How many days do they lie in a hepatic coma? What are the characteristics of viral and toxic hepatic coma? The clinical picture of hepatic coma is based on

Symptoms of the last stage of liver cirrhosis are pronounced. At this stage, the disease is characterized by:

intestinal disorders;
weakness;
frequent vomiting;
loss of body weight;
exhaustion of the body;
atrophy of the muscles of the shoulder girdle and intercostal region;
a strong increase (in certain cases, a decrease) in body temperature.

Last stage cirrhosis may be accompanied by other, more severe symptoms: speech impairment, uncharacteristic movements of body parts, short periods excited state, which are replaced by drowsiness.

All therapeutic measures carried out for the purpose of maintaining vital important functions the patient's body.

Consequences of the disease

Liver cirrhosis at the last stage is accompanied by the development of the following dangerous complications:

bleeding digestive tract;
ascitic syndrome;
hepatic coma;
bacterial peritonitis;
cancer.

Consequences such as hepatic coma and bleeding of the digestive tract develop quite often.

Let's consider these violations in more detail.

The development of coma and encephalopathy is extremely dangerous. In this case, various neuromuscular disorders are observed, thought processes. Patients associate such manifestations with a depressive state, in which attention decreases, memory deteriorates, and there is a lack of interest in what is happening around them.

A comatose state develops against the background of liver failure; in this situation, the detoxification function of the organ is disrupted. A diseased liver is not able to neutralize toxic substances formed during metabolism. The most dangerous for nervous system The substance is ammonia, which is synthesized in the large intestine during the breakdown of proteins.

A healthy liver forms urea from ammonia, thereby neutralizing it and removing it from the body. in a natural way. When hepatic coma occurs, a significant amount of ammonia and toxic substances accumulate in the liver. Ammonia has a negative effect on respiratory center, resulting in hyperventilation. In the bloodstream and brain, the content of aromatic acids increases, while the amount of amino acids, on the contrary, decreases. Against this background, the nervous system cannot function normally.

Liver failure, in addition to signs of damage to the nervous system, is accompanied by a characteristic sweetish odor from the mouth. This symptom occurs at the initial stage of the pathology and becomes more pronounced with the development of encephalopathy.

The development of hepatic coma occurs gradually - appetite decreases, nausea, headaches, painful sensations in the area of the right hypochondrium and epigastrium. Dizziness may also develop, fainting states, insomnia, itchy skin.

To diagnose liver dysfunction, biochemical analysis blood. Except clinical manifestations, uncharacteristic changes in electroencephalography (ECG) are observed - high-amplitude slow triphasic waves appear.

Carrying out intensive detoxification therapy in certain cases gives positive result. Therefore, immediate hospitalization of a patient with rapidly increasing liver failure extremely necessary. During treatment, laxatives and cleansing enemas are used. A synthetic disaccharide is also used, after decomposition of which milk, formic, acetic acid. In addition, it is important to adhere to a strict diet with the complete exclusion of proteins (meat and fish products, cottage cheese, eggs).

Internal bleeding and portal thrombosis

Varicose veins of the digestive tract - dangerous complication the last stage of liver cirrhosis, this disorder occurs quite often - in 40% of cases. Manifestations this state absent for a long time; the development of bleeding indicates advanced disease.

Such complications arise due to pressure drop in the portal vein and disruption of the blood clotting process. In addition, in such a situation, the capillaries and venous vessels of the digestive tract are dilated, which also disrupts blood flow.

Against the background of irreversible changes in the liver, portal thrombosis occurs - blood clots form in the portal vein, resulting in the development of portal hypertension. This disorder occurs in 25% of patients. Adequate therapeutic measures can prevent the occurrence of ascitic syndrome and hypersplenism.

Acute thrombosis is observed in very rare cases.

Doppler ultrasound is used to diagnose this disorder. ultrasonography, which allows you to identify a slowdown or complete absence venous blood flow.

In this case, bleeding is treated with clipping (endoscopic vein ligation). A synthetic analogue of somatostatin, octreotide, is also administered intravenously.

Forecast

It is quite difficult to say for sure how long people live with liver cirrhosis at the last stage. Life expectancy depends on the patient’s behavior and complications that develop. If ascites occurs, the life expectancy of 25% of patients is no more than 3 years. In the case of the development of hepatic encephalopathy, the prognosis is extremely unfavorable - the life expectancy of most patients does not exceed 12 months. With late-stage alcoholic cirrhosis, 40% of patients live 3 years.

