BOOK
Hepatology and Critical Care, An Issue of Critical Care Clinics, E-Book
Rahul S. Nanchal | Ram M. Subramanian
(2016)
Additional Information
Book Details
Abstract
This issue of Critical Care Clinics focuses on Hepatology and Critical Care. Articles include: Acute on Chronic and Decompensated Chronic Liver Failure, Hepatic Encephalopathy, Respiratory Complication in Liver Disease, GI Issues in Liver Disease, Bridging the Patient with Liver Disease to Transplant or Recovery, Infections in Liver Disease, Kidney Injury in Liver Disease, The Liver in Critical Illness, Hematological Issues in Liver Disease, Pharmacological Issues in Liver Disease and more!
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Hepatology and Critical Care\r | i | ||
| Copyright\r | ii | ||
| Contributors | iii | ||
| CONSULTING EDITOR | iii | ||
| EDITORS | iii | ||
| AUTHORS | iii | ||
| Contents | vii | ||
| Preface: Hepato-centric Musings of Two Intensivists—Back to the Future\r | vii | ||
| Acute-on-chronic and Decompensated Chronic Liver Failure: Definitions, Epidemiology, and Prognostication\r | vii | ||
| Hepatic Encephalopathy—the Old and the New\r | vii | ||
| The Circulatory System in Liver Disease\r | vii | ||
| Kidney Injury in Liver Disease\r | viii | ||
| Respiratory Complication in Liver Disease\r | viii | ||
| Gastrointestinal Issues in Liver Disease\r | viii | ||
| Hematological Issues in Liver Disease\r | viii | ||
| Pharmacologic Issues in Liver Disease\r | ix | ||
| Infections in Liver Disease\r | ix | ||
| The Liver in Critical Illness\r | ix | ||
| Current Evidence for Extracorporeal Liver Support Systems in Acute Liver Failure and Acute-on-Chronic Liver Failure\r | ix | ||
| Perioperative Care of the Liver Transplant Patient\r | x | ||
| CRITICAL CARE CLINICS\r | xi | ||
| FORTHCOMING ISSUES | xi | ||
| October 2016 | xi | ||
| January 2017 | xi | ||
| April 2017 | xi | ||
| RECENT ISSUES | xi | ||
| April 2016 | xi | ||
| January 2016 | xi | ||
| October 2015 | xi | ||
| Preface: Hepato-centric Musings of Two Intensivists—Back to the Future\r | xiii | ||
| Acute-on-chronic and Decompensated Chronic Liver Failure | 301 | ||
| Key points | 301 | ||
| INTRODUCTION | 301 | ||
| CAUSES AND RISK FACTORS FOR DEVELOPMENT OF CIRRHOSIS | 302 | ||
| Viral Disease | 302 | ||
| Metabolic Disease | 303 | ||
| Autoimmune Disease | 303 | ||
| EPIDEMIOLOGY OF ADVANCED LIVER DISEASE | 303 | ||
| CLINICAL IMPLICATIONS OF ADVANCED LIVER DISEASE: ACUTE-ON-CHRONIC VERSUS DECOMPENSATED CHRONIC LIVER DISEASE | 305 | ||
| DISCUSSION | 306 | ||
| REFERENCES | 307 | ||
| Hepatic Encephalopathy—the Old and the New | 311 | ||
| Key points | 311 | ||
| INTRODUCTION | 311 | ||
| CLASSIFICATION OF HEPATIC ENCEPHALOPATHY | 312 | ||
| HEPATIC ENCEPHALOPATHY, CEREBRAL EDEMA, AND MORTALITY IN ACUTE LIVER FAILURE AND OVERT TYPE C HEPATIC ENCEPHALOPATHY | 313 | ||
| CLINICAL FEATURES AND APPROACH TO EVALUATING A PATIENT WITH HEPATIC ENCEPHALOPATHY | 313 | ||
| NEUROLOGIC ASSESSMENT IN OVERT HEPATIC ENCEPHALOPATHY | 313 | ||
