Diagnostic Criteria and Principles of Treatment for Liver Failure
Feb 27, 2023
Source: Cainiu Health
Dr. Zhou Chao
Introduction
The diagnostic criteria for liver failure generally include severe gastrointestinal symptoms and abnormal mental status. Laboratory findings show prolonged prothrombin time, prothrombin activity less than 40%, and daily bilirubin levels exceeding ten times the normal value. Imaging examinations reveal features such as advanced cirrhosis, ascites, and portal hypertension. The treatment principle emphasizes early diagnosis, timely implementation of appropriate therapies, comprehensive management, and prevention of complications.
Diagnosis of liver failure is generally based on clinical symptoms, laboratory tests, and imaging examinations. The treatment principle usually involves actively addressing the underlying cause and providing comprehensive management to prevent complications.
I. Diagnostic Criteria
1. Clinical Symptoms
If a patient presents with extreme fatigue, severe gastrointestinal symptoms, and abnormal neuropsychiatric manifestations such as restlessness, coma, somnolence, personality changes, or obvious signs of bleeding, along with progressively deepening jaundice and asterixis (sudden flexion of the wrist joint when the fingers are extended, followed by rapid extension, accompanied by tremors and hyperkinesia), liver failure should be primarily considered.
2. Laboratory Tests
Liver failure may be suspected if laboratory findings show significantly prolonged prothrombin time, prothrombin activity less than 40%, daily bilirubin increase exceeding 17.1 μmol/L, or bilirubin levels more than 10 times the upper limit of normal, along with enzyme-bilirubin dissociation and elevated blood ammonia levels.
3. Imaging Examinations
Imaging studies showing features of advanced cirrhosis—such as markedly reduced liver volume, irregular liver surface, ascites, thrombosis, or portal hypertension—can help confirm the diagnosis of liver failure when combined with the above clinical and laboratory findings.
II. Treatment Principles
The general principles for treating liver failure emphasize early diagnosis and early intervention. Treatment should be tailored according to the specific etiology and may involve targeted or comprehensive therapies to improve outcomes and actively prevent various complications. For example, in the early stages of disease, timely treatment can help delay hepatic decompensation, prevent hepatocellular carcinoma, and potentially reverse pathological changes. During the decompensated phase, comprehensive management aims to improve liver function, treat complications, and reduce or delay the need for liver transplantation.
In addition, associated complications of liver failure can also aid in disease diagnosis. It is recommended that patients maintain proper nutrition and regular作息 (daily routines) in everyday life to enhance physical resistance.
