Intensive Care Nursing/Liver Failure

Acute Liver Failure

Digestive system showing bile duct

Background

• 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)

• 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

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

Management

• 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 (discuss • contribs) 11:59, 7 September 2014 (UTC)