| OBJECTIVES OF SERIAL LABORATORY TESTING RELEVANT TO HEPATIC ENCEPHALOPATHY AND INTRACRANIAL HYPERTENSION IN ACUTE LIVER FAILURE | 314 | ||
| RISK FACTOR FOR DEVELOPMENT OF INTRACRANIAL HYPERTENSION IN ACUTE LIVER FAILURE | 314 | ||
| CLINICAL AND LABORATORY ASSESSMENT IN OVERT TYPE C HEPATIC ENCEPHALOPATHY (DECOMPENSATED CIRRHOSIS AND ACUTE-ON-CHRONIC LIV ... | 315 | ||
| Precipitating Factors for Overt Type C Hepatic Encephalopathy | 315 | ||
| Computed Tomography Brain Imaging in Acute Liver Failure and Overt Type B Hepatic Encephalopathy | 315 | ||
| MRI Brain Imaging in Acute Liver Failure and Overt Type B Hepatic Encephalopathy | 318 | ||
| PHARMACOLOGIC TREATMENT OPTIONS | 318 | ||
| Invasive Neuromonitoring Strategy in Acute Liver Failure | 318 | ||
| Noninvasive Neuromonitoring Strategy in Acute Liver Failure | 320 | ||
| Neuroprotective Strategies in Acute Liver Failure | 320 | ||
| PREVENTION AND MANAGEMENT OF INTRACRANIAL HYPERTENSION | 320 | ||
| PLASMA AMMONIA–LOWERING STRATEGIES IN ACUTE LIVER FAILURE | 323 | ||
| THERAPEUTIC STRATEGIES FOR MANAGING TYPE C HEPATIC ENCEPHALOPATHY IN THE INTENSIVE CARE UNIT | 323 | ||
| Plasma Ammonia–Lowering Strategies | 323 | ||
| Reduction of intestinal ammonia production and absorption | 323 | ||
| Lactulose (β-galactofructose) and lactitol (β-galactosidosorbitol) | 323 | ||
| Polyethylene glycol | 324 | ||
| Ammonia-lowering antibiotics | 324 | ||
| Rifaximin | 324 | ||
| Neomycin | 324 | ||
| Metronidazole | 324 | ||
| Plasma ammonia–lowering devices and nonpharmacologic interventions | 324 | ||
| Continuous renal replacement therapy | 324 | ||
| Molecular adsorbent recirculating system | 325 | ||
| Therapeutic hypothermia (goal temperature of 34°C) | 325 | ||
| Embolizing large spontaneous portosystemic shunts | 325 | ||
| Alternative pathway therapy | 325 | ||
| Neurotransmitter blockade | 325 | ||
| Nutritional and micronutrient supplementation | 325 | ||
| SURGICAL TREATMENT OPTIONS | 326 | ||
| SUMMARY | 326 | ||
| REFERENCES | 326 | ||
| The Circulatory System in Liver Disease | 331 | ||
| Key points | 331 | ||
| PATHOPHYSIOLOGY OF PORTAL HYPERTENSION | 332 | ||
| HYPERDYNAMIC CIRCULATORY SYNDROME | 332 | ||
| Collateral Circulation | 333 | ||
| Proposed Mechanisms for Splanchnic Vasodilatation | 333 | ||
| FLUID RETENTION IN LIVER FAILURE | 334 | ||
| Determining the Cause of Ascites | 334 | ||
| Cardiac Dysfunction in Liver Disease | 334 | ||
| Cardiac Cirrhosis | 334 | ||
| Latent Cardiac Dysfunction | 336 | ||
| Systolic Dysfunction | 336 | ||
| Left Ventricular Hypertrophy | 336 | ||
| Diastolic Dysfunction | 337 | ||
| Electrophysiologic Abnormalities | 337 | ||
| Pathophysiology of Cirrhotic Cardiomyopathy | 337 | ||
| Clinical Impacts of Cardiac Dysfunction in Liver Disease | 337 | ||
| Hemodynamic Monitoring of Patients with Liver Disease in the Intensive Care Unit | 339 | ||
| REFERENCES | 340 | ||
| Kidney Injury in Liver Disease | 343 | ||
| Key points | 343 | ||
| DEFINITION OF ACUTE KIDNEY INJURY | 343 | ||
| EPIDEMIOLOGY AND ETIOLOGY OF ACUTE KIDNEY INJURY IN LIVER DISEASE | 344 | ||
| Acute Kidney Injury and Acute Liver Failure | 344 | ||
