acute liver failure - icmdoc.files.wordpress.com · acute liver failure carries high mortality...
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Acute Liver Failure Dr Steve Gill Consultant in ICM and Anaesthesia Nottingham University Hospitals Follow me on twitter @ICMDoc
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Objectives Understand the definitions and common causes of
acute liver failure
Discuss the clinical features and management options
Describe the indications for referral to a transplant centre
Consider the specific considerations for post-resection liver failure
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Definitions
Varying definitions
Typically based on time from symptoms to encephalopathy
Slower onset may be confused for chronic liver disease
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Causes
Viruses
Drugs
Autoimmune
Others
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Clinical features
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Management - general Airway/Breathing - for low GCS
Circulation - typically high CO with low SVR
ICP management
Maintain glucose level
Correct only coagulopathy if bleeding
Antibiotics
Nutrition
CVVH
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Management - specific
n-acetylcystiene
Lactulose
Steroids
Transplantation
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When to refer Paracetamol
pH<7.3
Or all three of …
INR>6.5
Creatinine >300
Grade III or IV encephalopathy
Non-Paracetamol
INR >6.5
Or 3 of …
Age <11 or >40
Bilirubin >300
Jaundice to coma >7/7
INR >3.5
Drug toxicity
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Post-Liver Resection Failure Defined as “a postoperative acquired deterioration …
increased INR and bilirubin on or after day 5”
Grade A - abnormal lab parameters but no change in management
Grade B - change in normal post op management required but without invasive treatment
Grade C - requiring invasive treatment
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Risk factors for post-resection liver failure
Size of resection
Preoperative liver disease
Ischaemia/reperfusion injury
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Prevention
Patient selection and surgical strategy
Anaesthetic agent
Minimise blood loss
Insulin therapy
Ischaemic preconditioning
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Management Optimise & support ABCDE
Rule out vascular compromise
Treat infection
N-acetylcystine
Nutrition & laxatives
Reduce portal venous flow
Rescue hepatectomy and transplantation
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Any questions??
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Summary Acute liver failure carries high mortality especially in the
developing world where viral infection is the commonest cause
Treatment is mostly supportive
Post-resection liver failure can be risk assessed and steps take to prevent and treat it throughout the preoperative course
Transplantation is effective in a number of situations but limited by donor availability
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I will post links to this talk and relevant papers via twitter later today (hopefully) @ICMDoc