Acute-on-chronic Liver Failure Complicated With Hepatic Encephalopathy,rhabdomyolysis,renal Failure And Gastrointestinal Failure:a Case Report And Review Of The Literature

Objective: Acute-on-chronic liver failure(ACLF)is a common type of liver failure in China,with a high fatality rate.In clinic,ACLF often appear such as hepatic encephalopathy(HE),kidney injury and other complications,at the same time accompanied by one or more of the Gastrointestinal tract symptoms.With the progress of the severity of liver failure,Gastrointestinal symptoms aggravating lead to Gastrointestinal failure(GIF).However,ACLF combined with GIF has insidious onset,no characteristic clinical manifestations in the early stage,and is often prone to clinical misdiagnosis.With the persisting of the disease,ACLF and GIF often interact to form a vicious cycle,leading to multiple organ failure(MOF),which seriously affects the prognosis of the patient.This article describes the clinical diagnosis and treatment of a patient with ACLF combined with HE,rhabdomyolysis(RM),renal failure(RF)and GIF,in order to enhance the understanding of ACLF combined with GIF and the improving the prognosis of the patient.Methods: The case of a patient with chronic HBV infection who was admitted to the Second infectious disease Depatment of the Third Hospital Hebei Medical University after drinking a large amount of alcohol for a short period of time and developed acute-on-chronic liver failure complicated with hepatic encephalopathy,rhabdomyolysis,renal failure and gastrointestinal failure was selected.The pathogenesis,clinical manifestation,diagnosis,treatment and prognosis of acute-on-chronic liver failure,rhabdomyolysis,renal failure and gastrointestinal failure were discussed in combination with relevant literature.Results: The patient had a history of chronic HBV infection.The symptoms of fever with vomiting appeared 3 days before admission,yellow face and oliguria appeared 2 days ago and delirium appeared 1 day ago.After comprehensive treatment such as blood purification,alkalization of urine,liver protection,hemostasis,and symptomatic and supportive treatment,the patient’s liver function improved,myohemoglobin disappeared,whereas gastrointestinal symptoms of the patient became progressively worse and gastrointestinal function failure appeared.In critical condition,the patient abandoned treatment and was discharged,then he died out of hospital.Conclusions: On the basis of acute-on-chronic liver failure,gastrointestinal failure is at high risk.The condition of gastrointestinal function failure progresses rapidly,which easily leads to multi-organ function failure and seriously affects the prognosis of patients.In order to improve the prognosis of ACLF,awareness and diagnosis of GIF on early stage is needed.