Liver Diseases in the Pediatric Intensive Care Unit: A Clinical Guide

Description

In recent years, substantial progress has been made in the approaches to diagnosis and treatment of severe liver diseases in the pediatric ICU, from various forms of liver failure and hepatitis to acute and chronic liver disease. New techniques and tools are being utilized to prevent patients from experiencing complications and for patients in recovery from operations on the native or donor liver. This book describes the clinical presentation and management of liver diseases in the intensive care unit with the pediatric patient in mind. In addition, advances in bone marrow transplantation, cardiac-generated liver disorders and new therapeutic approaches, such as artificial liver support, are discussed in detail.  Presenting the current available knowledge in a compelling form, Liver Diseases in the Pediatric Intensive Care Unit is a valuable resource for pediatric gastroenterologists and hepatologists, pediatricians and intensivists. Preface Contents Contributors Liver Injury and Failure in Critically Ill Children Epidemiology Pathophysiology of Liver Injury in Critically Ill Patients Hypoxic Liver Injury Sepsis and Inflammation Venous Congestion Treatment-Associated Liver Injury Parenteral Nutrition-Associated Liver Disease (PNLAD) Drug-Induced Liver Injury (DILI) Transfusions Clinical Presentation and Patterns of Acquired Liver Injury and Failure Patterns of Liver Injury Clinical Presentation and Evolution Diagnosis Hypoxic Liver Injury Cholestatic Liver Dysfunction Pitfalls in Diagnosis Aminotransferases Bilirubin Alkaline Phosphatase INR Albumin Novel Markers and Tests Serum Bile Acids Levels Indocyanine Green Plasma Disappearance Rate (ICG-PDR) Liver Stiffness An Approach to Abnormal Liver Tests in the ICU Treatment Treating the Underlying Cause and Preventing Further Injury Treating the Complications Specific Treatment and Research Conclusion References Acute Liver Failure Definition Aetiologies of Acute Liver Failure in Newborn and Infants (Tables 1 and 2) Metabolic Diseases Indeterminate Hepatitis Viral Infections Haemophagocytic Lymphohistiocytosis (HLH) Foetal Alloimmune Hepatitis Giant Cell Hepatitis with Autoimmune Haemolytic Anaemia Vascular Disorders/Decrease in Liver Perfusion Etiologies of Acute Liver Failure in Children (Tables 1 and 2) Indeterminate Hepatitis Viral Infections Drugs Paracetamol/Acetaminophen Isoniazid Volatile Anaesthetic Agents (Halothane, Desflurane, Enflurane, Isoflurane, and Sevoflurane) Anticonvulsant Agents: Phenytoin, Carbamazepine, Valproic acid, and Some of the Newer Anticonvulsants Other Drugs Toxics Autoimmune Metabolic Hematological Disorders Vascular Disorders Clinical Presentation Laboratory Tests Complications Treatments Non-specific Treatments Specific Treatments Extracorporeal Therapy as a Bridge to Liver Transplantation Prognosis Conclusions References Acute-on-Chronic Liver Failure Definitions and Diagnostic Criteria Prevalence Etiology Etiology of Chronic Liver Disease Etiology of the Acute Insult Pathogenesis Natural History and Outcome of ACLF Predictive Models and Mortality Management Conclusions References Liver Failure and the Brain Pathophysiology Hyperammonia Glutamine Blood Brain Barrier (BBB) Glutamate Cerebral Autoregulation Cerebral Edema Epidemiology and Clinical Presentation of HE Diagnosis, Monitoring, and Prognosis Treatment Outcome Conclusion References Liver Failure and the Kidneys Introduction Physiopathology Definition and Diagnosis Management Conclusion References Liver Failure and Extracorporeal Therapies Renal Replacement Therapies RRT Method Continuous Renal Replacement Therapies Intermittent Hemodialysis Peritoneal Dialysis Extracorporeal Liver Support Therapies Artificial Extracorporeal Liver Support Systems (Table 1) Albumin Dialysis Therapeutic Plasma Exchange (Plasmapheresis) Artificial Extracorporeal Liver Support Efficacy Biological Extracorporeal Liver Support Systems Conclusion References Liver Failure and the Lungs Introduction Lung Inflammation PARDS Management Intra-abdominal Hypertension Diagnosis and Management of IAH Hepatopulmonary Syndrome Diagnosis and Management of HPS Porto-Pulmonary Hypertension Diagnosis and Management of POPH Treatments and Transplant Consideration Hepatic Hydrothorax Conclusions References Liver Failure and the Heart Introduction The Heart and the Liver: Anatomic Relationships Cardiac Complications of Pediatric Liver Diseases High-Output Cardiac Failure Pathophysiology Clinical Presentation Treatment Cirrhotic Cardiomyopathy Pathophysiology Clinical Manifestations Treatment Hepatic Complications of Pediatric Cardiac Disease Hepatic Complications of Acute Cardiac Insufficiency: Ischemic Hepatitis Fontan-Associated Liver Disease (FALD) Pathophysiology Clinical Presentation Treatment Conclusion References Liver Failure and Haematopoietic Stem Cell Transplantation Introduction Sinusoidal Obstructive Syndrome Physiopathology Risk Factors of SOS Clinical Presentation and Diagnosis Criteria Prevention Treatment Fluids Management Transfusion Support Ventilation Nutrition Infection Treatments Liver Dysfunction Treatment Delirium Treatment Other Causes of Liver Injury in Children Undergoing HSCT Infection Hepatotropic Virus Sepsis Graft Versus Host Disease Acute Graft Versus Host Disease Chronic Graft Versus Host Disease Metabolic Parenteral Nutrition-Associated Cholestasis Iron Overload Drug-Related Injury Conclusions References Liver Transplantation in Critically Ill Children Main Aspects of Liver Transplantation in Children Surgical Approaches Donor Selection Outcomes and Surgical Complications Waiting for a Transplant Indications Pretransplant Evaluation and Listing Pretransplant Management and Complications on the Waiting List Post-transplant Management Liver Function Monitoring Potential Complications Immunosuppression and Rejection Conclusion References Index