Leberparameter in der Intensivmedizin

Zusammenfassung

Leberwerterhöhungen sind bei intensivmedizinischen Patienten mit einer erhöhten Mortalität asso­ziiert. Neben chronischen Lebererkrankungen sind vor allem akute und iatrogene Ereignisse häufige Ursachen von Leberwerterhöhungen auf der Intensivstation. Zur Ursachenfindung empfiehlt sich die Bestimmung von Parametern der Leberzellintegrität (GPT, GOT und GLDH), der Cholestase (AP, GGT und Bilirubin) und der Synthesefunktion (INR und Albumin). Die Sonografie stellt ein kostengünstiges und schnell verfügbares bildgebendes Verfahren zur Diagnostik eines chronischen Leberparenchymschadens, zur Überprüfung der Perfusion sowie zur Detektion von raumfordernden Prozessen oder einer extra­hepatischen Cholestase dar. Ergänzend liefert die transiente Elastografie wichtige Informationen bezüglich einer vorbestehenden chronischen Lebererkrankung. Bei der Interpretation der Befunde ist stets die vorherige intensivmedizinische Behandlung zu berücksichtigen. Neben den häufigen septischen und ischämischen Schädigungen der Leber nehmen therapieassoziierte Komplikationen durch Medikamententoxizität oder durch parenterale Ernährung eine zentrale Bedeutung ein. Die Therapie besteht hauptsächlich in der korrekten Identifizierung und nach Möglichkeit Behebung der zugrundeliegenden Problematik. 

Abstract

Elevated liver function tests in ICU-bound patients are associated with a greater risk of mor­tality. Chronic liver diseases as well as acute events and complications of therapy are among the causes. The disorder could further be investigated by assessment of liver cell integrity markers (AST, ALT and GLDH), cholestasis parameters ­(bilirubin, GGT, ALP) and liver synthethic function (albumin, coagulation profile). Ultrasound and elastography are cheap and mobile options to evaluate chronic liver disease, cholestasis or perfusion of the liver. The interpretation of the results should include the medical history on the ICU. Liver injury could be due to septic or isch­aemic complications as well as toxic side effects or parenteral nutrition. The main therapeutic option is to identify the cause of the liver dysfuntion and to eliminate it as far as possible. 

Schlüsselwörter

Intensivmedizin - Leberchirurgie - OP-Management

Key words

intensive care medicine - liver surgery - surgical strategy

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