The duration and quality of life with liver cirrhosis directly depends on how accurately the patient complies with all the instructions of the attending physician. First of all, it is necessary to completely stop drinking alcohol and other hepatotoxic substances. Compliance with this condition is especially important in alcoholic cirrhosis. Eliminating alcohol allows 60% of patients to live more than 5 years. It is equally important to adhere to a strict diet - avoiding fatty, fried, spicy foods.

It is necessary to carry out full therapeutic courses in inpatient conditions, regularly undergo examinations in medical institutions and promptly respond to any changes in the body.

The development of severe pathologies of other organs, in particular cancer, significantly worsens the prognosis.

Comatose liver: types and stages, first aid rules

Hepatic coma is a pathological condition that is the final stage of hepatic encephalopathy.

This is a complete depression of the central nervous system, resulting from a severe form of intoxication with liver failure.

Coma develops due to an increase in the concentration in the body of substances such as ammonia, phenols, sulfur-containing and aromatic amino acids, and fatty acids with low molecular weight.

These substances are metabolic products and have a harmful toxic effect on the brain. The pathogenesis of this condition of the body is varied.

The important question is “How long do people with hepatic coma live?”

Unfortunately, all the signs and pathogenesis of the disease indicate irreversible processes in the body. This means that death occurs in almost 90% of cases.

Stages
Symptoms and causes
Causes
First aid
Treatment
Forecast and conclusions

Kinds

There are several types of hepatic coma, namely:

Stages

According to the clinical picture, hepatic coma can manifest itself in 3 stages. These include precoma, threatening coma, frolicking coma.

In this condition, sepsis often manifests itself, as a result of which there is a high body temperature, leukocytosis and olirugia are intensified. This stage can last a few minutes or several days.

Symptoms and causes

Symptoms can be completely different depending on the stage and type:

Other symptoms may also appear, as there may be different reasons and complications of this condition.

Causes

The most common cause of hepatic coma is hepatitis B different forms: alcoholic, viral, acute, toxic.

Coma can also develop with a progressive disorder of the blood supply to the liver. This disorder is provoked by thrombosis of the hepatic vein, and is possible with surgical intervention, in case of mistaken vein ligation. One of the most common causes is cirrhosis of the liver.

Less common signs- this is portal vein thrombosis, schistosomiasis, etc.

Pathogenesis. It should be noted that metabolic disturbances significantly accelerate the onset of hepatic coma. The main toxic substance is ammonia, as well as aromatic amino acids, etc. These substances are formed in the large intestine.

The pathogenesis of hepatic coma includes a process in which lipids are oxidized, and this is what leads to the fact that the permeability of cells becomes much greater and, therefore, various autolysis products, etc., accumulate, that is, toxic poisons.

Also, the pathogenesis of this condition includes circulatory disorders, circulatory hypoxia and intravascular hypercoagulation. The following processes aggravate central nervous system disorders in hepatic coma:

Violation of acid-base and water-electrolyte balance;
Hemodynamic processes;
Hypoxia;
Kidney failure.

First aid

If a person shows signs of a hepatic coma, the first thing you need to do is call “ Ambulance"and record how much time has passed to inform the doctors.

Urgent first first aid consists of placing the person on his side and ensuring that there is normal air access.

This condition is characterized by disorders of thinking and behavior, so care must also be taken to ensure that the person does not injure himself. If the patient is vomiting, then the oral cavity should be cleaned of vomit.

Also, emergency first aid is to give the patient drink in large quantities. In order not to aggravate the situation, no further actions are taken. Further emergency care is provided by doctors in the intensive care unit. Since in this case only drug therapy is needed.

Treatment

Treatment of hepatic coma consists of the following measures:

Therapeutic therapy is prescribed individually to each patient, based on test results (general, biochemical, liver tests).

Forecast and conclusions

Hepatic coma is the last stage of encephalopathy, which has a very unfavorable prognosis. It is better, of course, to treat encephalopathy in its early stages. Self-medication in this case is strictly prohibited.

According to medical practice, the prognosis is this: about 80-90% of cases are fatal.

