فشل كبدي

Liver failure
A person with massive ascites and caput medusae due to cirrhotic liver failure
التخصص	طب الجهاز الهضمي, طب الكبد&Nbsp;

فشل الكبد هو فقدان الكبد لقدرته الطبيعية على تخليق البروتينات والأيض كجزء من وظائفه الطبيعية. ويوجد نوعان:

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 الأنواع

• فشل الكبد الحاد - development of hepatic encephalopathy (confusion, stupor and coma) and decreased production of proteins (such as albumin and blood clotting proteins) within four weeks of the first symptoms (such as jaundice) of a liver problem. "Hyperacute" liver failure is said to be present if this interval is 7 days or less, while "subacute" liver failure is said to be present if the interval is 5-12 weeks.
• فشل الكبد المزمن usually occurs in the context of cirrhosis, itself potentially the result of many possible causes, such as excessive alcohol intake, hepatitis B or C, autoimmune, hereditary and metabolic causes (such as iron or copper overload or non-alcoholic fatty liver disease).

 الأعراض

• إصفرار واضح في لون الجلد
• إصفرار واضح في العين (يرقان)
• شحوب في لون البراز
• تحول لون البول إلى اللون الداكن أو الأسود
• غثيان وقيئ
• Abdominal distension primarily due to fluid (Ascites)
• Excessive Fatigue
• Itchy skin
• Difficulty with concentration, confusion, loss of acute memory
• Lethargy and sleepiness
• Tremor which is prominent in the hands and finger
• Dry skin

Liver failure is a life threatening disease and anyone with the above symptoms should seek immediate medical attentions.

 الأسباب

• Drug overdose: the classic drug is acetaminophen. There are warnings on labels of acetaminophen bottles about liver failure.
• Prescription medications like anti seizure medications, antibiotics (tetracyclines), anti inflammatory drugs
• Herbal supplements like kava, ephedra, skull cap and others
• Hepatitis B, C and E
• Wild or poisonous mushrooms
• Autoimmune disorders: primary biliary cirrhosis
• Hemochromatosis (inherited disorder where too much iron accumulates in the liver)
• Blood vessel disorders like Budd-chiari syndrome
• Rare metabolic disorders like Wilson's disease rare disorder where there is excess copper deposition in the body
• Reye's syndrome is acute liver failure in children which may be related to use of aspirin
• Alcoholism- causes progressive damage to the liver
• Cancer

 التشخيص

The diagnosis of liver failure involves blood work and examination of the liver. A small liver biopsy can be applied under local anesthesia. Individuals whom are at risk may undergo a biopsy by inserting a small tube down the neck and into the liver. This is done under X ray visualization and takes about 30 minutes.

 المضافعات

عند حدوث فشل الكبد والتأخر في علاجه، فإنه من الممكن حدوث العديد من المضاعفات مثل:

 تضخم المخ

This is due to fluid increase in the brain which deprives the brain of oxygen. This swelling accounts for the mental confusion, tremors and excess sleepiness .

 نزيف حاد

The liver makes proteins which help stop bleeding. In liver failure these protein compounds are not made and the individual develops a tendency to bleed. The bleeding often occurs in the stomach and can be massive.

 العلاج

The majority of individuals with acute liver failure requires of attention in the intensive care unit. The aim of treatment is to decrease pressure in the brain, treat any infection, prevent bleeding and perform a dialysis if the kidney has stopped making urine. The treatment can be complex and requires delicate fluid balance, nutrition and monitoring of pressure in the brain. Many of these individuals develop difficult breathing and may be placed on a (mechanical ventilation) machine for days or weeks. The fluid from the abdomen may need to be repeatedly removed using a small needle. This small procedure is easily performed and allows one to breathe easier. However, repeated removal of this fluid also results in a loss of valuable body proteins.

If the patient continues to go downhill, then a liver transplant may be required. The problem with a liver transplant is obtaining a donor. The surgery is also complex and is only done at a few centers in the USA. Moreover after a liver transplant, many complications can occur and one has to remain on strong medications to prevent rejection of the liver.

 الوقاية

While one cannot completely prevent liver failure one can reduce the risk. This means doing the following:

• Follow instructions on all medications and never exceed the dose
• Drink alcohol in moderation or avoid it completely
• Avoiding risky behaviour like injectable drugs and sharing needles
• Getting vaccinated against hepatitis B
• Avoiding contact with other individual's body fluids and blood
• Avoiding the fume from toxic chemicals
• Not sharing any personal care products with anyone
• Ensure that you wear a condom when having sex with an unknown partner, avoiding sex with multiple partners
• Eating healthy and exercising on a regular basis.

In the years past, liver failure carried a very high mortality. However, with better knowledge, availability of liver transplantation and improved Intensive care unit monitoring, survival has is almost assured.