encefalopatia wątrobowa

poalkoholowa marskość wątroby

opis przypadku

leczenie

Hepatic coma is a complex of disorders of the central nervous system that occur in the course of acute or chronic liver diseases. Alcohol abuse is the main factor leading to hepatic cirrhosis in adults. Alcohol is the cause of 50% of all cases of hepatic cirrhosis in Western countries, and probably also in Poland. Women are more susceptible to liver damage due to alcohol; the permissible dose is several times lower, while the progress of the disease is more rapid. The case of a 43-year-old female patient is presented, admitted to the Clinic as an emergency case due to symptoms of hepatic coma in the course of toxic alcoholic cirrhosis. The patient had been abusing high proof alcohol since the age of 20. During hospitalization of the patient, the increasing ascites and secondary anemia were observed. According to the West Haven Criteria, grade IV b hepatic coma was defined, whereas by means of the Child- Pugh scale hepatic failure was classified into class C. Ultrasonography confirmed the features of hepatic cirrhosis. In laboratory tests, features of the damage of the liver parenchyma were observed: ALAT 622 IU/l, ASPAT 4052 IU/l, total bilirubin 14,75 mg/dl. Examinations of the coagulation system demonstrated: INR presenting the value of 2.74, prothrombin time between 30.4 and 31.6 s, APTT from 53.90 to 67.20 s. The treatment covered application of the following: Lactulosum, Neomycinum, Ornithini aspartas, Phytomenadionum, Spironolactonum, Furosemidum. The patient was transfused 2 doses of erythrocyte mass. After the application of treatment, a transitory improvement of the patient’s general health status was obtained. Subsequently, paracentesis was performed due to the proceeding ascites, resulting in the letting of 5 litres of liquids. Bacteriological inoculation identified E.coli. On the 15th day the patient died due to the massive bleeding from the alimentary tract, as well as other body foramen.