How long do patients diagnosed with hepatic coma live? As a rule, death occurs after a few days. With subacute liver dystrophy, the prognosis is favorable, since with proper therapy the mortality rate is much lower, but liver cirrhosis may develop as a result.

Brief information. Furosemide and Aldactone are taken in combination for ascites.

Symptoms of liver cirrhosis at the last stage, complications and prognosis for life

Liver cirrhosis develops in several stages, each of which has characteristic symptoms. The last stage of liver cirrhosis is the final phase of the disease and is accompanied by many complications. In the absence of an emergency medical care the terminal stage is fatal.

a brief description of

Cirrhosis is a liver disease that is characterized as a fatal pathology. It consists of irreversible changes in the parenchyma and gradual loss of functionality. As a result of exposure to pathogens, liver cells mutate. Their genome changes, so new hepatocytes are reproduced in a pathologically altered form.

The immune system mistakes mutated liver cells for foreign viral agents and begins to destroy them. Chronic inflammatory process, which leads to the proliferation of fibrous adipose tissue.

The following pathological manifestations are characteristic of cirrhosis:

healthy parenchyma tissue is almost completely replaced by fibrous stroma;
the liver changes shape and structure;
the body ceases to perform its functions.

The development of the disease is chronic, since the destructive process lasts several years and has 4 stages.

A characteristic feature of cirrhosis is the formation of additional false lobules, which consist of fatty connective tissue and do not have their own blood vessels.

Causes of pathology

Cirrhotic changes in the parenchyma are a consequence of liver diseases caused by viral or toxic agents.

There are several types of cirrhosis:

Regardless of the pathogen that provoked the development of cirrhosis, the disease develops in 4 stages. The course of each stage can take from several months to several years, depending on the individual characteristics of the organism.

The exception is the last stage, which is accompanied by severe destructive processes and proceeds quite rapidly.

Symptoms of the last stage

The last phase of cirrhosis is called the end stage. It is characterized by an exacerbation of all negative processes and is accompanied by serious complications.

At this stage, clearly visible following symptoms diseases:

Patients have severe liver deformation and splenomegaly. There are also secondary symptoms inherent in this phase of cirrhosis. These include gynecomastia (in men), varicose veins veins on the stomach, spider veins, hyperpigmentation and dry skin, redness of the palms. Swelling appears lower limbs, thinning out hairline on the body.

In a quarter of patients in the terminal phase of cirrhosis, a decrease in liver size is observed.

Complications

In addition to the main clinical symptoms, at the last stage of cirrhosis, complications appear that often lead to death. The terminal phase occurs in every patient, regardless of compliance with the prescribed treatment or lifestyle.

Factors that provoke the rapid development of complications are:

Alcohol-dependent patients are more likely than others to ignore their doctor’s instructions. Among this category of patients, the most rapid onset of complications inherent in terminal stage.

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Ascites

A characteristic complication that occurs due to impaired functionality of the portal and inferior hepatic vena cava. Fatty degeneration of the parenchyma causes portal hypertension. This pathology is accompanied by obstruction of blood flow and decreased nutrition of abdominal tissues.

As a result of hypoxic fasting, there is an increased secretion of lymphatic fluid, which accumulates in abdominal cavity, volume up to 20 liters. Large cluster water causes bloating and dilation of the abdominal veins (head of the jellyfish).

Ascites in liver cirrhosis

The danger of ascites is that it provokes the following processes:

respiratory and heart failure;
sepsis;
protein deficiency;
impaired blood flow and bleeding.

Spontaneous peritonitis, which often accompanies ascites, increases the risk of death. Abdominal hydrops can be treated conservatively with early stages and surgical in acute cases.

Repeated occurrence of ascites is possible, since cirrhosis, which provokes the accumulation of water, is an irreversible disease.

Bleeding

Portal hypertension, which develops as a result of degenerative processes in the liver, often causes internal bleeding. Stagnation and disruption of blood flow provoke expansion and blockage of blood lines. Damage is observed not only in the liver, but also in the gastrointestinal tract, as well as throughout the abdominal cavity.

Since the walls of veins and blood vessels are subject to fibrotic degeneration, they become fragile and brittle. As a result, the wall ruptures and blood is released into the abdominal cavity. Due to the fragility of blood vessels, nosebleeds in cirrhosis are a frequently observed symptom in the terminal stage of the disease.

