Acute Liver

Acute Liver Failure Rapidly progressive life-threatening condition Liver injury in a patient with no pre-existing liver disease Common causes; Paracetamol overdoses, autoimmune disease Patients often appear well but can rapidly deteriorate

Referrals to Liver Unit Discuss with Regional Liver Units e.g Royal Free or Kings Definition : Coagulopathy + hepatic encephalopathy + deranged liver function. Consider how best to transfer

General treatment Fluid Resuscitation then Noradrenaline as needed N-acetylcysteine (parvolex) for liver protection Hypoglycaemia is common – hourly BMs Avoid 5% Dextrose – risk of cerebral oedema Infusion of 20% or boluses of 50% Dextrose

Neurology West Haven Criteria Patients can rapidly deteriorate from Grade 1 to Grade 4 Risk of death is due to Neurological complications e.g. Cerebral oedema West Haven Criteria Grade 1 – euphouria, anxiety Grade 2 – lethargic, disorientation Grade 3 – confusion, responsive to verbal stimuli Grade 4 – coma Targets; pC02 4.5-5, p02 >10, Head up 30o, neutral head position, target Na >145

Interventional Radiology E.g. Obstetrics, Gastrointestinal bleeding Consider where best to arrive especially if bleeding Interventional Radiology is often in remote area Consider pre-booking to obtain hospital number Transfer with blood products, Txacid, vit K Wide bore iv access O negative blood available at destination

Acute Gastro Referrals Usually for upper GI Bleeding Often had local attempt at OGD They need airway protection for the transfer if not already intubated Ongoing bleeding consider SSB tube

Sengstaken Blakemore tube

Summary Liver patients - high risk of deterioration often become encephalopathic consider intubation pre-transfer Bleeding patients – Liase where to arrive to especially Interventional Radiology Transfer with blood products