Intensive Care Nursing/Liver Failure

Acute Liver Failure

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Digestive system showing bile duct

Background

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  • Hypoxia and hypoperfusion
  • Viruses- Hepatitis (A, B + E), herpes simplex virus, cytomegalovirus, Epstein–Barr virus, and parvoviruses
  • Alcohol and drug ingestion
  • Bilary system
  • Malignancy
  • Pregnancy (AFLP + HELLP)
  • Budd-Chiari syndrome
  • Wilson disease

Classification(Kings College criteria by Grady et al, 1993)

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  • Hyperacute- encephalopathy occuring within 7 days of onset of jaundice
  • Acute- 8-28 days jaundice to encephalopathy
  • Subacute- as above but from 28 days and 6 months

Presentation

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  • Jaundice
  • Ascites
  • Hypovoaemia and hypotentsion
  • Drug ingestion
  • Encephalopathy
  • Coagulopathy
  • Renal dysfunction
  • Hypoglycaemia

Management

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  • Fluid resuscitation
  • Systemic circulation- inotropes and vasoconstriction
  • IV Acetylcysteine
  • Antibiotics
  • Encephalopathy- cerebral oedema- intracranial hypertension prevention/limitation (decision benefit/risk analysis of intracranial pressure monitoring)
  • Ammonia levels
  • Sodium- hypertonic saline
  • Avoid fever
  • Airway maintenance- intubation may be required
  • Liver transplant
  • Extracorporeal liver-assist devices


References:

Bernal, W., & Wendon, J. (2013). Acute liver failure. The New England Journal of Medicine, 369(26), 2525-2534. doi:10.1056/NEJMra1208937 [link here]

O'Grady JG, Schalm SW, Williams R. (1993) Acute liver failure: redefining the syndromes. Lancet. 342:273-27

Sargent, S. (2007) Pathophysiology and management of hepatic encephalopathy. British Journal of Nursing, 16(6), 335-339. [link here]


ICUnurses (discusscontribs) 11:59, 7 September 2014 (UTC)