Multiprofessional Critical Care Review: Pediatric 2024 (MCCRCP24ON)-Hepatic Failure

Hepatic Failure

Pdf Summary

This document, authored by Dr. Rajit K. Basu, focuses on hepatic failure and organ transplantation, particularly in pediatric patients. Key points include interpreting liver failure's pathophysiologic parameters, recognizing liver failure's impact on other organs, and understanding critical peri-transplant management.<br /><br />**Epidemiology:**<br />Pediatric Acute Liver Failure (PALF) incidence varies by age, predominantly indeterminate in cause. Outcomes show 55% spontaneous recovery, 11% mortality without treatment, and 34% requiring transplantation.<br /><br />**Clinical Presentation:**<br />PALF presents non-specifically with symptoms like encephalopathy, seizures, ascites, and hypoglycemia. Diagnostic markers include elevated INR and PT. Additional workup includes checking for acetaminophen, viral titers, autoimmune antibodies, and metabolic disorders.<br /><br />**Extra-hepatic Associations:**<br />ALF impacts organ function energetically, either in isolation or in conjunction.<br /><br />**Hepatic Encephalopathy (HE):**<br />HE results from PALF and includes cognitive impairments and psychomotor issues. Its mechanisms aren't fully understood.<br /><br />**Hepatorenal Syndrome (HRS):**<br />Characterized by renal vasoconstriction, reduced GFR, and impaired Na/H20 management. Type 1 HRS is more severe, leading to multiple organ dysfunction syndrome (MODS).<br /><br />**Management:**<br />Key measures include early and prophylactic support, normovolemia, hypokalemia treatment, nutritional interventions, and medications like rifaximin, antibiotics, lactulose, H2 receptor antagonists, and proton pump inhibitors. Liver support techniques like ECLS are also mentioned.<br /><br />**Peri-Transplant Management:**<br />Early referral to a liver transplant center is crucial for children with ALF, deteriorating liver function, uncorrectable coagulopathy, metabolic crises, unresectable tumors, or post-surgery biliary atresia.<br /><br />**Surgical and Post-Transplant Considerations:**<br />Key factors are preventing/healing hepatic arterial thrombus, graft loss, necrosis, and biliary leaks. Post-transplant management focuses on immunosuppression using steroids and calcineurin inhibitors, addressing primary nonfunction, arterial thrombus, and sepsis.<br /><br />**Conclusions:**<br />High suspicion for hepatic failure, managing neurologic impairment, maintaining normal metabolic parameters, and supportive care for associated organ dysfunction are emphasized along with early transplantation consideration.

Keywords

Pediatric Acute Liver Failure

Hepatic Failure

Organ Transplantation

Liver Transplant

Hepatic Encephalopathy

Hepatorenal Syndrome

Peri-Transplant Management

Dr. Rajit K. Basu

Liver Support Techniques

Post-Transplant Care

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