Non cardiogenic pulmonary oedema/ALI- occurs in 40% cases [ie hepatopulmonary syndrome: [syndrome of shortness of breath and hypoxemia (low oxygen levels in the blood of the arteries) caused by vasodilation (broadening of the blood vessels) in the lungs of patients with liver disease]] Ie not porto-pulmonary hypertension which is for cirrhosis serotonin to systemic lung effects] Most common in POD ALF [paracetamol-induced ALF] Other causes: Aspiration of gastric contents Neurogenic 2o raised ICP Primary pneumonia Infection Increased risk of bacterial and fungal sepsis [Impaired host defence mechanism, due to impaired opsonisation, chemotaxis and intracellular killing, substantially increases risk of sepsis] Conventional markers of sepsis (ie. Temp, WCC) are absent in ALF Diagnosis difficult in context of progressive MOF Common organisms: Staph, streps, coliforms, candida 15 - 35% nosocomial infection rate vs 5 - 7 % in general hospital population (CLD) Severe sepsis 58% mortality Septic shock 98% mortality Haematological complications [poorer clotting, etc] Decreased circulating levels: Dec Fibrinogen Dec II, V, VII, IX, X Platelet dysfunction Quantitative (70% <100) Qualitative Increased incidence of pancytopenia (haemopahogocytosis) [reduction in the number of red and white blood cells, as well as platelets] Investigations Baseline FBC [WBCs would indicate infection] U&E, LFT
Non cardiogenic pulmonary oedema/ALI- occurs in 40% cases [ie hepatopulmonary syndrome: [syndrome of shortness of breath and hypoxemia (low oxygen levels in the blood of the arteries) caused by vasodilation (broadening of the blood vessels) in the lungs of patients with liver disease]] Ie not porto-pulmonary hypertension which is for cirrhosis serotonin to systemic lung effects] Most common in POD ALF [paracetamol-induced ALF] Other causes: Aspiration of gastric contents Neurogenic 2o raised ICP Primary pneumonia Infection Increased risk of bacterial and fungal sepsis [Impaired host defence mechanism, due to impaired opsonisation, chemotaxis and intracellular killing, substantially increases risk of sepsis] Conventional markers of sepsis (ie. Temp, WCC) are absent in ALF Diagnosis difficult in context of progressive MOF Common organisms: Staph, streps, coliforms, candida 15 - 35% nosocomial infection rate vs 5 - 7 % in general hospital population (CLD) Severe sepsis 58% mortality Septic shock 98% mortality Haematological complications [poorer clotting, etc] Decreased circulating levels: Dec Fibrinogen Dec II, V, VII, IX, X Platelet dysfunction Quantitative (70% <100) Qualitative Increased incidence of pancytopenia (haemopahogocytosis) [reduction in the number of red and white blood cells, as well as platelets] Investigations Baseline FBC [WBCs would indicate infection] U&E, LFT
Alimentary-notes-BETA.docx