Internal bleeding is dangerous condition and requires emergency medical intervention. Extensive blood loss quickly leads to the death of the patient.

A condition such as hepatic coma is the final stage in the development of cirrhosis and cannot be treated. This concept is used to define the complete failure of all liver functions and the occurrence of hepatocerebral failure. Hepatic encephalopathy is a consequence of toxic and hypoxic damage to the central nervous system.

It is caused by the following reasons:

metabolites and toxins that accumulate in the body as a result of impaired liver function;
deficit nutrients in the bloodstream, which leads to insufficient nutrition of the brain and causes disturbances in brain activity.

Neurological disorders and functional liver failure cause confusion, motor and speech disorders, drowsiness and extensive necrosis of parenchymal tissues. Hepatic coma develops rapidly and ends in the death of the patient.

End-stage treatment

How to cure the last stage of cirrhosis? Unfortunately, the terminal phase of the disease cannot be cured. Conservative treatment, carried out at this stage, cannot reverse the process of destruction of the parenchyma and compensate for the loss of liver functionality. Mostly, medical methods designed to alleviate the patient's suffering and support vital functions.

The only solution in the last stage of the pathology is organ transplantation.

Forecast for life

The terminal phase of cirrhosis is accompanied by a disappointing prognosis. How long do patients live if the last stage of the disease has occurred? Life expectancy depends on the accompanying complications and individual characteristics of the body.

The table shows the average time, depending on the existing complications:

Hepatic coma is fatal within a few days. The terminal stage can develop within 2-5 years before complete refusal liver and patient death.

The last stage of cirrhosis is the most difficult for the patient, since it is accompanied by disease processes and constant need for medical care. The final phase can be delayed by 15-20 years if timely and adequate treatment is carried out, diet is followed and bad habits are given up.

Hepatic coma– the final stage of progression of liver failure, accompanied by disorders of the central nervous system. This pathology occurs due to the effect on the general condition of the body various types intoxication, as well as in case of cirrhosis or organ death.

Despite the bright severe symptoms and various treatment methods for this pathological process, a large percentage of deaths are recorded. This may be due to the fact that the pathogenesis of the advanced stage of the disease is characterized by an effect on the brain, which leads to its swelling.

The main group of people who have been diagnosed with this disease are patients under forty years of age. This problem can develop in the human body over some time, and does not make itself felt immediately. The first signs of the disease are: depressed state the patient and a violation of sleep patterns - a person sleeps during the day and is awake at night.

When the first signs of illness appear, the patient needs to provide first emergency aid either independently to someone nearby or to doctors. This must be done immediately, since the disease entails multiple complications for the health and life of the affected person.

Etiology

The degree of intensity of symptoms of this condition directly depends on the stage of the disease, or more precisely, the damage to the nervous system. Actually provoke this pathology there may be many reasons. The main causes of the disease include:

impact medicines which have a detrimental effect on the liver;

various kinds of toxins and chemicals that enter the human body through the air or through contact in working conditions;

alcohol, tobacco and drug abuse;

infections in which the structure and functioning of an organ are disrupted;

neoplasms of a benign or malignant nature in oncology or cirrhosis;

congenital anomalies of the structure of an internal organ;

bleeding in the gastrointestinal tract;

disruption of the cardiovascular system;

liver injuries;

termination of pregnancy (abortion);

poisoning the body with poisons of various origins– industrial or natural;

bacteria.

Varieties

The course of the disease can occur in several stages:

precomatose state of the patient - there is a sharp change in the victim’s mood, slow thinking and disorientation in space and time. Duration from two hours to several days;

threatening coma - the person becomes worse every hour. This stage is characterized by memory loss and loss of consciousness. Duration - from one or two days to ten;

hepatic coma - at this stage the patient’s position is extremely difficult, there are rare periods of full consciousness, the smell of ammonia appears from the mouth, breathing is weak and heavy.

The causes of the disease are:

endogenous - in which the liver ceases to fully perform its functions. Occurs due to exposure to toxic substances;

exogenous – often expressed in cirrhosis;

mixed;

false.

