急性肝衰竭

由梅奥诊所的工作人员
定义
急性肝衰竭当您的肝脏迅速失去其功能。更常见的，肝功能衰竭发展缓慢，两年课程。但在急性肝功能衰竭，肝功能衰竭的发展在几天之内的问题。 急性肝功能衰竭可导致许多并发症，包括出血过多和增加大脑的压力。另一种急性肝功能衰竭的任期是暴发性肝衰竭。 急性肝衰竭是一种医疗紧急情况，需要住院治疗。急性肝衰竭的一些原因，可以逆转的待遇。但在其他情况下，肝脏移植可能是唯一的急性肝衰竭的治疗。 症状 体征和急性肝衰竭的症状可能包括： 的皮肤和眼球发黄（黄疸） 嫩在你的腹部右上区 恶心 呕吐 的不舒服一般意义上的 难以集中注意力 迷失或混乱 困倦 肌肉震颤 当去看医生 急性肝功能衰竭可以开发一个健康的人，否则很快，这是危及生命。如果你或你认识的人突然间开发出的眼睛或皮肤上，上腹部或精神状态，性格或行为的任何不寻常的变化压痛黄，就医的权利了。 原因
  肝脏
急性肝衰竭时发生肝细胞受损明显，不再能发挥作用。急性肝衰竭，其中包括有许多潜在的原因： 对乙酰氨基酚过量。服用过多，对乙酰氨基酚（泰诺，其他人）是在美国急性肝衰竭的最常见原因。急性肝功能衰竭发生，如果你采取一切在一次对乙酰氨基酚剂量非常大，也可以发生如果您需要更小的剂量每天几天，特别是在慢性肝病的人。 处方药。一些处方药可导致急性肝衰竭，其中包括抗生素，非甾体抗炎药和抗惊厥等。 草药补充。草药药品和补充已与急性肝功能衰竭，包括卡瓦，麻黄，黄芩和薄荷油等。 肝炎和其他病毒。甲型肝炎，乙型肝炎和戊型肝炎可导致急性肝功能衰竭。其他病毒，可引起急性肝功能衰竭，包括EB病毒，巨细胞病毒和单纯疱疹病毒。 毒素。毒素可导致急性肝功能衰竭，包括有毒的野生蘑菇毒鹅膏，有时对其他食用动物误。 自身免疫性疾病。肝功能衰竭可能造成自身免疫性肝炎 - 一种疾病，其中你的免疫系统攻击肝细胞，引起炎症和损伤。 在肝静脉疾病。血管疾病，造成淤塞，形成在肝静脉可引起急性肝功能衰竭。这些措施包括门静脉血栓形成，布加氏综合征和静脉闭塞症。 代谢性疾病。罕见的代谢性疾病，如威尔森氏症，妊娠急性脂肪肝，雷氏症候群，很少引起急性肝功能衰竭。 癌症。癌症的开始，为了从你身上其他地方蔓延可导致肝肝脏要失败的肝脏或癌症。 急性肝衰竭的许多情况没有明显的原因。 并发症 急性肝功能衰竭常常导致并发症，包括： 过多的脑液（脑水肿）。过多的液体造成的压力，建立你的大脑，它可以取代的空间之外，通常占用（症），脑组织。脑水肿还可以剥夺你的大脑的氧气。 出血病症。阿不肝脏不能产生凝血因子，能够帮助血液凝固的足量。从胃肠道溃疡或出血其他地方是难以控制，因为它不凝结迅速。 感染。急性肝功能衰竭的人正处于发展，特别是在血液和呼吸道和泌尿道的各种感染，增加的风险。 肾功能衰竭。肾功能衰竭后，通常会发生肝功能衰竭，尤其是在对乙酰氨基酚过量，这既损害肝脏和肾脏的情况。 准备您的预约 如果医生怀疑您可能会遇到急性肝功能衰竭，您可能会住进医院接受治疗。急性肝功能衰竭大多数人都在治疗重症监护病房。 问题期望从你的医生 医生会问你或你的家庭成员的一些问题，设法确定可能造成的急性肝功能衰竭。你的医生可能会问： 你什么时候开始遇到的症状？ 什么处方药，你走？ 什么过分的非处方药，你走？ 什么草药补充剂你走？ 您是否使用了违禁药物？ 你去过肝炎诊断？ 