Akutno zatajenje jetre

master's thesis

• Title (english): Acute liver failure
• Author: Danjela Palac
• Mentor: Tajana Filipec Kanižaj (mentor)
• Committee member: Ivica Grgurević (predsjednik povjerenstva)
• Committee member: Jasenka Markeljević (član povjerenstva)
• Committee member: Tajana Filipec Kanižaj (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2020-07-17, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Akutno zatajenje jetre (AZJ) je rijetko životno-ugrožavajuće stanje karakterizirano akutnom ozljedom jetre, jetrenom encefalopatijom i produljenim protrombinskim vremenom (PV/INR .1.5). Uzrokuje masivnu nekrozu hepatocita što dovodi do ozbiljnog poremećaja jetrene funkcije koji može dovesti do multi-organskog zatajenja i smrti. Pravovremeno prepoznavanje akutnog zatajenja jetre je iznimno važno jer u protivnom prognoza bolesti je vrlo loša uz visoku stopu smrtnosti. Oboljele osobe zahtijevaju intenzivno liječenje u jedinicama za intenzivnu skrb po mogućnosti u ustanovi gdje je moguće izvesti transplantaciju jetre kao krajnji oblik terapije. Može se podijeliti u 3 kategorije s obzirom na vrijeme nastanka: hiperakutno - manje od 7 dana; akutno – od 7 do 21 dan; i subakutno - 21 dan do 26 tjedana. Etiologija akutnog zatajenja jetre je ključna za izbor terapije kod pacijenta. Vodeći uzroci su predoziranje acetaminofenom (paracetamolom) i virusni hepatitisi. Na dijagnozu akutnog zatajenja jetre trebamo posumnjati kod svakog pacijenta sa žuticom, bolovima u gornjem desnom kvadrantu i promjenama u neurološkom statusu koje su nastupile unutar 26 tjedana. Dijagnoza akutnog zatajenja jetre se postavlja na temelju detaljne anamneze i
statusa pacijenta uz laboratorijsku dijagnostiku, potrebne slikovne metode i patohistološku analizu uzorka jetre. Glavna značajka
terapije akutnog zatajenja jetre je provođenje liječenja u odgovarajućoj ustanovi uz ključnu mogućnost provođenja transplantacije
jetre kao krajnjeg oblika terapije, praćenje pacijenta i pružanje nutritivne potpore. Samo 40% pacijenata sa akutnog zatajenja jetre će se spontano oporaviti dok će ostali pacijenti trebati transplantaciju jetre kao oblik liječenja. Potrebno je razlikovati pacijente kojima je jedina opcija oporavka transplantacija jetre od pacijenata koji imaju mogućnost spontanog oporavka jer na taj
način izbjegavamo nepotrebno korištenje cjeloživotne imunosupresivne terapije i komplikacije operacijskog postupka kod osoba kojima transplantacija jetre nije potrebna za oporavak. Moguć je razvoj brojnih komplikacija u sklopu bolesti kao što su hemodinamska nestabilnost, krvarenje, infekcije, metabolički poremećaji, neurološki poremećaji, akutno zatajenje bubrega i respiratorni poremećaj. Prognoza pacijenata sa AZJ je bolja iz godine u godinu zbog konstantnih poboljšavanja u liječenju osnovne bolesti i njezinih komplikacija te zbog istraživanja novih vrsta terapijskih metoda.

Abstract (english)

Acute liver failure (ALF) is a rare life-threatening condition characterized by acute liver injury, hepatic encephalopathy and prolonged prothrombin time (PV/INR .1.5). It causes massive necrosis of hepatocytes which leads to a serious disturbance of liver function that can lead to multi-organ failure and death. It is extremely important to diagnose the ALF in due time,
otherwise the prognosis of the disease is very poor with a high mortality rate. Patients require intensive treatment in intensive care units preferably in an institution where it is possible to perform a liver transplant as the ultimate form of therapy. ALF can be divided into 3 categories according to the time of onset: hyperacute - less than 7 days; acute – from 7 to 21 days; and subacute - 21 days to 26 weeks. The etiology of acute liver failure is crucial for the choice of therapy for the patient. The leading causes are acetaminophen overdose (paracetamol) and viral hepatitis. The diagnosis of acute liver failure should be suspected in every patient with jaundice, pain in the upper right quadrant and changes in neurological
status that occurred within 26 weeks. Diagnosis of acute liver failure is based on thorough anamnesis and physical status and fulfilled with laboratory diagnosis, necessary imaging methods and pathohistological analysis of the liver sample. The main feature of acute liver failure therapy is the implementation of treatment in the appropriate institution with the crucial possibility of conducting liver transplantation as the ultimate form of therapy, monitoring the patient and providing nutritional support. Only 40% of patients with acute liver failure will recover spontaneously while other patients will need a liver transplant as a form of treatment. It is necessary to distinguish patients whose only option for recovery is liver transplantation from patients who have the possibility of spontaneous recovery because in this way we avoid unnecessary use of lifelong immunosuppressive therapy and complications of the surgical procedure in people who do not need liver transplantation. Numerous complications of the disease are possible, such as hemodynamic instability, bleeding, infections, metabolic disorders, neurological disorders, acute renal failure, and respiratory disorders. The prognosis of patients suffering from ALF is improving over time due to constant improvements in the treatment of the underlying disease and its
complications and due to the research of new types of therapeutic methods.

• Keywords: akutno zatajenje jetre; jetrena encefalopatija; predoziranje acetaminofenom; transplantacija jetre
• Keywords (english): acute liver failure; hepatic encephalopathy; acetaminophen overdose; liver transplantation
• Language: croatian
• URN:NBN: urn:nbn:hr:105:401673
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2021-03-30 11:19:11