Symptoms

The symptoms of the disease directly depend on the stage of hepatic coma. So, at the initial stage the following are observed:

changes in behavior from depressed to unreasonably cheerful;

sleep problems;

slow thinking;

impaired concentration, but the patient answers questions correctly and recognizes people;

attacks of dizziness;

increased sweat production.

The following symptoms will be characteristic of the second stage:

forgetfulness;

periodic loss of consciousness;

the patient is completely disoriented;

tremors appear in the lower and upper limbs, increasing over time;

unpleasant odor from the mouth;

the skin takes on a yellow tint.

Symptoms of the most severe stage:

the face does not express any emotions;

unconscious state;

rapid pulse;

the smell of ammonia hovers over the patient;

pupils react poorly to light.

Without treatment, in the third stage, convulsions and a complete lack of breathing appear.

Since hepatic coma develops slowly, a few weeks before the onset of the first stage of the disease, a person complains of:

aversion to food;

seizures;

severe weakness;

loss of sense of taste and smell;

bleeding from mucous membranes;

a burning sensation on the skin that is unbearable.

Complications

Since the pathogenesis of the disease is quite severe, when untimely treatment hepatic coma may develop such consequences as:

cerebral hemorrhages;

spicy and;

blood poisoning;

cirrhosis, in case of this disease not only the cause, but also the complication;

, which invariably leads to the death of the patient.

Diagnostics

To establish the correct diagnosis, it is important to determine in detail the causes of hepatic coma, pathogenesis and classification of the disease. In addition, the following diagnostic methods are carried out:

studying the pathogenesis and determining the time of manifestation of the first symptoms - people with cirrhosis of the liver and hepatitis B deserve special attention;

and, general and biochemical;

and gastrointestinal tract;

electroencephalogram;

additional consultations with a gastroenterologist, neurologist, resuscitator;

cerebrospinal fluid analysis.

Treatment

Before experts take on professional treatment, it is necessary to carry out first emergency aid, because most often the deterioration of the patient’s condition is observed at home (only emergency nurses can carry it out together with those who were near the patient). Thus, emergency care techniques consist of:

first aid - the person is given rest and drinking plenty of fluids, during attacks of vomiting, it is necessary to clear the oral cavity of vomit;

pre-hospital emergency care – reduce a person’s increased excitability;

assistance directly to medical institution- Medicinal drips are immediately prescribed. Conduct various methods detoxification and lowering blood acidity.

The only treatment for hepatic coma is an organ transplant; this method of therapy is most often prescribed for cirrhosis. The operation is performed only if the patient's condition has stabilized.

But, despite all treatment methods, the prognosis of the disease is quite sad, because most patients do not live to see an organ transplant. Of all those who were subject to hepatic coma, only a quarter receive a new organ. The highest mortality rate is observed in patients under ten and over forty years of age. This happens due to progression, reduction in liver size, cerebral edema and acute respiratory failure.

Prevention

Measures to prevent hepatic coma:

timely treatment various diseases liver, especially cirrhosis;

adequate use of medications;

refusal to self-treat any diseases;

handle toxic substances with caution, wear protective clothing and otherwise prevent exposure chemical compounds into the body;

maintain a healthy lifestyle, giving up all bad habits;

enrich food with vitamins and nutritional minerals;

undergo a full examination at the clinic twice a year.

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Diseases with similar symptoms:
A disease characterized by a violation of the integrity of liver tissue due to acute or chronic damage is called liver failure. This disease is considered complex, due to the fact that after liver damage, metabolic processes are disrupted. If appropriate measures are not taken to cure the disease, then under certain conditions liver failure can develop quickly and rapidly and lead to death.

The diagnosis of liver cirrhosis is sentence for the patient. The prognosis is disappointing, so one question immediately appears in my thoughts: “ How long do you have to live?" It is impossible to give an unambiguous answer to the question of how long people can live with cirrhosis of the liver.

Many factors influence the number of days given to these patients. Some live up to 10 years, and some die within a year. How long people have stomach cirrhosis will depend significantly on the extent of the damage and the patient's lifestyle.

What affects life expectancy in liver cirrhosis?

For life expectancy serious illness influenced by a number of factors:

Life expectancy taking into account the stage of the disease

Liver cirrhosis is an acquired pathology; it is rarely congenital. Observations and examinations of patients help determine what percentage of patients can live more than 5 years after diagnosis.

