Intensive Care Nursing/Liver Failure
Acute Liver Failure
[edit | edit source]
Background
[edit | edit source]- 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)
[edit | edit source]- 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
[edit | edit source]- Jaundice
- Ascites
- Hypovoaemia and hypotentsion
- Drug ingestion
- Encephalopathy
- Coagulopathy
- Renal dysfunction
- Hypoglycaemia
Management
[edit | edit source]- 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)