Liver Dysfunction In Intensive Care Patients
Mohamed Abdel-Moneim Ibrahim Waly;
Abstract
The liver is the largest gland in the human body (weighing an average of 1500 g). It lies under the diaphragm in the right hypochondriac and epigastric regions. The liver receives roughly 25% of the total cardiac output (1mL of blood per 1g of liver) via a dual vascular supply, hepatic artery and portal vein. Intrinsic and extrinsic mechanisms play important roles in the regulation of hepatic blood flow.It plays a key role in the metabolism of carbohydrate, protein and fat, and metabolism of toxins and drugs, and in modulation of immunity in the human body.
Liver dysfunction is frequently observed in critically ill patients. Its occurrence is associated with high morbidity and mortality. The most frequent entities of hepatic dysfunction in ICU are shock liver and cholestatic liver dysfunction with incidence rates up to 10 and 30%, respectively. Both conditions are frequently triggered by hypoxic and/or ischemic events, most commonly cardiogenic shock and sepsis/septic shock. Apart from chronic liver diseases and malignancies, iatrogenic factors such as total parenteral nutrition, surgical procedures, drugs and blood transfusions promote its occurrence.
Liver injury often is evaluated with routinely performed biochemistry tests, including AST, ALT, ALP, and Gamma-glutamyltranspeptidase. INR is a marker of the synthetic function of the liver and constitutes an important prognosis marker used in several scoring systems. Serum bilirubin is the most facile test of liver function but it is a late marker of liver dysfunction.
Early recognition and subsequent therapy of the underlying conditions are still the therapeutic cornerstones. The mainstay of clinical management of liver injury in the ICU is related to early diagnosis and correct identification of etiology.
The ideal treatment of acute liver failure and HRS is the liver transplantation, however, because of the long waiting lists in the majority of transplant centers, most patients die before transplantation.The severity of liver disease can best be assessed by the Child-Turcotte-Pugh (CTP) score and MELD score.
Liver dysfunction is frequently observed in critically ill patients. Its occurrence is associated with high morbidity and mortality. The most frequent entities of hepatic dysfunction in ICU are shock liver and cholestatic liver dysfunction with incidence rates up to 10 and 30%, respectively. Both conditions are frequently triggered by hypoxic and/or ischemic events, most commonly cardiogenic shock and sepsis/septic shock. Apart from chronic liver diseases and malignancies, iatrogenic factors such as total parenteral nutrition, surgical procedures, drugs and blood transfusions promote its occurrence.
Liver injury often is evaluated with routinely performed biochemistry tests, including AST, ALT, ALP, and Gamma-glutamyltranspeptidase. INR is a marker of the synthetic function of the liver and constitutes an important prognosis marker used in several scoring systems. Serum bilirubin is the most facile test of liver function but it is a late marker of liver dysfunction.
Early recognition and subsequent therapy of the underlying conditions are still the therapeutic cornerstones. The mainstay of clinical management of liver injury in the ICU is related to early diagnosis and correct identification of etiology.
The ideal treatment of acute liver failure and HRS is the liver transplantation, however, because of the long waiting lists in the majority of transplant centers, most patients die before transplantation.The severity of liver disease can best be assessed by the Child-Turcotte-Pugh (CTP) score and MELD score.
Other data
| Title | Liver Dysfunction In Intensive Care Patients | Other Titles | خلل وظائف الكبد في مرضى العناية المركزة | Authors | Mohamed Abdel-Moneim Ibrahim Waly | Issue Date | 2017 |
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