Liver Failure

This is a unique question-and-answer chapter for surgical residents and trainees, concentrating on liver failure. Hepatorenal syndrome occurs in patients with pre-existing parenchymal liver disease after a precipitating event such as surgery or a hypotensive episode (e.g., GI bleed, dialysis, sepsis). Hematuria is associated with nephritic syndrome, urothelial tumors or renal/bladder calculi. Hepatic encephalopathy or portal-systemic encephalopathy is a reversible impairment of neuropsychiatric function associated with impaired hepatic function. There may be benefit to administering relatively higher levels of branch-chain amino acids with minimized aromatic amino acids portosystemic shunts interfere with ammonia metabolism in the liver. Transjugular intrahepatic portosystemic shunt (TIPS) has been shown to lead to an increase in urine output and a marked or complete reduction in ascites. The pathophysiology of hyponatremia is either due to increased anti-diuretic hormone (ADH) due to circulatory insufficiency (hypovolemic hyponatremia) or renal impairment that fails to eliminate solute free water (hypervolemic hyponatremia).