Acute liver failure resident survival guide: Difference between revisions

Revision as of 06:36, 8 December 2013

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Vendhan Ramanujam M.B.B.S [2]

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Management

Altered mental status & PT prolongation by 4-6 sec or INR ≥1.5
presenting w/ nonspecific abdominal Sx
w/o preexisting chronic liver disease, cirrhosis & any illness of <26 wks duration

Acute liver failure

Mandatory hospital admission

w/o altered mental status, significant coagulopathy & abnormal LFT

w/ altered mental status

High dependency ward admission

Worsening mental status

ICU admission

w/ or progression to grade I/II hepatic encephalopathy

Transfer to transplant center

Initial evaluation:
Detailed H/o and PE
Labs: CBC, PT/INR, serum BCH, ABG, ammonia, acetaminophen & tox screen for other drugs/toxins, viral serology (A-E), autoimmune markers, amylase, lipase, *bilirubin:alkaline phosphatase, blood grouping & typing, HIV status

General management

Etiology specific management

Complication specific management

General Management

Etiology Specific Management

Continuous monitoring under quite environment w/ preventive treatment strategies

Cerebral edema & increased ICP

Coagulopathy

Drugs

GI bleeding

Hemodynamic instability

Hepatic encephalopathy

Infections

Metabolic disturbances

NAC

Nutritional deficiency

Renal failure

*Monitor ICP, CPP & cerebral oxygenation
*Elevate head end to 30°
*Monitor fluid status
*3% NS
*Avoid NGT and suction

*Platelet count & coagulation profile (12th hourly)
*Inj. Vit. K
*Cryoprecipitate

*Discontinue medications
*Avoid nephrotoxic & hepatotoxic drugs

*Ranitidine

*Monitor CVP w/ central venous catheter

*Frequent monitoring of mental status

*CBC (12th hourly)
*CXR; sputum, blood & urine cultures (daily)
*Cefotaxime, meropenem, fluconazole or vancomycin

*Serum BCH, ABG, lactate (12th hourly)
*Serum glucose (2nd hourly)

*NAC (i.v × 2d then P.O.)

*Eternal feeding
*Parental feeding

*Urinary I/O

Complication Specific Management

Etiologies

Acetaminophen toxicity

Acute fatty liver of pregnancy/HELLP

Acute ischemic injury

Autoimmune

Budd-Chiari

Drug induced

Malignant infiltration

Mushroom poisoning

Viral

Wilson's disease

Etiology undetermined

Do's

Dont's

References

Template:WikiDoc Sources

Complications

Ascites