Hepatic coma

The hepatic coma, also called liver coma or Coma hepaticum known, represents a disturbance of consciousness - in the form of a coma. The trigger is liver failure. The Hepatic coma is fatal in almost all cases.

What is hepatic coma?

Symptoms include loss of consciousness, bad breath, areflexia, impaired consciousness, impaired memory, and also incontinence. Depending on the stage, the symptoms can vary in severity.
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It comes to one Hepatic coma, those affected cannot be awakened by external stimuli. The cause of such a disturbance of consciousness is a failure of the liver. If there is a lack of detoxification function or if liver tissue dies, the organ fails.

First there is hepatic encephalopathy. In the process, so much ammonia is accumulated in the blood that it leads to a disorder and subsequently to a coma. There are two forms: the so-called liver failure and liver disintegration coma. If the hepatic hepatic coma occurs, it ends - in almost all cases - with the death of the patient.

causes

The causes of a hepatic coma vary. If it is a hepatic decay coma, also known as endogenous hepatic coma, it comes to the death of liver tissue. The endogenous hepatic coma is usually triggered by toxic damage to the organ, such as drugs, chemicals or poisons.

Occasionally, hepatitis (type B or D, colloquially also known as jaundice) and gestational fat liver (an extremely rare complication of pregnancy) can lead to a hepatic coma. If it comes to a liver failure coma, there is cirrhosis of the liver.

Liver cirrhosis is the terminal stage of chronic liver disease; the liver tissue has already changed (formation of nodules), so that the liver cells can no longer perform their function. Subsequently, there are circulatory disorders and a complete cessation of function of the organ.

Cirrhosis of the liver, at least in Europe, is mainly caused by alcohol abuse; Sometimes viral hepatitis can also be responsible for liver cirrhosis. However, certain immune and tropical diseases can also trigger cirrhosis.

There is an accumulation of toxins, such as ammonia compounds, which lead to the detoxification functions of the organ being impaired. The toxins are then passed on to the affected person's brain, causing a hepatic coma.

Symptoms, ailments & signs

Symptoms include loss of consciousness, bad breath, areflexia, impaired consciousness, impaired memory, and also incontinence. Depending on the stage, the symptoms can vary in severity. While there are hardly any problems with tiredness in the first stage, sleepiness in the third stage - in addition to muscle tension - is the biggest problem.

Diagnosis & course of disease

The doctor makes the diagnosis on the basis of the symptoms present, whereby the medical history also plays an important role. So that the doctor can convince himself that it is actually a hepatic coma, he has blood tests carried out, whereby the detoxification function of the liver and subsequently the ammonia concentration are determined.

In the further course, an ultrasound of the organ can give an insight into how big the liver already is and sometimes what nature or structure is present. Other procedures, such as computed tomography (CT), are also used to help confirm the diagnosis. Before the person concerned loses consciousness, the hepatic coma runs in three stages (I to III), with an increasing disturbance of consciousness.

In the first stage (stage I) a decrease in intellectual performance is noticed. The need for sleep increases. In the second stage (stage II) there is increased fatigue, memory and orientation disorders and increased muscle tension. Sometimes the person concerned also reacts more slowly to the direct address.

In the third stage (stage III) the patients can hardly be woken up; when they are perky they appear disoriented and confused. Muscle tension is increased and the person is unable to hold urine or stool. Liver coma occurs in the fourth stage (stage IV).

Complications

In most cases, a hepatic coma leads to death. They can suffer from various complaints and disorders and are therefore extremely limited in their everyday life. In most cases this leads to a very bad breath and also to unconsciousness. People also suffer from other disorders of consciousness and paralysis.

Incontinence or memory disorders can also occur. The patients are extremely tired and exhausted because of the liver coma. The resilience of the person affected 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.

Treatment does not always lead to a positive course of the disease. In some cases, poisoning can be treated with the help of drugs. However, the affected person is then dependent on dialysis. If this is not possible, a liver transplant will be necessary so that the person can continue to survive. In many cases, the life expectancy of the person affected is significantly restricted and reduced by the hepatic coma.

When should you go to the doctor?

A doctor should be consulted if there is a noticeable bad breath or changes in body odor. If there is a feeling of illness, general malaise or peculiarities of the skin, a doctor's visit is advisable. A doctor is required in the event of disorders of consciousness, impairment of memory activity or the loss of acquired knowledge and skills. A decrease in memory is always a warning from the organism that needs to be clarified. In the event of a loss of natural reflex activity, the person concerned needs medical assistance. An increased need for sleep, sudden tiredness, sluggishness or listlessness are signs of existing disorders that should be investigated.

