- Variceal bleeding – oesophagus, rectum, stoma site. Octreotide as effective, and far fewer side effects than vasopressin.
- Coagulopathy – Blood products, vit K. Novoseven (activated factor VII) effective in refractory coagulopathy but reports of thrombosis.
- Encephalopathy – subtle manifestations eg going quiet, often precede catastrophic decompensation. Very prognostic. Restrict protein to 1-2g/kg, lactulose. Not great evidence for branched chain amino acids or gut antibiotics.
- Hepatorenal syndrome – ie secondary renal impairment
- Hepatopulmonary syndrome – end stage: shunts + nondegraded vasoactive metabolites causing pulmonary hypertension.
Fulminant Liver Failure
- Deranged liver function with coagulopathy and jaundice
- and exclusion of chronic liver disease
- Developing within 2 weeks of onset of jaundice
Broad spectrum antibiotics usually added in. Some suggest N-acetyl cysteine even without Paracetamol ingestion (Gastroenterology. 2009 Sep;137(3):856-64).
Transplant: indicated when bilirubin >150, hypoalbuminaemia, failing nutrition.