RT Book, Section
A1 Roccaro, Giorgio
A1 Subramanian, Ram M.
A2 Schmidt, Gregory A.
A2 Kress, John P.
A2 Douglas, Ivor S.
SR Print(0)
ID 1201809925
T1 Management of the Patient with Cirrhosis
T2 Hall, Schmidt and Wood’s Principles of Critical Care, 5<sup>th</sup> Edition
YR 2023
FD 2023
PB McGraw Hill
PP New York, NY
SN 9781264264353
LK accesssurgery.mhmedical.com/content.aspx?aid=1201809925
RD 2024/10/13
AB KEY  POINTSPortal  hypertension,  resulting  from  increased  intrahepatic  resistance  to  portal  flow  and  increased  portal  inflow,  underlies  the  transition  from  compensated  to  decompensated  cirrhosis.The  sequelae  of  portal  hypertension  affect  each  organ  system,  requiring  multidisciplinary  management.Grades  III  and  IV  hepatic  encephalopathy  require  immediate  ICU  transfer  and  elective  intubation  for  airway  protection.Pulmonary  derangements  resulting  from  portal  hypertension  may  be  severe  and  include  hepatopulmonary  syndrome,  portopulmonary  hypertension,  and  hepatic  hydrothorax.Hepatorenal  syndrome  is  a  diagnosis  of  exclusion  and  is  characterized  by  functional  renal  impairment  in  the  setting  of  advanced  liver  disease,  portal  hypertension,  circulatory  dysfunction,  and  increased  activity  of  the  renin-angiotensin  system.Spontaneous  bacterial  peritonitis  is  a  common  known  precipitant  of  HRS,  which  is  associated  with  increased  mortality  in  cirrhotic  patients;  therefore  empiric  antibiotic  treatment  is  warranted  in  patients  in  whom  the  suspicion  for  SBP  is  high.Aggressive  intravenous  resuscitation,  airway  protection,  and  early  endoscopic  management  of  cirrhotic  patients  presenting  with  suspected  variceal  bleeding  is  critical.