你是否有抑郁症或有自杀想法的历史？ 多少酒，你喝？ 要询问你的医生 如果你爱的人或已与急性肝功能衰竭的诊断，这里有一些问题要问医生： 是什么原因我的急性肝功能衰竭？ 什么是我的急性肝功能衰竭可以扭转的机会？ 什么是急性肝功能衰竭的治疗方法？ 我是否需要进行肝脏移植？ 该医院是否有肝脏移植单位？ 我应该转移到医院，肝脏移植的执行？ 测试和诊断 试验和用于诊断急性肝衰竭的程序包括： 血液测试。血液检查，以确定您的肝脏如何运作可能包括凝血酶原时间的考验，哪些措施需要多长时间你的血液凝固。如果您有急性肝功能衰竭，血液不凝结尽快应该。 肝组织考试。你的医生可能建议的程序，消除了肝组织（肝活检）小部分。对肝组织的测试可以帮助医生了解为什么你的肝脏是失败。对于具有活检期间，如急性肝功能衰竭者，例如，医生执行一个经颈静脉肝组织活检出血危险的人。要做到这一点，一个微小的切口，是在你的脖子右侧和细管（导管）作出传递到你的颈部大静脉，通过你的心和向下，到退出您的肝静脉。你的医生然后插入一根针下，通过导管和检索的肝组织样本。 治疗和药物 急性肝功能衰竭的人被视为在医院加护病房。急性肝衰竭的治疗可能包括： 药物扭转中毒。急性肝衰竭由对乙酰氨基酚过量或蘑菇中毒造成的使用药物治疗，可以扭转这种毒素的影响。 解除多余的液体在大脑中。脑水肿，急性肝功能衰竭，增加对大脑的压力造成的。药物可以帮助减少你的大脑中的液体积聚。 筛选感染。你的医疗小组将考虑你的血液和尿液样本，将定期对检测感染的迹象。如果医生怀疑您有一个感染，你会收到药物来治疗感染。 防止严重出血。人急性肝功能衰竭常常在发展出血消化道溃疡。你的医生会给你的药物，以减少出血的风险。如果您失去了很多血，你可能需要输血。 肝移植。急性肝衰竭无法逆转在许多情况下。在这种情况下，唯一的治疗方法可能是肝脏移植。在肝脏移植手术，外科医生删除已损坏的肝，代之以从捐赠者的健康肝脏它。 预防 降低到您的肝脏照顾你的急性肝衰竭的危险。尝试： 按照药品的说明。如果你对乙酰氨基酚或其他药物，检查的推荐剂量指示包插入不超过剂量。 告诉您所有的药物你的医生。告诉你的关于对非处方和草药您正在服用医生。这些可能会影响你的处方药服用。 适量喝酒，如果在所有。金额限制你喝的酒不超过一喝一妇女每天不超过两杯男性一天。 避免危险行为。获得帮助如果您使用非法静脉注射毒品。不要共用针头注射毒品使用。如果您选择性交，使用避孕套。如果您选择有纹身或身体穿孔，约清洁和安全小心当谈到选择一间店铺。 需要接种疫苗。如果你在感染肝炎的风险增加，如果你已经感染的任何形式或肝炎病毒，如果您有慢性肝病，谈谈你对获得的乙肝疫苗的医生。疫苗也可用于甲型肝炎 避免接触其他人的血液和体液。肝炎病毒可以传播意外针扎或血液或体液不当清理。也有可能成为共享牙刷剃须刀片或感染。 随身携带喷雾剂照顾。当您使用喷雾清洁，确保室内通风，或戴上口罩。喷涂时采取类似的杀虫剂，杀菌剂，油漆和其他有毒化学品的保护措施。始终按照制造商的说明。 观看什么，你的皮肤得到。当使用杀虫剂和其他有毒化学品，包括你的手套，穿长袖衬衫，帽子和口罩皮肤。 选择健康的饮食习惯。选择植物为主的水果和各种蔬菜的饮食。限制高脂肪食物。 保持健康的体重。肥胖可能导致这种情况称为非酒精性脂肪肝疾病，其中可能包括脂肪肝，肝炎和肝硬化。 


