Last week I was discharged from the hospital to go home aunt Lee today become unconscious, how is this going? Aunt Lee usually body is not s
Last week I was discharged from the hospital to go home aunt Lee today become unconscious, how is this going? Aunt Lee usually body is not strong, but it is still tough. Last week, a sudden big vomiting blood, spit half face, people are unconscious, scared the whole family. 120 ambulances rushed to a nearby aunt Lee a large hospital emergency department, after the medical staff rescue after finally turned the corner, "is the diagnosis of decompensated cirrhosis and esophageal variceal bleeding". After leaving home, the whole family to take care of aunt Lee, aunt Lee's mood, appetite is also good recovery. Filial daughter specially carefully cooked chicken turtle soup up to her body, unexpectedly only eat a meal at noon, evening aunt Lee confused, confused daughter and daughter-in-law, the morning of the second day on the confusion, coma. Aunt Lee did not bleed this time, I do not know what is the reason for coma. Family rushed please 120 ambulance to the hospital again, the doctor immediately after a dying, and told aunt Lee's family: is your aunt Lee up into cirrhosis hepatic coma! What the hell is going on here?
Although Aunt Li has not been infected with hepatitis B and hepatitis C virus, but there is an autoimmune disorder, caused by autoimmune hepatitis caused by cirrhosis. Aunt Lee usually live a full, happy family, didn't feel what special abnormality, wait until the appearance of gastrointestinal bleeding, is already in advanced cirrhosis, in which the doctor said "decompensated cirrhosis".
The liver is originally human metabolism and detoxification center, but the liver cirrhosis, portal venous pressure to the blood supply of liver increased, leading to other vessels and portal vein connected also gradually expanded, such as esophageal vein or gastric varices. To decompensated cirrhosis, once these varicose vascular rupture occurs, massive hemorrhage of upper digestive tract, which is decompensated cirrhosis the most common complication, aunt Lee hematemesis is how it happened. But after aunt Lee home and no recurrent vomiting, coma and why not clear, sending the hospital?
The original problem is done to mother aunt Lee filial daughter of the chicken turtle soup on. Although the liver is the body's metabolism and detoxification center, but in patients with decompensated liver cirrhosis, liver metabolism and detoxification function of the decline in ammonia, mercaptan and other toxic substances in the body's metabolic capacity decreased significantly. In animal eating high protein diet, intestinal ammonia and thiols have increased significantly, while the hardening of the liver is not as normal as the rapid liver metabolism, toxic substances to remove these toxic substances, leading to increased concentration in vivo, and cause brain dysfunction, which is what medicine the "hepatic encephalopathy", also called "hepatic coma". Aunt Lee because of good appetite, eat a lot of girls carefully stewed turtle soup chicken such a high protein diet, soon appeared hepatic coma.
Hepatic encephalopathy is the most serious complication of liver cirrhosis, but it is often ignored. Mild hepatic encephalopathy with no obvious clinical manifestations were as normal people, in normal social activities, can show abnormal personality and behavior, such as the recent sudden showing excitement, aggressive, or indifferent, selfish, or easy driving a vehicle when the accident risk. At this time of hepatic encephalopathy if not promptly recognized and not timely medical treatment, further development can show cognitive dysfunction on time and place and around their loved ones, such as aunt Lee to eat chicken turtle soup actually his daughter as a wife. If the condition of further development, it can be expressed as lethargy or no perception of coma, when there is danger. No wonder the second hospital doctor immediately to Aunt Lee family in critical condition notice.
Common causes of hepatic encephalopathy in patients with liver cirrhosis include: (1) eating high protein diet caused intestinal ammonia production increased; (2) the constipation: intestinal ammonia and mercaptan and other toxic substances can not be discharged in time; (3) infection: increased tissue decomposition resulting in ammonia production increased; (4) digestion vaginal bleeding, blood in the intestine in ammonia production increased, while the bleeding caused by ischemia and shock and reduce the brain cells, tolerance to toxic substances and prone to hepatic encephalopathy; (5) alkaloses: vomiting, diarrhea, or eating too little, can cause hypokalemic alkalosis, and the formation of alkali make up, ammonia poisoning and easily enter the brain; (6): sedative and hypnotic sedative and hypnotic drugs such as diazepam, barbiturates, can directly inhibit the function of nerve conduction in patients with liver cirrhosis, which may induce Hepatic encephalopathy.
According to the above causes of the hepatic encephalopathy in patients with decompensated cirrhosis in the daily recuperation and tonic, should pay attention and have a choice. First, avoid eating a high protein diet, do not make the surge in ammonia production in human gut. Second, in particular, do not eat large amounts of animal protein. In addition to ammonia production increased, aromatic amino acid metabolites in animal protein contains more, and this kind of amino acids also can inhibit brain nerve conduction induced hepatic coma in cirrhosis, one of the reasons for the onset of coma which is aunt Lee eat lots of chicken turtle soup. Third, in patients with decompensated cirrhosis, with a small amount of vegetable protein is appropriate, because less aromatic amino acids in plant protein, branched chain amino acids and branched chain amino acids was more, can block the antagonism of some toxic substances on the brain function. Fourth, you can eat bananas and other fruits, to maintain smooth stool, 1~2 times a day, always keep the timely removal of ammonia in the intestine. Fifth, in the loss of appetite, or vomiting, diarrhea, it is necessary to promptly fill potassium, such as the introduction of fresh cucumber juice, apple juice, etc., to avoid the occurrence of hypokalemic alkalosis caused by hepatic encephalopathy. Sixth, the appropriate vitamin supplements and probiotics, such as vitamin C, vitamin B2, vitamin K and Lactobacillus acidophilus, stable internal environment. Seventh, unless the anemia obvious hemorrhage in patients with liver cirrhosis, otherwise generally avoid taking iron supplements and / or preparations containing minerals, because iron can aggravate the liver sclerosis effect. Eighth, try to avoid the use of sedative hypnotic drugs, to avoid the direct cause of hepatic coma. Ninth, the esophageal varices, usually should do some soft rotten food, avoid eating too coarse food, non edible food such as prickly hard, spiny fish, chicken bones and nuts, to prevent rough hard foods scratch esophageal varicose vein or gastric varices caused by upper gastrointestinal hemorrhage.
Liberation Daily 2009 manuscripts