Intensive Care Nursing/Liver Failure

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)