A. Obtain an advance directive; if not available and the patient is competent, encourage one be executed B. Begin planning ahead for end-of-life issues C. Anticipate and schedule regular reevaluation…
Poor performance status (palliative performance scale and Karnofsky scale) Advanced age Malnutrition Comorbid illness Increasing organ dysfunction Hospitalization for acute decompensation Principles of Palliative Care Palliative care is rooted in…
Highly sensitive and specific to identify different stages of fibrosis Applicable to the monitoring of disease progression or regression as part of the natural history of liver disease or treatment…
Fig. 7.1 A typical tracing of a hepatic venous pressure gradient (HVPG). Equilibration of WHVP requires over 20 s. The HVPG is calculated as the difference between WHVP and free hepatic…
Vaccine Before transplantation After transplantation Influenza Inactivated Live attenuated Recommended (yearly) If inactivated not available (2 weeks before transplantation) Recommended (yearly) Not recommended Hepatitis B Recommended if seronegative (3–4 high-dose…
Clinical feature One point Two points Three points Total bilirubin (mg/dL) < 2 2–3 > 3 Albumin (g/dL) > 3.5 2.8–3.5 < 2.8 INR < 1.7 1.7–2.3 > 2.3 Ascites None Mild Moderate to severe Encephalopathy…
Indications for liver transplantation Acute liver failure due to Acetaminophen overdose Idiosyncratic drug-induced liver injury Acute fatty liver of pregnancy Toxin exposure—Amanita phalloides (mushroom poisoning) Acute viral hepatitis—hepatitis A–E, herpes…
Organ/system 0 1 2 3 4 Liver (bilirubin, mg/dL) < 1.2 ≥ 1.2 to ≤ 1.9 ≥ 2 to ≤ 5.9 ≥ 6 to < 12 ≥ 12 Kidney (creatinine,…
Fig. 24.1 Factors responsible for the susceptibility of cirrhotic patients to bacterial infections. NOD2 nucleotide-binding oligomerization domain containing 2, IgA immunoglobulin A, IBO intestinal bacterial overgrowth, HLA-DR human leukocyte antigen,…
Control and patient monitoring Monitor blood pressure, heart rate and O2 saturation Control of diuresis Central or good peripheral vascular accesses Volume replacement Conservative transfusion policy to: Restore and maintain…
