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| Liver coma: (Encephalopathy) |
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Liver is the most important organ that helps in clearing waste products of metabolism from the blood stream. All the food that is eaten is assimilated in the intestines and absorbed into the blood stream and is carried to the liver by the portal vein. In the liver the cells are active round the clock and break down the absorbed nutrients into energy yielding forms, storage forms and body building forms of basic products. The waste produced as the end result is also made non toxic and excreted either as bile or through the urine. When liver cell failure occurs the waste products accumulate in the blood, slowing down the brain function. The coma can progress through four stages, the earliest being slowness of speech or altered sleep wake cycle and the last stage being deep state of coma. In most occasions coma is reversible completely unless the liver failure is very advanced.
One of the several toxins that is measurable is ammonia. As most toxins are waste products of protein metabolism (aromatic aminoacids), this state is also called protein intolerance, this is directly proportional to the degree of liver failure. Thus treatment of liver coma involves reducing intake of protein in the diet and clearing the large bowel of faecal matter. Oral antibiotics also help by reducing the bacterial load in the gut, indirectly reducing the ammonia production from waste matter. Coma can also be a result of low sodium level in the blood or due to intake of drugs with sedative action. In this case correction of sodium level will restore normalcy. Infections in the body of patients with cirrhosis of liver can predispose to liver coma.
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