| Acute Kidney Injury and Chronic Liver Disease | 345 | ||
| ASSESSING KIDNEY FUNCTION IN LIVER DISEASE | 345 | ||
| DIAGNOSING AND STAGING ACUTE RENAL (DYS-) FUNCTION AND INJURY IN LIVER DISEASE | 346 | ||
| HEPATORENAL SYNDROME | 347 | ||
| Epidemiology and Etiology | 347 | ||
| Definition and Diagnosis | 348 | ||
| Management of Patients with the Hepatorenal Syndrome | 349 | ||
| METABOLIC ACIDOSIS IN LIVER DISEASE | 349 | ||
| Etiology | 349 | ||
| Anion gap metabolic acidosis | 349 | ||
| Lactic acidosis | 349 | ||
| Ketoacidosis | 349 | ||
| Non–anion gap metabolic acidosis | 349 | ||
| Diarrhea | 349 | ||
| Renal tubular acidosis | 349 | ||
| Diagnosis | 350 | ||
| Management | 350 | ||
| RENAL REPLACEMENT THERAPY IN LIVER DISEASE | 350 | ||
| Indications for Renal Replacement Therapy and Patient Selection | 350 | ||
| Renal Replacement Therapy Modalities | 350 | ||
| Complications of Renal Replacement Therapy | 351 | ||
| SIMULTANEOUS LIVER–KIDNEY TRANSPLANTATION | 351 | ||
| Outcomes | 351 | ||
| Predictors of Renal Recovery after Liver Transplantation | 351 | ||
| Selection Criteria for Simultaneous Liver–Kidney Transplantation | 352 | ||
| REFERENCES | 352 | ||
| Respiratory Complication in Liver Disease | 357 | ||
| Key points | 357 | ||
| HEPATOPULMONARY SYNDROME | 357 | ||
| Pathophysiology | 357 | ||
| Clinical Manifestations | 358 | ||
| Diagnosis | 359 | ||
| Treatment | 359 | ||
| HEPATIC HYDROTHORAX | 360 | ||
| Pathophysiology | 360 | ||
| Clinical Manifestation | 360 | ||
| Diagnosis | 360 | ||
| Treatment | 361 | ||
| SPONTANEOUS BACTERIAL PLEURITIS | 362 | ||
| Treatment | 362 | ||
| PORTOPULMONARY HYPERTENSION | 362 | ||
| Epidemiology | 363 | ||
| Clinical Manifestations | 363 | ||
| Pathogenesis | 363 | ||
| Diagnosis | 363 | ||
| Treatment | 364 | ||
| SUMMARY | 365 | ||
| REFERENCES | 365 | ||
| Gastrointestinal Issues in Liver Disease | 371 | ||
| Key points | 371 | ||
| INTRODUCTION | 371 | ||
| GASTROINTESTINAL BLEEDING | 372 | ||
| Esophageal Varices | 372 | ||
| Management of Acute Esophageal Hemorrhage | 372 | ||
| Rescue Therapies | 375 | ||
| Transjugular Intrahepatic Portosystemic Shunt | 375 | ||
| Balloon Tamponade | 375 | ||
| Gastric Varices | 375 | ||
| Management of Bleeding Gastric Varices | 376 | ||
| DISTINCTIVE CAUSES OF NONVARICEAL GASTROINTESTINAL BLEEDING IN CIRRHOTIC PATIENTS | 376 | ||
| NUTRITIONAL CONCERNS AND DYSMOTILITY IN CIRRHOSIS | 377 | ||
| SUMMARY | 380 | ||
| REFERENCES | 380 | ||
| Hematological Issues in Liver Disease | 385 | ||
| Key points | 385 | ||
| INTRODUCTION | 385 | ||
| MECHANISMS OF HEMATOLOGIC ABNORMALITIES IN LIVER FAILURE | 386 | ||
| Coagulation Factors | 386 | ||
| Platelets | 387 | ||
| Von Willebrand Factor | 387 | ||
| Fibrinolysis | 387 | ||
| DIAGNOSING HEMATOLOGIC ABNORMALITIES | 388 | ||
| CLINICAL IMPLICATIONS OF COAGULOPATHY OF LIVER DISEASE | 390 | ||
| Bleeding | 390 | ||
| Disseminated Intravascular Coagulation and Accelerated Intravascular Coagulation and Fibrinolysis | 390 | ||
| Thrombosis | 391 | ||
| MANAGEMENT | 391 | ||