In principle, regular check-ups and preventive examinations by a doctor are recommended. If performance is impaired for no apparent reason, if there are emotional changes or persistent muscle tension, a doctor is required. A doctor's visit should be initiated in the event of incontinence. If the excretions cannot repeatedly be regulated by willpower, a doctor should be consulted. If existing symptoms spread or if they intensify, a doctor should be reported on the observations. Since hepatic coma is a condition in which the patient cannot be addressed, those present should provide first aid and call an ambulance as soon as loss of consciousness becomes apparent.

Treatment & Therapy

If a hepatic coma occurs, the patient is immediately taken to the intensive care unit. There is an acute danger to life. However, because hepatic coma is a symptom, the underlying disease that led to the condition is treated primarily. Only when the medical professionals treat the underlying disease can the patient wake up from the coma.

If viral hepatitis is present, antiviral therapies - in the form of drugs - are carried out. If poisoning, for example by mushrooms, is the reason for the hepatic coma, drugs are also administered. Due to the fact that the liver can still recover independently, even if it is damaged by around 90 percent, doctors often use what is known as liver dialysis.

This gives the damaged organ the time it needs for regeneration. With such dialysis it is also possible that the time required for a liver transplant can be bridged. In many cases, liver dialysis is the only treatment option to treat hepatic coma.

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Outlook & forecast

The prognosis for hepatic coma is poor. Most people die because of the health problems. In about 90 percent of those affected, the disease results in death. The functioning of the liver is impaired and the organism can no longer adequately detoxify. Ultimately, there is a risk of organ failure and thus death of the person concerned.

Without medical care there is no prospect of relief from the symptoms. In addition, there are no self-help measures that can improve liver activity. In some patients, an organ transplant succeeds or the symptoms can be alleviated with liver dialysis. Dialysis gives the human organism time to activate a regeneration process.

In basically healthy people with a stable immune system, an 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. Often there are reactions of rejection to the new liver, which contributes to an additional worsening of the overall situation. If the survival of the person concerned can be ensured, life-long impairments can be expected. The susceptibility to disease is increased and regular check-ups are necessary.

prevention

The hepatic coma can be prevented if potential causes - such as viral hepatitis or alcohol abuse - are avoided through a relatively healthy lifestyle. If you are already addicted to alcohol, it is advisable to undergo therapy so that further liver damage can be prevented.

Hepatitis is mainly transmitted through unprotected sex. Protected sex or hygienic behavior, since the virus is also transmitted via direct blood contact, reduces the risk of infection. A vaccination against hepatitis B is also possible.

The hepatic coma is an extremely dangerous, life-threatening condition which, without therapy - and accordingly without aftercare - usually has fatal consequences.

Aftercare

Follow-up care for a hepatic coma should therefore be continued with intensive medical care if possible. Primarily, this focuses on fighting the underlying cause that led to the condition in the long term and ideally eliminating it completely. If the liver is severely restricted in its function, so that liver failure is inevitable, a liver transplant is required.

After the treatment of acute hepatic coma, liver dialysis should therefore take place between intensive medical therapy and liver transplantation. In any case, alcohol, nicotine and other drugs should be completely avoided. This can no longer repair irreversible damage, but it can prevent it from progressing further. A healthy lifestyle and diet as well as regular medical check-ups are also part of a comprehensive aftercare.

If the liver coma is in an initial stage, further drug treatment can also inhibit the progression of the condition. Last but not least, psychological follow-up care should also be considered, as the loss of cognitive abilities as a result of the condition can also cause mental problems.

You can do that yourself

With the diagnosis of hepatic coma, there are few or no options left for the patient to help themselves in everyday life. This disease does not offer any alternative to medical treatment.

When the first complaint occurs, the person affected should seek out a team of experts and rely on medical care. The instructions of the medical team must be followed. Depending on the stage of the coma, the sick person can no longer be addressed and can therefore not carry out any independent activities. Relatives should inform themselves fully about the disease and its consequences. If you need emotional support in coping with the situation, it is advisable to consult a therapist.

In the initial phase of the disease, the person affected suffers from a decline in performance and an increased need for sleep. If it is possible for him in this state, the way of life should be optimized. This includes the complete avoidance of toxins and pollutants as well as a healthy diet. Stop consuming alcohol as soon as possible. This behavior can in a few cases reduce the further breakdown of the liver tissue. Working with liver specialists is helpful in order to make use of their expertise for optimal further treatment. Together, it should be worked out which individual possibilities the patient has to improve his well-being.