Ebook The Washington manual of critical care (3/E): Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook The Washington manual of critical care (3/E): Part 2
Ebook The Washington manual of critical care (3/E): Part 2
SECTION XIIHEPATIC DISEASES45Acute Liver FailureClaire Meyer and Jeffrey s. CrippinAcme liver faillire (ALF) is characterized by coagulopathy, encepha Ebook The Washington manual of critical care (3/E): Part 2alopathy, and severe hepatic injury in patients without chronic liver disease (Table 45.1). Exceptions to die absence of pre-existing liver disease include autoimmune hepatitis and Wilson’s disease, if the disease lias only been recognized within tile last 26 weeks. Approximately 2000 cases of ALP a Ebook The Washington manual of critical care (3/E): Part 2re reported per year in 11» United States.CAUSES AND DIAGNOSISDetermining 11» cause of ALE is imperative, since some etiologies dictate specific tteatEbook The Washington manual of critical care (3/E): Part 2
ments. In a prospective multicenter study of 308 patients (199Í to 20011 by 11» Acute Liver Failure Study Group. 11» following causes were most frequeSECTION XIIHEPATIC DISEASES45Acute Liver FailureClaire Meyer and Jeffrey s. CrippinAcme liver faillire (ALF) is characterized by coagulopathy, encepha Ebook The Washington manual of critical care (3/E): Part 2titis B) (11%). Table 45.1 outlines the possible causes of ALF. as well as the studies needed to evaluate patients for each etiology. On presentation, initial laboratory analysis should include a complete blood count, basic metabolic panel, liver chemistries, magnesium, pliosphate. prothrombin time, Ebook The Washington manual of critical care (3/E): Part 2 lactic acid, arterial blood gas. ammonia, acetaminophen level, acute viral l»patitis panel, toxicology screen, ceruloplasmin level, antinuclear antibEbook The Washington manual of critical care (3/E): Part 2
odies, amismooth muscle antibodies. HIV status, and a pregnancy test (il applicable).ETIOLOGY-SPECIFIC MANAGEMENT OF ACUTE LIVER FAILURE (See AlgorithSECTION XIIHEPATIC DISEASES45Acute Liver FailureClaire Meyer and Jeffrey s. CrippinAcme liver faillire (ALF) is characterized by coagulopathy, encepha Ebook The Washington manual of critical care (3/E): Part 2cion for acetaminophei overdose, particularly when there is inadequate knowledge of the circumstances preceding a patient's presentation to tl» hospital. N-acetylcysteine (NAC) therapy is indicated when acetaminopl»n-ielated ALF is known or suspected, regardless of tl» giade of encephalopathy, and s Ebook The Washington manual of critical care (3/E): Part 2liould be initiatec as soon after acetaminophen ingestion as possible. Tl» nomogram shown in Figure 45.1 lielps to guide treatment based on 11» serumEbook The Washington manual of critical care (3/E): Part 2
acetaminophen level when a single ingestion occurred at a known time. However, in the setting of ALF. treatment with NAC should be initiated if the seSECTION XIIHEPATIC DISEASES45Acute Liver FailureClaire Meyer and Jeffrey s. CrippinAcme liver faillire (ALF) is characterized by coagulopathy, encepha Ebook The Washington manual of critical care (3/E): Part 2wn to have occurred within 4 hours of presentation, activated charcoal lowers the plasma acetaminophen level more effectively than does gasu ic lavage 01 ipecac, and is typically given as a single dose (1 g kg). The efficacy of NAC is not reduced by prior treatment with activated charcoal. Patiems w Ebook The Washington manual of critical care (3/E): Part 2ill acetaminophen toxicity should be treated with NAC even if they present to medical care after a significant delay. A reffospective study includingEbook The Washington manual of critical care (3/E): Part 2
patients who began NAC 10 to 36 liours after overdose showed improved outcomes in tliis group, compared to tíiose receiving DO antidote. Refer K AlgorSECTION XIIHEPATIC DISEASES45Acute Liver FailureClaire Meyer and Jeffrey s. CrippinAcme liver faillire (ALF) is characterized by coagulopathy, encepha Ebook The Washington manual of critical care (3/E): Part 2prospective, controlled trial of NAC for acetaminophen-related ALF showed reduced mortality I Peto odds ratio 0.29) in patients treated wit! NAC.TABLE 45.1Diagnosis and Causes of Acute Liver FailureỊ1Acme hepatic nyjry <26 wks without evidence of pre-existing lfEbook The Washington manual of critical care (3/E): Part 2
fp-iow serum level Coes not rule OU. ngesbon). use nomogram when time of ingestion known Hew medicaions. entireties, NSAOs.Serum drug levạs antccnvufeSECTION XIIHEPATIC DISEASES45Acute Liver FailureClaire Meyer and Jeffrey s. CrippinAcme liver faillire (ALF) is characterized by coagulopathy, encepha Ebook The Washington manual of critical care (3/E): Part 2ancy recent travel skn lesions mmincccmpromised slateHepatitis B Surface antigen, hepatites B core Igf.t htepaxs AlgM hepatitis E antibody hepebbs c antibody, hepatitis c RNA HV antibody, H$v arcbodes and DMA vzv ONA consKfer evaluation for rare viral causes includrg parvovirus B19, adenovirus, and Ebook The Washington manual of critical care (3/E): Part 2EBVShock liverhistory of heart falure cardiac arrest, volume depletion, or substance abuseBhP. lactate dehydrogenase, lactate. echocardtoựamIrrtltrajvEbook The Washington manual of critical care (3/E): Part 2
e malignancyhistory cf malignancy hepatomegalyIf suspected, cross-secttonai fibdomna imaging and Iner btopsy (If feasitxe)Budd-Chiari syndromehistory SECTION XIIHEPATIC DISEASES45Acute Liver FailureClaire Meyer and Jeffrey s. CrippinAcme liver faillire (ALF) is characterized by coagulopathy, encepha Ebook The Washington manual of critical care (3/E): Part 2venousthromboembcltsm: iympriiijfncfiafhiyPatent <40 yrs old history of neuropsycheUK Seritn ceruloplasmin and copper, 24-hr U'ine copper unc acid. hemotyss labs if symptoms. Kayser-Fleischer rings on sit lamp suspected, liver biopsy (if feasible) for qiwrrtatrve copper measurement examWilson s dise Ebook The Washington manual of critical care (3/E): Part 2aseAcute tany Ir.er of pregnancyKLLPAulttmmuneHepsbtisPregnancyhistory of other autoimmune dseasesB-HCG in women of chkiteannọ poier protenire K »VK bEbook The Washington manual of critical care (3/E): Part 2
iopsy performed.Ailnuchea antibody arcsmooth muse suspectes ivwbwsy (if 'easiyeiALGORITHM 45.1Treatment Algorithm for Acute Liver FailureSECTION XIIHEPATIC DISEASES45Acute Liver FailureClaire Meyer and Jeffrey s. CrippinAcme liver faillire (ALF) is characterized by coagulopathy, encephaSECTION XIIHEPATIC DISEASES45Acute Liver FailureClaire Meyer and Jeffrey s. CrippinAcme liver faillire (ALF) is characterized by coagulopathy, encephaGọi ngay
Chat zalo
Facebook