| Antithrombotic Prophylaxis | 391 | ||
| Bleeding | 391 | ||
| Thrombosis | 392 | ||
| SUMMARY | 393 | ||
| REFERENCES | 393 | ||
| Pharmacologic Issues in Liver Disease | 397 | ||
| Key points | 397 | ||
| INTRODUCTION | 397 | ||
| PHARMACOKINETIC AND PHARMACODYNAMIC ALTERATIONS | 398 | ||
| Absorption | 398 | ||
| Distribution | 398 | ||
| Metabolism/Elimination | 399 | ||
| NEUROLOGY | 399 | ||
| Antiepileptics | 399 | ||
| Analgesics | 402 | ||
| Sedatives | 402 | ||
| CARDIOVASCULAR | 402 | ||
| Vasopressors | 402 | ||
| β-Blockers | 403 | ||
| Antiarrhythmics | 403 | ||
| PULMONARY | 403 | ||
| GASTROINTESTINAL | 403 | ||
| Acid Suppression | 403 | ||
| Antiemetics | 404 | ||
| Molecular Adsorbent Recirculating System | 404 | ||
| RENAL | 404 | ||
| HEMATOLOGY | 405 | ||
| Venous Thromboembolism Prophylaxis and Anticoagulation | 405 | ||
| Heparin-Induced Thrombocytopenia | 406 | ||
| INFECTIOUS DISEASE | 406 | ||
| SUMMARY | 407 | ||
| REFERENCES | 407 | ||
| Infections in Liver Disease | 411 | ||
| Key points | 411 | ||
| INTRODUCTION | 411 | ||
| EPIDEMIOLOGY OF INFECTIONS IN LIVER DISEASE | 411 | ||
| Incidence/Prevalence | 412 | ||
| Significance of Infectious Insult in Liver Disease | 412 | ||
| Major Risk Factors of Infection in Liver Disease | 412 | ||
| Types of Infection in Liver Disease | 413 | ||
| Shift of Spectrum to Resistant Infections | 413 | ||
| PATHOGENESIS OF INFECTION | 413 | ||
| Cirrhosis-Associated Immunodeficiency | 414 | ||
| Cirrhosis-Induced Systemic Inflammation | 414 | ||
| CHALLENGES IN THE DIAGNOSIS OF INFECTIONS IN LIVER DISEASE | 415 | ||
| CONSEQUENCES OF INFECTION IN LIVER DISEASE | 416 | ||
| Acute on Chronic Liver Failure | 416 | ||
| Circulatory Failure and Shock | 416 | ||
| Renal Failure | 416 | ||
| Hepatic Encephalopathy | 417 | ||
| Coagulopathy | 417 | ||
| Respiratory Failure | 417 | ||
| MANAGEMENT OF INFECTIONS IN LIVER DISEASE | 417 | ||
| General Approach to Management of Infections in Liver Disease | 417 | ||
| Hemodynamic resuscitation | 418 | ||
| Albumin | 418 | ||
| Hydrocortisone | 419 | ||
| Nutritional support | 419 | ||
| Approach to Antibiotic Therapy | 419 | ||
| Antibiotic Prophylaxis | 419 | ||
| Gastrointestinal bleeding | 419 | ||
| Primary prophylaxis (preventing first episode of spontaneous bacterial peritonitis) | 419 | ||
| Secondary prophylaxis (preventing recurrence of spontaneous bacterial peritonitis) | 420 | ||
| SPECIAL CONSIDERATIONS | 420 | ||
| Spontaneous Bacterial Peritonitis | 420 | ||
| Importance of Fungal Infections | 420 | ||
| SUMMARY | 420 | ||
| REFERENCES | 421 | ||
| The Liver in Critical Illness | 425 | ||
| Key points | 425 | ||
| INTRODUCTION | 425 | ||
| CAUSES OF LIVER DISEASE | 425 | ||
| SEVERITY OF LIVER DYSFUNCTION | 427 | ||
| SELECTIVE REVIEW OF ORGAN DYSFUNCTION AND INTERVENTION | 428 | ||
| Neurologic | 428 | ||
| Cardiovascular | 430 | ||
| Respiratory | 432 | ||
| Renal | 432 | ||
| Hepatic | 433 | ||
| Gastrointestinal/Nutrition | 433 | ||
| Coagulation | 434 | ||
| Endocrine | 434 | ||
| Infectious Disease | 434 | ||
| Rehabilitation | 435 | ||
