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Critical care of the patient with liver disease 

Critical care of the patient with liver disease
Chapter:
Critical care of the patient with liver disease
Author(s):

Andrea De Gasperi

, James Y. Findlay

, and John R. Klinck

DOI:
10.1093/med/9780199651429.003.0021
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date: 19 August 2019

Liver failure associated with encephalopathy, sepsis, and multi-organ dysfunction is a common cause of intensive care admission and mortality remains high. This usually occurs in the setting of end-stage liver disease and is precipitated by infection, bleeding, surgery, or exacerbation of underlying disease. Most such patients are not suitable for transplant as long as multi-organ support is needed because perioperative mortality is prohibitive. In those already on the transplant waiting list, treatment aims to restore them to a state in which transplant is feasible, while others may be considered for transplant if they recover from the acute decompensation. This contrasts with acute liver failure (ALF), a much less common condition, for which a timely decision to transplant despite multi-organ failure is usually life-saving. This chapter focuses on current management of extrahepatic organ failure in all these settings, the aim of which is to enable transplantation when appropriate. The introduction describes the background of these disorders in terms of their requirement for critical careand is followed by a detailed description of ALF. Further sections are arranged by organ system, giving details of management in all presentations of severe liver disease. A final section addresses the difficult issue of removal of the critically ill patient from the transplant waiting list.

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