1. Acute Liver

2. 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

3. 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

4. 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

5. 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; pC , p02 >10, Head up 30o, neutral head position, target Na >145

6. 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

7. 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

8. Sengstaken Blakemore tube

9. 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