BCC4: Clive Woolfe on Chronic Liver Disease
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Clive Woolfe, Irishman and RPA Intensivist, speaks at Bedside Critical Care Conference. In this podcast, he gives an overview of the prognostication and management of chronic liver disease. See www.intensivecarenetwork.com for the podcast.
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BCC4: Clive Woolfe on Chronic Liver Disease
- 1. Chronic Liver Disease BCC, Cairns, September 2013 Clive Woolfe
- 5. and
- 6. Figures
- 7. Cirrhosis “late stage of progressive hepatic fibrosis” Death from Portal Hypertension, progressive MOF, not encephalopathy
- 12. The economic cost and health burden of liver disease in Australia January 2013
- 14. MELD Model for Endstage Liver Disease 9.57 x ln(Creatinine) + 3.78 x ln(Bilirubin) +11.2 x In(INR) + 6.43
- 15. MELD Model for Endstage Liver Disease 9.57 x ln(Creatinine) + 3.78 x ln(Bilirubin) +11.2 x In(INR) + 6.43 20 40 60 80 100 0 10 15 20 25 30 40 83 80 78 74 71 90 81 63 42 21 Waiting List Survival 1 year post OLTx Survival MELD Score %
- 17. ICU
- 18. ICU Reversible precipitant? ! Organ support as a bridge to transplant
- 19. Precipitants Look for Reversibility Drugs BDZ Narcotics Ammonia Diet Infection GI bleeding Hypokalaemia Constipation Metab Alkalosis Vascular Occlusion Porto-systemic shunts NH3 Dehydration VD Hemorrhage Diuretics Paracentesis HCC Alcohol
- 20. Variceal Haemorrhage Median Follow Up 2.5 years
- 22. Organ support
- 24. Efficacy of “Treatments” for HE +
- 25. Respiratory Bleeding Sepsis ?Hepato-pulmonary Syndrome Porto-Pulmonary Hypertension PAP Massive TidalVolumes Paracentesi
- 26. CVS E. Coli
- 27. Renal/Fluids Renal hypoperfusion RAA activation Low Intravascular Volume vs. High TBW Hepatic CongestionHepatorenal Syndrome Late presentation: Low muscle mass Low urea production “Euvolaemia”
- 28. Gastrointestinal
- 29. Precipitating Event SBP Prophylaxis Sepsis ! 24% of cirrhotic inpatients RTI UTI C.Diff Mortality increase: 39 to 49%
- 30. Finally... ICU Reversible precipitant? ! Organ support as a bridge to transplant
- 31. ICU Reversible precipitant? ! Organ support as a bridge to transplant