It should be noted that, according to medical statistics, the survival rate is quite good. 50% of patients live more than 7 years. However, the effectiveness of treatment and life expectancy in cirrhosis is influenced by degree of liver infection. In medicine, there are four degrees of severity of the disease:

First (compensation). initial stage diseases - compensated cirrhosis, is expressed by the ability of living liver parenchyma cells to take over directly their functions and the functions of dead cells. Often, a patient with the first stage does not feel any signs of pain. Additional factors influence life expectancy in this situation. On average, patients who do not experience symptoms of the disease live approximately 7 years. This short term, however, with a complex diagnosis it is considered a good indicator.

Second (subcompensated cirrhosis of the liver). With the arrival of the second stage of the disease, the first signs begin to appear. This is due to the fact that subcompensated cirrhosis is expressed by depletion of functional liver cells. Parenchyma cells die, disrupting the entire working process of the organ. Symptoms at this stage of the disease include weight loss and nausea. Life expectancy is no more than five years.

Third stage (decompensation). During decompensation, healthy parenchyma is replaced by connective parenchyma fibrous tissue. The liver cannot do its job, complications appear that culminate in decomposition. The decompensated stage of the disease brings deterioration in the person’s condition, the patient may die within 3 years. Today in medicine there is a method that makes it possible, at the decompensated stage, not to wait for the liver to stop working, but to increase life expectancy by performing an organ transplant.

Fourth stage (terminal). The last stage of development of cirrhosis, the prognosis for treatment is the worst. Development various complications at this stage, liver decomposition has no chance, and the patient dies within a year.

Prognosis when complications occur
How long do people with this complex diagnosis live, have they determined, and are there any chances of life with the appearance of complications? Difficulties that arise during the disease are associated with possible bleeding and increased blood pressure in the venous trunk. High blood pressure can result in different irreversible processes which can lead to death. The following complications have a significant impact on life expectancy:

Ascites. Liver disease can cause fluid to form in the abdominal cavity. This complication called hydrocele or ascites. Parenchyma cells, dying, block the vessels and are filled with connective tissue. The organ’s function of blood purification is impaired, and the arterial pressure in the portal vein, kidney function begins to fail. Signs of dropsy are difficult to miss: the doctor, tapping the abdomen, may hear a dull sound (in healthy people the sound is more sonorous), a hernia appears (femoral, umbilical, inguinal), the abdomen increases in size.

During the examination, the specialist examines and interviews the patient to determine the need fluid puncture. To sample the fluid, a puncture of the dropsy is performed when cancer or infection is suspected (complicated by peritonitis). Cirrhosis, which is complicated by abdominal hydrops, negatively affects the prognosis and, without timely treatment, ends in death. A low percentage of patients can live with this complication for more than 2 years; the rest die much earlier.

Internal bleeding. They are the most dangerous and complex complications of this disease. Formation of bleeding in various organs leads to a very poor prognosis, most likely fatal. The most dangerous are bleeding gastrointestinal tract and esophagus. Most often, patients with internal bleeding don't live for a long time. The mortality rate of all patients is about 45%.

Hepatic encephalopathy. One of the most common complications of liver disease, its complexity is affected by the form of the disease. With these indicators, the patient manages to live no more than 2 years. And the more difficult the disease is, the less chance there is.

Hepatic coma- the most dangerous and difficult phase. In hepatic coma, the ability to destroy toxic substances resulting from metabolism is lost, and the process of protein maturation and synthesis is disrupted. Symptoms of the onset of hepatic coma: always wanting to sleep, increased body temperature, difficulty coordinating movements, loss of orientation, emotional imbalance.

During the progression of encephalopathy, against the background of liver disease, a coma may appear. A patient in a hepatic coma has:

irritation from direct exposure to natural light (the patient may automatically turn away from it);

loss of consciousness;

the appearance of pathological reflexes of the central nervous system;

stiffness of the back of the head and limbs;

At first there is a reaction to stimuli, but over time it disappears.

With a prolonged stay in a coma, a process occurs when death is recorded. The valves regulating the transition of substances between organs are paralyzed, there are no reactions, the pupils are enlarged. The cause of death in a coma is respiratory arrest.

