The hepatic coma, also known as hepatic coma or coma hepaticum, represents a disturbance of consciousness – in the form of a coma. The trigger is liver failure. Hepatic coma is fatal in almost all cases.
What is hepatic coma?
Symptoms include loss of consciousness, bad breath, areflexia, impaired consciousness, impaired memory, and also incontinence. Depending on the stage, the symptoms can vary in severity. See AbbreviationFinder for abbreviations related to Hepatic Coma.
If a liver coma occurs, those affected cannot be awakened by external stimuli. The reason why such a disturbance of consciousness occurs is a failure of the liver. If there is a lack of detoxification function or the death of liver tissue, the organ fails.
First, there is hepatic encephalopathy. So much ammonia is accumulated in the blood that it leads to a disorder and subsequently to a coma. There are two forms: the so-called liver failure coma and the liver decay coma. If hepatic liver coma occurs, it ends – in almost all cases – in the death of the patient.
Causes
The reasons why a hepatic coma occurs are different. If it is a liver decay coma, also known as an endogenous liver coma, liver tissue dies off. The endogenous hepatic coma is usually triggered by toxic damage to the organ, such as drugs, chemicals or poisons.
Sometimes hepatitis (type B or D, also known as jaundice) and a fatty liver of pregnancy (an extremely rare complication of pregnancy) can also lead to a coma with hepatic decomposition. If there is a coma with failure of the liver, there is cirrhosis of the liver.
Liver cirrhosis is the end stage of chronic liver disease; the liver tissue has already changed (formation of lumps) so that the liver cells can no longer perform their function. This leads to circulatory disorders and a complete functional cessation of the organ.
Cirrhosis of the liver is, at least in Europe, predominantly promoted by alcohol abuse ; sometimes viral hepatitis can also be responsible for liver cirrhosis. However, certain immune and tropical diseases can also trigger cirrhosis.
There is a build-up of toxins, such as ammonia compounds, causing the organ’s detoxification functions to be impaired. The toxins are then passed on to the affected person’s brain, resulting in a hepatic coma.
Symptoms, Ailments & Signs
Symptoms include loss of consciousness, bad breath, areflexia, impaired consciousness, impaired memory, and also incontinence. Depending on the stage, the symptoms can vary in severity. While in the first stage there are hardly any problems with tiredness, in the third stage sleepiness – along with muscle tension – is the biggest problem.
Diagnosis & course of disease
The doctor makes the diagnosis based on the existing symptoms, whereby the medical history also plays an important role. So that the doctor can be sure that it is actually a hepatic coma, he has blood tests carried out, whereby the detoxification function of the liver and subsequently the ammonia concentration are determined.
In the further course, an ultrasound of the organ can give an insight into how large the liver is and sometimes what its condition or structure is. Other procedures, such as computed tomography (CT), are also used to confirm the diagnosis. Before the affected person loses consciousness, the hepatic coma runs through three stages (I to III), with increasing disturbance of consciousness.
In the first stage (Stage I) a decrease in intellectual capacity is noted. The need for sleep increases. In the second stage (stage II) there is increased fatigue, memory and orientation disorders and increased muscle tension. Sometimes the person affected also reacts more slowly to being spoken to directly.
In the third stage (stage III), the patients can hardly be awakened; when alert, they appear disoriented and confused. There is increased muscle tension, with the affected person being unable to hold urine or stool. In the fourth stage (stage IV), hepatic coma occurs.
Complications
In most cases, a hepatic coma leads to the death of the person concerned. They can suffer from various complaints and disorders and are therefore extremely restricted in their everyday life. In most cases, this leads to a very bad breath odor and also to unconsciousness. Those affected also suffer from other disorders of consciousness and paralysis.
It can also lead to incontinence or memory problems. The patients are extremely tired and exhausted due to the liver coma. The resilience of those affected also decreases significantly as a result of this disease. In many cases, the patient’s relatives also suffer from depression and other psychological problems and need appropriate treatment.
Treatment does not always lead to a positive course of the disease. In some cases, poisoning can be treated with medication. However, the affected person is then dependent on dialysis. If this is not possible, a liver transplant is necessary so that the person concerned can continue to survive. In many cases, the life expectancy of those affected is significantly restricted and reduced by the hepatic coma.
When should you go to the doctor?
A doctor should be consulted if there is noticeable bad breath or changes in body odor. If you feel ill, feel generally unwell or have any peculiarities in your skin, you should consult a doctor. A doctor is required in the event of disturbances in consciousness, impairment of memory or the loss of acquired knowledge and skills. A drop in memory performance is always a warning from the organism that needs to be clarified. In the event of a loss of natural reflex activity, the person concerned needs medical support. An increased need for sleep, sudden tiredness, sluggishness or listlessness are signs of existing disorders that should be investigated.
