HEPATIC COMA

 HEPATIC COMA

This is also Called Hepatic Encephalopathy.
Introduction
√The liver is a cardinal body organ responsible for various activities in the body such as Excretion and removal of waste products from the body.
√When the liver Fails to perform it's function of excreting wastes from the blood,The toxins will accumulate in the blood and are supplied to various parts of the body including the Brain.
√When these toxins are transported to the brain in blood,The Brain's functions starts to decline (Fail),When the brain Fails to function,The patient will go into coma.
√This type of coma is what is called Hepatic Coma.
Definition
√.This is the loss of the Brain's Function following Failure of the liver to Excrete Excess toxins from the Blood and is charecterized by Fever and coma.
√.This is a decline in the Brain function Occuring as a result of Severe Liver Disease.
FUNCTIONS OF THE LIVER
1.It helps in the Blood Detoxification.
2.Excretion of Bilirubin
3.Synthesis of Plasma proteins.
4.Formation and Excretion of Bile.
5.Synthesis and Storage of Clotting factors.
6.Storage of Glycogen.
7.Metabolism of Fats,proteins and Carbohydrates.
8.Enzyme activation.
9.Excretion of Ammonia.
10.Storage of Blood.
CAUSES
√The causes are unknown but Liver Failure is the major cause.
RISK FACTORS
1.TRAUMA.
√This may rupture the liver blood vessels making it Fail to Function and perform.
2.AGE
√There couldn't degenerative changes to the liver weakening it.
3.TISSUE NECROSIS
√This may cause inability of the Hepatocytes loose there integrity and Failure to perform.
4.CHRONIC LIVER DISEASES
√Conditions like Liver Cirrhosis damage the liver severely causing failure of the liver to work.
5. INFECTION OF THE LIVER.
√This cause inflammation and eventually formation of abscess that alter the normal liver function.
TYPES OF HEPATIC COMA
√The Types are divided into Two.
1.HEPSTOCELLULAR HC.*
√This type Occurs as a result of Severe damage to a significant part of the hepatic cells in viral hepatitis.
√Other Causes include Intoxication with chemicals,Poisoning and following fungal infections.
2.SHUNT HEPATIC COMA**
√This is also called the Bypass hepatic coma.
√This occurs when outflow of blood from the intestines passes not through the liver.
√This causes Liver Ischemia leading to Tissue necrosis.
STAGES OF HEPATIC COMA
*PRE-COMA *
√ is characterized by impaired orientation, thinking, sleep disorder (drowsiness during the day and wakefulness at night).
*THREATENING HEPATIC COMA *
√This type,there is confusions. √Attacks of excitement are replaced by drowsiness and depression.
√There is a disorder of coordination of movements, a tremor of fingers.
√Speech is disturbed.
DEVELOPED HEPATIC COMA
√This is characterized by a complete lack of consciousness,and rigidity of the occipital muscles.
√There is Progression of jaundice.
√The body temperature rises, sepsis often joins.
√ The oliguria develops and leukocytosis grows.
STAGES OF HEPATIC COMA
√The five stages of hepatic encephalopathy, according to the West Haven Criteria,Include.
** STAGE 0. **
√At this stage, symptoms are minimal.
STAGE 1.
√Symptoms are mild.
√They may include a shortened attention span and changes to Sleeping habits, such as insomnia.
STAGE 2.
√ Symptoms are moderate.
√ At this stage,There is a feeling of disorientation or lethargy.
STAGE 3.
√Symptoms are severe.
√There is Inability to perform basic tasks.
√There is a feeling of confusion and experience personality changes.
STAGE 4.
√This stage is characterized bycoma
PATHOPHYSIOLOGY
√The liver is responsible for the Excretion of the Waste products from the Blood like Urea,Amonia and Creatinines.
√Following Excessive alcohol intake,The liver is damaged and eventually Fails to Excrete wastes from the blood.
√The waste products accumulate in the blood and are transported to the Brain causing Brain toxication.
√Symptoms like Confusions, Headache, Jaundice, Hallucinations occurs and eventually the Brain Fails to function and coma Occurs.
SIGNS AND SYMPTOMS
1.Fever related to the Infection.
2.Jaundice related to Failure of Unconjugated Bilirubin excretion.
3.Ascites related to excess protein insufficiency.
4.Confusions related to Brain Intoxication.
5.Headache related to cerebral hypoxia.
6.Hallucinations related to cerebral hypoxia.
7.Bleeding tendacies related to insufficient blood clotting factors.
8.Weakness related to Gluocose insufficiency.
9.Severe abdominal pains related to liver overactivity.
10.Tremors related to Excess toxins in blood.
MANAGEMENT
INVESTIGATIONS./DIAGNOSIS.
1.HISTORY TAKING.
√This will reveal risks such as Prolonged and Excessive alcohol intake.
2.PHYSICAL EXAM.
√This will show some Symptoms like Jaundice,Ascites,Pain when palpating the liver etc
3.LIVER FUNCTION TEST.
√The liver function tests may show raised enzymes levels signifying stress of the liver.
4.COMPLETE BLOOF COUNT.
√They will show raised leukocyte levels,The red blood cells may be reduced too including the clotting factors.
5.MRI/CT SCAN.
√This will show changes in the contour and size of the liver.
TREATMENT
1.Oxygen Therapy in cases of Breathing Difficulties.
2.Antiobitics .
√Gentamycin and Benzylpenicilli intravenously to treat the Infection.
3.Lactulose.
√This enables the liver to rest.
4.Liver Transplant.
5.Blood transfusion in cases of Severe Anaemia.
6.Diet.
√Reduce On Excess proteins intake and Fat intake.
√Increasea Carbohydrates intake.
7.Iv Analgesia.
√To relieve pain.
NURSING CARE
Aims
Environment
Maintenance of clear airway
Observations
Psychological Care
Rest
Pain Management
Care for Fever
Medication
Infection prevention
Nutrition
Elimination
Patient Education
PREVENTION
1.Avoid Excess Alcohol intake.
2.Avoid and Reduce on Excess Fat intake.
3.Maintain a good weight.
4.Vaccination against Hepatitis
5.Early Treatment and Diagnosis of Liver diseases

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