Hepatic coma in liver cirrhosis. Prevention and treatment
Bartels, O.; Riemann, J.F.; Groitl, H.
Fortschritte der Medizin 95(30): 1845-1850
1977
ISSN/ISBN: 0015-8178 PMID: 409655 Document Number: 118120
The prognosis of hepatic coma is poor if the patient has jaundice, ascites, defects in clotting factors, a low serum-albumin level and haemorrhage from oesophageal varices. After 5 years, the survival rate is less than 20%. Approved methods of intensive care are recommended. Cerebral oedema, respiratory and renal failure, infection and lactate acidosis are dangerous complications with the necessity to early treatment. The difficulty of parenteral nutrition depends on the extent of liver cell failure. In spite of the rise in blood ammonia mixtures of selected amino acids should be given in small doses. In selected cases temporary hepatic support and detoxification methods are indicated in hepatic coma. Charcoal haemoperfusion decreases the depth of coma and regulates the electroencephalogram, some patients fully recover consciousness. But there is no long-term improvement of survival-rates in cases complicated by bleeding oesophageal varices and by septic circulatory failure. The lethality of the first bleeding from varices is about 50%. Diagnostic endoscopy is necessary, sclerosing of oesophageal varicosis and laser-coagulation can be life-saving in hepatic pre-coma. The mortality of surgical procedures is more than 60%. Emergency anastomosis shunting portal blood has a better prognosis than ligation of the varices or oesophageal and high gastric transsection operations, demonstrated by surgical management in 248 cases. Even with this long-term succes is unusual.