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Organ Failure Complications

  • Hepatorenal syndrome (renal failure)
    • Decreased urine output
    • Labs show elevated creatinine
    • Admit to hospital (high mortality)
  • Hepatic encephalopathy (brain failure)
    • Introduction
      • Liver clears ammonia from body
      • In advanced liver failure, ammonia increases
    • Symptoms
      • Altered mental status/confusion
      • Asterixis
    • Treatment
      • Lactulose
        • Binds ammonia and is excreted
      • Rifaximin
        • Eliminates bacteria responsible for producing ammonia

Portal Hypertension Complications

  • Gastric/esophageal varices
    • Symptoms
      • Altered mental status
        • Hepatic encephalopathy triggered by reabsorbed GI blood
      • Melena
        • Black stools from digested GI blood
    • Treatment
      • Proton pump inhibitor (PPI)
        • Pantoprazole
      • Octreotide
      • Antibiotics
      • Classic procedure
        • Blakemore tube (balloon tamponade)
  • Ascites with spontaneous bacterial peritonitis (SBP)
    • Symptoms
      • Abdominal pain/tenderness
      • Ascites
      • Fever
    • Testing plan
      • Diagnostic paracentesis
        • >250 neutrophils
        • High protein
        • Low glucose
    • Treatment
      • Antibiotics
      • Albumin

Liver Failure Complications

  • Coagulopathy
    • Diagnose with abnormal coagulation studies
      • PT with INR
    • Patients can be BOTH hyper and hypocoagulable

Additional Reading