Liver Emergencies
Keep your differential wide in liver patients with abdominal pain, have a low threshold for abdominal imaging, and think specifically about the possibility of portal vein thrombosis and bacterial peritonitis even in the patient with a “benign” abdomen on physical exam - Anton Helman & Jennifer He
HWN Suggests
Liver Emergencies: Acute Liver Failure, Hepatic Encephalopathy, Hepatorenal Syndrome, Liver Test Interpretation & Drugs to Avoid
For such a large organ, EM physicians spend proportionally little time thinking about the liver. Sure, we’re often in the neighborhood (whether it be doing a FAST or diagnosing biliary disease), but the liver really doesn’t get the credit it’s due. Nonetheless, from time to time, whether it be the acute liver failure patient gushing from a varix whose INR is greater than his shoe size, or the confused hepatic encephalopathy patient levitating off the bed using nothing but asterixis, there are definitely times where the middle child of the abdomen steals the show.
Articles of Interest
EM Cases: Liver Emergencies
Liver patients are at higher risk of clotting than of bleeding.
Liver Emergencies: Thrombosis and Bleeding, Portal Vein Thrombosis, SBP, Paracentesis Tips and Tricks
We clear up the confusing balance between thrombosis and bleeding in liver patients, the elusive diagnosis of portal vein thrombosis, spontaneous bacterial peritonitis diagnosis and treatment and some tips and tricks on paracentesis.
Liver Trauma: Management in the Emergency Setting and Medico-Legal Implications
Traumatic abdominal injuries are life-threatening emergencies frequently seen in the Emergency Department (ED). The most common is liver trauma, which accounts for approximately 5% of all ED admissions for trauma. The management of blunt liver trauma has evolved significantly over the past few decades and, according to the injury’s severity, it may require massive resuscitation, radiological procedures, endoscopy, or surgery.
Management of Acute Liver Failure in the Emergency Department
It is important to note that NAC can be beneficial in cases of liver failure not related to APAP ingestion. In a prospective, double blinded trial of patients with acute liver failure without clinical or historical evidence of APAP overdose, NAC use was shown to increase likelihood of transplant free survival, with the biggest benefit to those with grade 1 or 2 hepatic encephalopathy.5 Its use appears to be safe, as the only statistically significant adverse outcome from its administration was an increased incidence of nausea and vomiting.
