[Therapy of hepatic insufficiency]

Area of Science:

• Hepatology
• Gastroenterology
• Internal Medicine

Background:

• Hepatic insufficiency commonly results from active liver cirrhosis with portal hypertension, potentially leading to hepatic coma.
• Both exogenous and rarer endogenous causes of hepatic coma exist, including fulminant hepatitis and severe intoxications.

Purpose of the Study:

• To outline the management strategies for hepatic insufficiency.
• To discuss the treatment of hepatic encephalopathy and different forms of hepatic coma.

Main Methods:

• Eliminating exacerbating factors like high protein intake, gastrointestinal bleeding, alcohol, and diuretics.
• Reducing toxic intestinal protein metabolites using sodium acetate buffer enemas or neomycin.
• Administering lactulose for long-term management to reduce hyperammoniemia and increase serum phenols.
• Considering ammonia-reducing amino acids like arginine, ornithine, and glutamic acid.
• Utilizing blood exchange, liver, and charcoal perfusions for endogenous hepatic coma.

Main Results:

• Lactulose treatment significantly reduces hyperammoniemia and increases serum phenols.
• Neomycin can reduce toxic protein metabolite production but may affect gut bacteria long-term.
• Ammonia-reducing amino acids show similar beneficial effects.

Conclusions:

• Early diagnosis and intensive care are crucial for managing hepatic insufficiency.
• While treatments exist, the prognosis for hepatic insufficiency from fulminant hepatitis remains poor in advanced stages.