Original Article:http://www.nlm.nih.gov/medlineplus/liverdiseases.html

Acute liver failure

By Mayo Clinic staff

Definition

Acute liver failure occurs when your liver rapidly loses its ability to function. More commonly, liver failure develops slowly over the course of years. But in acute liver failure, liver failure develops in a matter of days.

Acute liver failure can cause many complications, including excessive bleeding and increasing pressure in the brain. Another term for acute liver failure is fulminant hepatic failure.

Acute liver failure is a medical emergency that requires hospitalization. Some causes of acute liver failure can be reversed with treatment. But in other situations, a liver transplant may be the only cure for acute liver failure.

Symptoms

Signs and symptoms of acute liver failure may include:

§                         A yellowing of your skin and eyeballs (jaundice)

§                         Tenderness in the upper right area of your abdomen

§                         Nausea

§                         Vomiting

§                         A general sense of not feeling well

§                         Difficulty concentrating

§                         Disorientation or confusion

§                         Sleepiness

§                         Muscle tremors

When to see a doctor
Acute liver failure can develop quickly in an otherwise healthy person, and it is life-threatening. If you or someone you know suddenly develops a yellowing of the eyes or skin, tenderness in the upper abdomen or any unusual changes in mental state, personality or behavior, seek medical attention right away.

Causes

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Acute liver failure occurs when liver cells are damaged significantly and no longer able to function. Acute liver failure has many potential causes, including:

§                         Acetaminophen overdose. Taking too much acetaminophen (Tylenol, others) is the most common cause of acute liver failure in the United States. Acute liver failure can occur if you take a very large dose of acetaminophen all at once, or it can occur if you take smaller doses every day for several days, especially in people with chronic liver disease.

§                         Prescription medications. Some prescription medications can cause acute liver failure, including antibiotics, nonsteroidal anti-inflammatory drugs and anticonvulsants, among others.

§                         Herbal supplements. Herbal drugs and supplements have been linked to acute liver failure, including kava, ephedra, skullcap and pennyroyal, among others.

§                         Hepatitis and other viruses. Hepatitis A, hepatitis B and hepatitis E can cause acute liver failure. Other viruses that can cause acute liver failure include Epstein-Barr virus, cytomegalovirus and herpes simplex virus.

§                         Toxins. Toxins that can cause acute liver failure include the poisonous wild mushroom Amanita phalloides, which is sometimes mistaken for other edible species.

§                         Autoimmune disease. Liver failure can be caused by autoimmune hepatitis — a disease in which your immune system attacks liver cells, causing inflammation and injury.

§                         Diseases of the veins in the liver. Vascular diseases that cause blockages to form in the veins of the liver can cause acute liver failure. These include portal vein thrombosis, Budd-Chiari syndrome and venoocclusive disease.

§                         Metabolic disease. Rare metabolic diseases, such as Wilson's disease, acute fatty liver of pregnancy and Reye's syndrome, infrequently cause acute liver failure.

§                         Cancer. Cancer that begins in your liver or cancer that spreads to your liver from other places in your body can cause your liver to fail.

Many cases of acute liver failure have no apparent cause.

Complications

Acute liver failure often causes complications, including:

§                         Excessive fluid in the brain (cerebral edema). Excessive fluid causes pressure to build in your brain, which can displace brain tissue outside of the space it normally occupies (herniation). Cerebral edema can also deprive your brain of oxygen.

§                         Bleeding disorders. A failing liver isn't able to produce sufficient amounts of clotting factors, which help blood to clot. Bleeding from ulcers in the gastrointestinal tract or other locations is difficult to control because it doesn't clot quickly.

§                         Infections. People with acute liver failure are at an increased risk of developing a variety of infections, particularly in the blood and in the respiratory and urinary tracts. 

§                         Kidney failure. Kidney failure often occurs following liver failure, especially in cases of acetaminophen overdose, which damages both your liver and your kidneys.

Preparing for your appointment

If your doctor suspects you may be experiencing acute liver failure, you'll likely be admitted to a hospital for treatment. Most people with acute liver failure are treated in an intensive care unit.

Questions to expect from your doctor
Your doctor will ask you or your family members a number of questions to try to determine what may have caused your acute liver failure. Your doctor may ask:

§                         When did you first begin experiencing symptoms?

§                         What prescription medications do you take?

§                         What over-the-counter medications do you take?

§                         What herbal supplements do you take?

§                         Do you use illegal drugs?

§                         Have you ever been diagnosed with hepatitis?