Regular check-ups and check-ups with a doctor are generally recommended. If performance is impaired without any apparent reason, if there are emotional changes or persistent muscle tension, a doctor is needed. A doctor’s visit should be initiated in case of incontinence. If the excretions are repeatedly not controlled by willpower, a doctor should be consulted. If existing symptoms spread or increase in intensity, a doctor should be informed of the observations. Because hepatic coma is an unresponsive condition, bystanders should provide first aid and call an ambulance as soon as there is evidence of loss of consciousness.
Treatment & Therapy
If a hepatic coma occurs, the patient is immediately taken to the intensive care unit. There is acute danger to life. However, because hepatic coma is a symptom, the causative disorder that led to the condition is treated first. The patient can only wake up from the coma if the doctors treat the underlying disease.
If viral hepatitis is present, antiviral therapies – in the form of drugs – are carried out. If poisoning, for example from fungi, is the reason for the liver coma, medication is also administered. Due to the fact that the liver can still recover on its own, even if around 90 percent is damaged, doctors often rely on what is known as liver dialysis.
This gives the damaged organ the time it needs to regenerate. With such dialyses, it is also possible to bridge the time required for a liver transplant. In many cases, liver dialysis is the only treatment option to treat the hepatic coma.
Outlook & Forecast
The prognosis of hepatic coma is unfavorable. Most people die because of the health impairments. In about 90 percent of those affected, a fatal outcome appears in the course of the disease. There is a dysfunction of the liver activity and the organism can no longer carry out adequate detoxification. Ultimately, there is a risk of organ failure and thus the death of the person concerned.
Without medical care, there is no prospect of alleviating the symptoms. In addition, there are no self-help measures that can improve liver activity. In some patients, organ transplantation is successful or symptoms can be relieved with liver dialysis. Dialysis gives the human organism time to activate a regeneration process.
In basically healthy people with a stable immune system, an improvement can be documented in this way. Organ transplantation is associated with numerous risks and side effects. In addition to the actual operation, the difficulty also lies in the acceptance of the donor organ by the weakened and diseased organism. Rejection reactions to the new liver are common, which contributes to an additional deterioration of the overall situation. If the survival of the person concerned can be secured, lifelong impairments are to be expected. The susceptibility to illness is increased and regular check-ups are necessary.
Prevention
Hepatic coma can be prevented if potential causes – such as viral hepatitis or alcohol abuse – are avoided through a relatively healthy lifestyle. If you are already addicted to alcohol, it is advisable to undergo therapy so that further liver damage can be prevented.
Hepatitis is primarily transmitted through unprotected sex. Protected sex or hygienic behavior, since the virus is also transmitted through direct blood contact, reduces the risk of infection. It is also possible to get vaccinated against hepatitis B.
Hepatic coma is a highly dangerous, life-threatening condition, which without therapy – and accordingly also without aftercare – usually has fatal consequences.
Aftercare
The follow-up care for a hepatic coma should therefore also be continued in intensive care if possible. Primarily, this focuses on combating and ideally eliminating the underlying cause that led to the condition over the long term. If the function of the liver is severely restricted so that liver failure is unavoidable, a liver transplant is required.
After treatment of the acute hepatic coma, liver dialysis should therefore be performed to bridge the gap between intensive medical therapy and liver transplantation. In any case, alcohol, nicotine and other drugs should be avoided entirely. While this can no longer repair an irreversible damage, it can prevent it from progressing further. A healthy lifestyle and diet, as well as regular medical check-ups are also part of comprehensive aftercare.
If there is an initial stage of hepatic coma, further drug treatment can also inhibit the progression of the condition. Last but not least, psychological follow-up care should also be considered, since the loss of cognitive abilities as a result of the condition can also cause mental problems.
You can do that yourself
With the diagnosis of hepatic coma, there are few or no options for the patient to help themselves in everyday life. This disease offers no alternatives to medical treatment.
The person concerned should consult a team of experts at the first symptoms and trust in the medical care. The instructions of the medical team must be followed. Depending on the stage of the coma, the patient is no longer able to speak and is therefore unable to carry out any independent activities. Relatives should inform themselves comprehensively about the disease and its consequences. If you need emotional support in coping with the situation, it is advisable to see a therapist.
In an initial phase of the disease, the affected person suffers from decreasing performance and an increased need for sleep. If it is possible for him in this state, the way of life should be optimized. This includes the complete avoidance of toxins and pollutants as well as a healthy diet. Alcohol consumption should be stopped as soon as possible. In a few cases, this behavior can reduce the further deterioration of the tissue of the liver. Working together with liver specialists is helpful in order to make use of their expertise for optimal further treatment. Together we should work out which individual options the patient has to improve his or her well-being.
