Reviewed By: Pramod Kerkar, MD, FFARCSI

Liver shock is one of the most common causes of high level serum aminotransferase levels i.e. more than 20 times the upper limit of normal. 1 to 9% of the people have elevated liver enzymes, which can cause acute liver failure if left untreated. The only treatment option available is to correct the underlying disease state. Rapid diagnosis and immediate commencement of treatment is critical, as delay in diagnosis has been shown to worsen mortality risk.

Can you be Cured of Shock Liver?

Can You Be Cured Of Shock Liver?

Treatments directed at the predisposing condition include optimization of whole body circulation, infection control, maintenance of adequate mean arterial pressure, and preservation of liver microcirculation and oxygenation through the use of inotropes, vasodilators and diuretics. The therapeutic strategies for the patient with severe hemorrhage Fenoldopam mesylate has been recommended to maintain blood flow and reduce visceral ischemia membranes (directs the blood flow from the serousal tissue to visceral mucus).

In patients with heart failure and septic shock, dopamine (due to the vasoactive effects of it) is administered to maintain blood pressure in the normal range. The lower doses of dobutamine to maintain mucosal perfusion and hepatic blood flow are administered. An ideal inotropic agent has not yet been identified, and the existing studies have reported only limited benefit in specific clinical circumstances. For example, dopamine may offer a survival benefit for patients with normotensive cardiogenic shock and kidney injury, and dobutamine has been proposed to augment splanchnic blood flow to the liver in patients with low cardiac index. But, these findings from small studies are not widely generalizable. Reduced oxygen consumption by the organ during the administration of dopamine has been reported in patients with severe hepatic failure. Also, higher than normal doses of steroids may reduce the need for norepinephrine in hypotensive patients with liver failure. All mentioned items have no effects on patient’s survival, but can keep patient’s life to find a transplant liver.

The use of multiple therapeutic agents such as N-acetyl cysteine, albumin, hemodialysis and Molecular Adsorbents Recirculating System (MARS) are presented as advanced therapies, but the only definite treatment of these patients is liver transplant. Another approach uses a modified dialysis system targeting substances bound to serum albumin, namely the molecular adsorbent recirculating system (MARS). It is theorized to remove small hydrophobic toxins that are normally detoxified by the healthy liver.

While MARS showed some early promise in increasing liver circulation and providing survival benefit in acute liver failure, there is not yet sufficient evidence to recommend its regular use. Finally, it should be noted that liver transplantation is rarely indicated for the treatment of Hypoxic Hepatitis (HH) or Shock Liver.

Conclusion

Management is non-specific but prompt resuscitation, correction of underlying cause, definitive treatment of sepsis and meticulous supportive care are likely to reduce the incidence and severity. The only recognized treatment is to correct the predisposing condition; the newest therapies directed at the liver still require further investigation before they can be widely recommended.

Also Read:

Pramod Kerkar

Written, Edited or Reviewed By:

, MD,FFARCSI

Pain Assist Inc.

Last Modified On: July 24, 2018

This article does not provide medical advice. See disclaimer

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