Life prognosis taking into account the etiology of the disease
Taking into account the etiology, the autoimmune (biliary) and alcoholic types of the disease are less severe. How long do people live in these cases? When, with the alcoholic type, the patient stopped drinking alcohol, then the amount last days life for him increases and is about 6-7 years. During the biliary type, everything is not so optimistic; after the first symptoms appear in the patient, it is no more than 5 years.
There is also a viral type of complications (viral hepatitis). This is the most Hard case during the treatment of cirrhosis with complications. The situation becomes even more complicated if two types develop simultaneously: viral and alcoholic. There can be no talk of a favorable outcome in these cases; the result is quick death.

Life time taking into account the age and gender of the patient

Age always plays a very important role in any disease, and during serious pathologies doubly. The chances of being cured of this disorder in old age are zero. The older you are, the worse the protection of the body’s immune system, and other chronic diseases. However, even for young people this disease does not always end positively. Quite often, people who have viral hepatitis, drug addicts and alcoholics suffer from cirrhosis of the liver.

The peculiarity of a woman’s body is hypersensitivity cells to ethyl alcohol. Therefore, alcoholic women tolerate this disease much worse, unlike men, and their life expectancy is much lower.

What happens if you violate a doctor's order?

You need to follow your doctor’s recommendations during treatment of any disease, not to mention such a complex disease as cirrhosis of the liver. Positive effect will occur only with full compliance with recommendations and prescriptions.

Healthy image life- This is the main aspect of treatment. It is necessary to exclude smoking, consumption of alcoholic beverages, which have toxic effects on the body. Only strict compliance with the instructions can help not only prolong life, but also increase the chances of a comfortable and normal future.
Parallel influence of other diseases

The appearance of cirrhosis against the background of other diseases internal organs worsens the prognosis. The worst results are observed during the course of cancer. In this case, the question about life expectancy cannot be answered unambiguously; one must take into account the complexity of the course of associated diseases and pathologies.

Medical practice

Medical statistics show many cases of successful treatment and relief from serious condition. However, dry numbers speak for themselves better than words. The worst treatment prognosis is for patients who have led an unhealthy lifestyle associated with drugs and alcohol. Life expectancy with additional complications is quite short. If you continue to use alcoholic drinks There is no talk of increasing the lifespan. Death occurs unexpectedly.

The fatal outcome with the third and most severe stage of cirrhosis is in the range of 65−93%. When the patient was able to survive inflammation of the peritoneum, the probability of recurrence of peritonitis in the first 6 months is 45%. The more time passes, the higher the indicator becomes and reaches 75%. The most common causes of death:

The functioning of organs is disrupted (kidneys and liver have failed). During a coma, death occurs in 100%. When the terminal form is complicated by the addition of oncology or failure of internal organs, the chances of recovery immediately decrease.

Bleeding of internal organs. The mortality rate after the first bleeding is approximately 35−50%. If a person survives, a relapse may occur and the mortality rate reaches 75%.

How to increase life expectancy?

Facts are data that, of course, can be argued with. It is quite possible to increase the amount of life during such a complex disease. Why do you need to comply? simple recommendations:

Self-medication is prohibited and cannot be carried out or completed. drug therapy without a doctor's prescription.

Having suffered from viral hepatitis, there is no need to wait for the onset of cirrhosis; it is necessary to begin treatment immediately. Most importantly, people with hepatitis need to follow a strict diet. Avoid fried, fatty, spicy foods, and eliminate alcoholic beverages.

Follow oral cavity.

Needs to be strengthened immune system, protecting the body from viruses.

We also need to remember about emotional state. It is important to tune in to a favorable result, enlisting the support of friends and family.

One way or another, we must certainly not forget that the health of any person is worth its weight in gold and during the appearance of some pathological conditions or signs of illness, you must immediately seek advice or help from a doctor. Protect yourself from unpleasant situations with fatal outcomes - conduct a full medical examination every year. When you are promptly diagnosed with a disease such as cirrhosis of the liver, the question of how long you have left to live is up to you to decide.

– a neurophysiological syndrome that develops in patients with liver failure, which is accompanied by severe depression of the central nervous system. The main signs are the absence of consciousness, the presence of pathological reflexes, decerebrate rigidity of the limbs, and in the terminal stage - the absence of pupillary and corneal reflexes. The diagnosis is established based on the clinic, EEG data, biochemical tests, CT, MRI. Priority directions treatment – correction of cerebral edema, intracranial hypertension, detoxification, hepatoprotective therapy. Most effective method– liver transplantation.

