Evaluating the patient with a possible acute abdomen and intraabdominal sepsis in the intensive care unit (ICU) can be challenging. Patients frequently have multiple potential sources of sepsis and are often unable to describe symptoms or localize tenderness on physical…
Introduction Acute liver failure (ALF), also known as fulminant hepatic failure, is a compelling example of complex critical illness. The initiating event is extreme liver injury from a variety of possible causes. Thereafter, a severe multisystem critical illness rapidly develops,…
Hepatic encephalopathy encompasses a spectrum of neuropsychiatric abnormalities that occur in patients with liver disease in the absence of other brain disease. , The spectrum includes personality changes, impaired mental function, motor abnormalities (i.e., asterixis, tremors, hyperventilation, hyperactive reflexes), and…
Definition Hepatopulmonary syndrome (HPS) is defined by an abnormally low arterial oxygen level associated with intrapulmonary vascular dilatations (IPVDs) in patients with liver disease. The presence of coexisting cardiopulmonary disease, which may contribute to impaired gas exchange, should be considered…
An association between advanced liver disease, ascites, and renal failure described in 1861 was named hepatorenal syndrome (HRS) by Helvig and Schutz in 1932. Until recently, HRS has been thought of as a purely functional form of renal failure without…
The change of a paradigm Portal hypertension is not the only driver of complications of cirrhosis Cirrhosis is typically classified as compensated or decompensated, based on the absence or presence (or previous history) of variceal bleeding, ascites, jaundice, or encephalopathy.…
Heart disease remains the leading cause of death in both men and women among African Americans, Hispanics, and Caucasians in the United States, accounting for nearly 650,000 deaths annually. Significant progress has been made over the past few decades in…
Rationale for using inotropic therapy in the critically ill Two different objectives for using inotropes in the critically ill have been considered: (1) the attempt to improve cardiac function in patients with low blood flow related to reduced myocardial contractility…
Introduction Shock can be defined as a state of circulatory failure to deliver sufficient oxygen to balance the demands of the tissues, which results in tissue hypoxia: a deficiency in the bioavailability of oxygen to the tissues of the body.…
Pathophysiology of shock Circulatory shock represents a final common pathway of cardiovascular failure. Septic shock is the most common cause of shock followed by cardiogenic and hypovolemic shock. Mortality remains high, particularly for patients with septic and cardiogenic shock, where…