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Critically Ill Patients with End-Stage Liver Disease.

Sara Crager1

  • 1Department of Emergency Medicine, 924 Westwood Boulevard, Suite 300, Los Angeles, CA 90049, USA; Division of Critical Care, Department of Anesthesia, University of California Los Angeles-David Geffen School of Medicine, Los Angeles, CA, USA.

Emergency Medicine Clinics of North America
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Summary

Critically ill patients with end-stage liver disease (ESLD) face high mortality. This review covers key complications like hepatic encephalopathy, bleeding, and sepsis in the intensive care unit (ICU).

Keywords:
CoagulopathyComplications of end-stage liver diseaseCritical illnessGastrointestinal bleedingHepatic encephalopathyHepatorenal syndrome

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Area of Science:

  • Hepatology
  • Critical Care Medicine
  • Internal Medicine

Background:

  • End-stage liver disease (ESLD) significantly increases mortality risk, particularly with intensive care unit (ICU) admission.
  • ESLD patients admitted to the ICU present complex clinical scenarios requiring specialized management.
  • Frequent complications in critically ill ESLD patients include hepatic encephalopathy, gastrointestinal bleeding, sepsis, hepatorenal syndrome, coagulopathy, and hepatic hydrothorax.

Purpose of the Study:

  • To review the pathophysiology of common conditions in critically ill ESLD patients.
  • To outline emergency department assessment and management strategies for these frequent complications.
  • To provide a comprehensive overview for clinicians managing severe liver disease in the ICU.

Main Methods:

  • Literature review of pathophysiology and clinical management.
  • Synthesis of current evidence on frequent ESLD complications.
  • Focus on emergency department and ICU settings.

Main Results:

  • Detailed review of hepatic encephalopathy, gastrointestinal bleeding, sepsis, bacterial peritonitis, hepatorenal syndrome, severe coagulopathy, and hepatic hydrothorax.
  • Emphasis on the pathophysiology and clinical presentation of each condition.
  • Guidance on diagnostic approaches and therapeutic interventions.

Conclusions:

  • Effective management of critically ill ESLD patients requires understanding specific complications.
  • Prompt recognition and intervention in the emergency department are crucial.
  • Multidisciplinary care is essential for improving outcomes in this high-risk population.