§                         Do you have a history of depression or suicidal thoughts?

§                         How much alcohol do you drink?

Questions to ask your doctor
If you or a loved one has been diagnosed with acute liver failure, here are some questions to ask the doctor:

§                         What caused my acute liver failure?

§                         What are the chances that my acute liver failure can be reversed?

§                         What are the treatments for acute liver failure?

§                         Will I need a liver transplant?

§                         Does this hospital have a liver transplant unit?

§                         Should I be transferred to a hospital that performs liver transplants?

Tests and diagnosis

Tests and procedures used to diagnose acute liver failure include:

§                         Blood tests. Blood tests to determine how well your liver is functioning may include the prothrombin time test, which measures how long it takes for your blood to clot. If you have acute liver failure, your blood doesn't clot as quickly as it should.

§                         Examination of liver tissue. Your doctor may recommend a procedure to remove a small section of liver tissue (liver biopsy). Tests of the liver tissue may help your doctor understand why your liver is failing. For people with a risk of bleeding during biopsy, such as those with acute liver failure, the doctor performs a transjugular liver biopsy. To do this, a tiny incision is made on the right side of your neck and a thin tube (catheter) is passed into a large vein in your neck, through your heart and down into a vein exiting your liver. Your doctor then inserts a needle down through the catheter and retrieves a sample of liver tissue.

Treatments and drugs

People with acute liver failure are treated in the intensive care unit of a hospital. Acute liver failure treatments may include:

§                         Medications to reverse poisoning. Acute liver failure caused by acetaminophen overdose or mushroom poisoning is treated with drugs that can reverse the effects of the toxin.

§                         Relieving excess fluid in the brain. Cerebral edema caused by acute liver failure can increase pressure on your brain. Medications can help reduce the fluid buildup in your brain.

§                         Screening for infections. Your medical team will take periodic samples of your blood and urine to be tested for signs of infection. If your doctor suspects that you have an infection, you'll receive medications to treat the infection.

§                         Preventing severe bleeding. People with acute liver failure often develop bleeding ulcers in the gastrointestinal tract. Your doctor will give you medications to reduce the risk of bleeding. If you lose a lot of blood, you may require blood transfusions. 

§                         Liver transplant. Acute liver failure can't be reversed in many cases. In these situations, the only treatment may be a liver transplant. During a liver transplant, a surgeon removes your damaged liver and replaces it with a healthy liver from a donor.

Prevention

Reduce your risk of acute liver failure by taking care of your liver. Try to:

§                         Follow instructions on medications. If you take acetaminophen or other medications, check the package insert for instructions on the recommended dosage and don't exceed that dosage.

§                         Tell your doctor about all your medicines. Tell your doctor about over-the-counter and herbal medicines that you're taking. These can interfere with prescription drugs you're taking.

§                         Drink alcohol in moderation, if at all. Limit the amount of alcohol you drink to no more than one drink a day for women and no more than two drinks a day for men.

§                         Avoid risky behavior. Get help if you use illicit intravenous drugs. Don't share needles used to inject drugs. If you choose to have sex, use condoms. If you choose to have tattoos or body piercings, be careful about cleanliness and safety when it comes to selecting a shop.

§                         Get vaccinated. If you're at increased risk of contracting hepatitis, if you've already been infected with any form of the hepatitis virus or if you have chronic liver disease, talk to your doctor about getting the hepatitis B vaccine. A vaccine is also available for hepatitis A.

§                         Avoid contact with other people's blood and body fluids. Hepatitis viruses can be spread by accidental needle sticks or improper cleanup of blood or body fluids. It's also possible to become infected by sharing razor blades or toothbrushes.

§                         Take care with aerosol sprays. When you use an aerosol cleaner, make sure the room is ventilated, or wear a mask. Take similar protective measures when spraying insecticides, fungicides, paint and other toxic chemicals. Always follow the manufacturer's instructions.

§                         Watch what gets on your skin. When using insecticides and other toxic chemicals, cover your skin with gloves, long sleeves, a hat and a mask.

§                         Choose a healthy diet. Choose a plant-based diet with a variety of fruits and vegetables. Limit high-fat foods.

§                         Maintain a healthy weight. Obesity can cause a condition called nonalcoholic fatty liver disease, which may include fatty liver, hepatitis and cirrhosis.