alcohol consumption should be discontinued as soon as possible. Further decay of the tissue of the liver can be reduced by this behavior in a few cases. Collaboration with liver specialists is helpful in order to draw on their expertise for optimal further treatment. Together, it should be worked out what individual options the patient has to improve his or her well-being.
