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Friday, November 12, 2021

Liver Emergencies

emDocs - November 12, 20211 - By Antón Helman
Key Take Home Points for Liver Emergencies: Thrombosis and Bleeding, Portal Vein Thrombosis, Spontaneous Bacterial Peritonitis and Paracentesis
  • Do not assume that the liver patient with a high INR is anticoagulated; they may still be at risk for thrombosis
  • Keep your differential wide in liver patients with abdominal pain, have a low threshold for abdominal imaging, and think specifically about the possibility of portal vein thrombosis and bacterial peritonitis even in the patient with a “benign” abdomen on physical exam
  • IV albumin should be considered in the patient with acute liver failure and/or bacterial peritonitis and/or paracentesis >5L of ascitic fluid
  • Do not forget to order a fibrinogen level in the liver patient with life-threatening bleeding and give cryoprecipitate or fibrinogen to keep the fibrinogen level > 100
  • It is considered generally safe to perform a paracentesis in a liver patient with an INR as high as 8 and a platelet count as low as 20,000
  • Consider use of POCUS, a pigtail catheter, Z-track technique and tissue glue adhesive for paracentesis