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Semin Respir Crit Care Med 2018; 39(05): 566-577
DOI: 10.1055/s-0038-1672200
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Critical Care Management of Gastrointestinal Bleeding and Ascites in Liver Failure

Kapil Rajwani
1   Division of Pulmonary and Critical Care, Weill Cornell Medical College, New York, New York
,
Brett E. Fortune
2   Division of Gastroenterology and Hepatology, Center for Liver Diseases and Transplantation, Weill Cornell Medical College, New York, New York
,
Robert S. Brown Jr.
2   Division of Gastroenterology and Hepatology, Center for Liver Diseases and Transplantation, Weill Cornell Medical College, New York, New York
› Author Affiliations
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Publication History

Publication Date:
28 November 2018 (online)

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Abstract

Gastrointestinal (GI) bleeding and ascites are two significant clinical events that frequently present in critically ill patients with chronic liver failure or decompensated cirrhosis. GI bleeding in patients with cirrhosis, particularly portal hypertensive-associated bleeding, carries a high short-term mortality (15–25%) and requires early initiation of a vasoactive agent and antibiotics as well as timely endoscopic management. Conservative transfusion strategies and adequate airway protection are also imperative to assist in bleeding control. The presence of ascites among hospitalized cirrhotics requires early analysis of ascitic fluid to diagnose spontaneous bacterial peritonitis and initiate appropriate antibiotics and albumin to reduce patients' high associated mortality rates of greater than 25%. Appropriate utilization of portal decompression using transjugular intrahepatic portosystemic shunt placement for selected patients with failure to control bleeding or ascites and early consideration for liver transplantation referral is critical to improve patient survival. This review will aim to elucidate the current strategies for the management of critically ill patients with chronic liver failure presenting with GI bleeding or ascites.

Keywords

chronic liver failure - gastrointestinal bleeding - varices - portal hypertension - ascites
 

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