General information

Diagnostics
Verification of the diagnosis of hepatic coma is based on data clinical picture diseases, laboratory and instrumental methods research. If possible, consultation with a gastroenterologist and resuscitator should be carried out with the participation of the patient’s relatives, since it is important to evaluate the anamnestic data: when the first symptoms appeared, the rate of their progression, possible etiological factors. When examining the patient, jaundice is noticeable. skin, liver odor. There is no consciousness. Depending on the stage of coma, reflexes to strong stimuli and pupillary reflexes are preserved or absent.
Characteristic changes in results laboratory research in hepatic coma there are signs of hepatocellular failure: hyperbilirubinemia, a significant increase in the activity of serum transaminases, a decrease in the prothrombin index and the number of platelets in the blood, anemia, hypoalbuminemia. When analyzing the cerebrospinal fluid, an increase in protein levels is determined. A toxicological study and blood test for markers are required. viral hepatitis.

Treatment of hepatic coma
Patients in a state of hepatic coma are hospitalized in the department intensive care. Treatment begins with determining the cause of the pathology as quickly as possible ( infection, bleeding from the gastrointestinal tract, mushroom poisoning, etc.) and elimination etiological factor. Constant ECG monitoring, pulse oximetry, and intracranial pressure monitoring are mandatory. Hepatic coma is characterized by progressive respiratory failure, so tracheal intubation is performed and artificial ventilation lungs. The drugs of choice for deep sedation are fentanyl and propofol. In order to correct glucose deficiency and oxygen starvation brain cells are injected intravenously with a glucose solution. If bleeding and coagulopathy occur, fresh frozen plasma is used. A decrease in hemoglobin level below 70 g/l is an indication for blood transfusion. Correction of hypoproteinemia is carried out using albumin.
A rapid (within several hours) deterioration of neurological symptoms indicates intracranial hypertension, therapy for which is indicated even in the absence of invasive methods of controlling intracranial pressure. More than 85% of patients develop cerebral edema. Basic treatment intracranial hypertension and cerebral edema includes mechanical ventilation and sedation, normalization of body temperature, electrolyte and gas composition of the blood. If these methods are ineffective, hyperosmolar therapy is used (intravenous drip of mannitol, hypertonic solution sodium chloride), hyperventilation (ventilation in hyperventilation mode makes it possible to reduce ICP for 1-2 hours and gain time for other activities), administration of sodium thiopental, moderate hypothermia, in extreme cases– decompressive craniotomy.
For prevention infectious complications, including during mechanical ventilation, antibiotic therapy is carried out (cephalosporins, vancomycin). Hepatic coma, like any critical condition, is characterized by stress damage to the gastrointestinal mucosa; To prevent gastrointestinal bleeding, proton pump inhibitors and Vicasol are prescribed. To reduce the absorption of ammonia in the intestines and toxic damage to brain cells, lactulose preparations are used. Ciprofloxacin and metronidazole effectively suppress ammoniogenic flora. L-ornithine-L-aspartate preparations are also prescribed, which stimulate enzyme activity in hepatocytes, muscle and brain cells. To speed up bowel movements, enemas with a solution of magnesium sulfate are given.
Nutrition of a patient with hepatic coma is parenteral, maintaining calorie content and limiting the amount of protein. Hepatoprotective therapy is prescribed to increase the resistance of hepatocytes to damaging factors and accelerate regeneration processes (arginine glutamate, milk thistle preparations, thiotriazoline and other drugs). Extracorporeal detoxification methods (hemodialysis, hemosorption and others) are mandatory.

Prognosis and prevention
Hepatic coma is a prognostically extremely unfavorable condition. The survival rate of patients is no more than 20%, only small part patients can wait for liver transplantation. The highest mortality rate is when patients are under 10 and over 40 years of age, the duration of jaundice is less than seven days before the development of severe encephalopathy, the bilirubin level is more than 300 µmol/l, a rapidly progressive decrease in liver size, and severe respiratory failure.
Prevention of hepatic coma consists of timely adequate treatment liver diseases, competent prescription of medications, avoiding self-medication by patients, avoiding poisoning with toxic substances, mushrooms, preventing viral hepatitis, avoiding alcohol.