| SUMMARY | 435 | ||
| REFERENCES | 435 | ||
| Current Evidence for Extracorporeal Liver Support Systems in Acute Liver Failure and Acute-on-Chronic Liver Failure | 439 | ||
| Key points | 439 | ||
| INTRODUCTION: THE TWO SYNDROMES OF LIVER FAILURE | 440 | ||
| Acute Liver Failure | 440 | ||
| Acute-on-Chronic Liver Failure | 440 | ||
| Rationale for Use of Extracorporeal Liver Support in Acute Liver Failure and Acute-on-Chronic Liver Failure | 440 | ||
| EXTRACORPOREAL LIVER SUPPORT SYSTEMS: ARTIFICIAL AND BIOARTIFICIAL | 441 | ||
| ARTIFICIAL EXTRACORPOREAL LIVER SUPPORT: DETOXIFICATION AND THE ALBUMIN HYPOTHESIS | 441 | ||
| Molecular Adsorbent Recirculating System | 441 | ||
| Molecular Adsorbent Recirculating System and Acute-on-Chronic Liver Failure: Clinical Studies | 441 | ||
| MOLECULAR ADSORBENT RECIRCULATING SYSTEM AND ACUTE LIVER FAILURE | 442 | ||
| Molecular Adsorbent Recirculating System and Inflammatory Profile | 444 | ||
| Single-Pass Albumin Dialysis | 444 | ||
| Prometheus: Fractionated Plasma Separation and Adsorption | 444 | ||
| High-Volume Plasmapheresis | 445 | ||
| ARTIFICIAL EXTRACORPOREAL LIVER SUPPORT: ADVERSE EFFECT PROFILE | 445 | ||
| Bioartificial Extracorporeal Liver Support: Design | 445 | ||
| Bioartificial Extracorporeal Liver Support in Acute Liver Failure | 446 | ||
| Is It Wise to Pool Extracorporeal Liver Support Data in Meta-analysis for Acute Liver Failure or Acute-on-Chronic Liver Fai ... | 447 | ||
| DISCUSSION: FUTURE DIRECTIONS | 447 | ||
| REFERENCES | 448 | ||
| Perioperative Care of the Liver Transplant Patient | 453 | ||
| Key points | 453 | ||
| INTRODUCTION | 453 | ||
| INTRAOPERATIVE MANAGEMENT | 454 | ||
| Personnel | 454 | ||
| Phases of the Liver Transplantation Procedure | 454 | ||
| Anesthesia Technique | 454 | ||
| Vascular Access, Monitors, and Other Considerations | 456 | ||
| IMMEDIATE POSTOPERATIVE CARE | 456 | ||
| Protocols for Postoperative Care | 458 | ||
| Graft Function | 458 | ||
| SYSTEM-BASED CONSIDERATIONS FOR POSTOPERATIVE MANAGEMENT | 459 | ||
| Respiratory System Considerations | 459 | ||
| Weaning from mechanical ventilatory support after “routine” liver transplantation | 459 | ||
| Respiratory compromise after liver transplantation | 459 | ||
| Acute respiratory distress syndrome after liver transplantation | 460 | ||
| Perioperative hepatopulmonary syndrome | 460 | ||
| Ventilator-associated pneumonia and noninvasive ventilation | 461 | ||
| Cardiovascular System Considerations | 461 | ||
| Hypertension and arrhythmias | 461 | ||
| Portopulmonary hypertension | 462 | ||
| The Nervous System | 462 | ||
| Renal Considerations | 463 | ||
| Metabolic Considerations | 463 | ||
| Coagulation Management | 464 | ||
| Immunosuppression | 464 | ||
| Infectious Disease Issues | 465 | ||
| POSTOPERATIVE COMPLICATIONS | 465 | ||
| Postoperative Hemorrhage | 465 | ||
| Vascular, Biliary, and Wound Complications | 465 | ||
| Readmission to the Intensive Care Unit | 466 | ||
| SPECIAL CONSIDERATIONS | 466 | ||
| SUMMARY | 466 | ||
| REFERENCES | 466 | ||
| Index | 475 |