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INTRODUCTION: Sepsis, responsible for 2% of ail hospital admissions in one year, has a 30% mortality rate in Intensive Care Units (ICU). Several scores are used to evaluate critical patients and their prognosis. The SOFA score helps to establish the importance of organic dysfonctions and is based on six criteria. One of these criteria is the bilirubin level. During a sepsis, a pathologie level of bi lirubin is associated with a higher risk of death. However the overall evaluation of the liver fonction is important for the prognosis. The main purpose of this study is to determine which enzyme or metabolic product is correlated to a higher risk of death during a septic shock. METHOD: We conducted a prospective study including 100 adult patients hospitalised in the ICU of Saint-Luc Hospital from 20 11 to 2013. Among them, 50 patients presented a severe sepsis or a septic shock. We measured the levels of bilirubin, lactate, INR, glycemia and hepatic enzymes during their hospitalisation period in the ICU. This group was compared to 30 patients who underwent a hepatic transplant, and to 20 patients who had a cardiac surgery and a subsequent vasopressor treatment. The same biologie parameters were measured for those two groups. RESULTS AND DISCUSSION: On average the hospital isation period in ICU of patients with severe sepsis and septic shock lasted for 8, 3 days, with a mortality rate of 30%. Patients who underwent a liver transplant stayed in ICU for 5, 2 days and the mortality after the surgery was 10%.The bilirubin level of patients who died due to sepsis (5,21 mg/dl) is similar to the bilirubin of patients who left the ICU after the liver transplant (5,39 mg/dl). Among septic patients there is a significant difference between the bilirubin levels of patients who died (5,21 mg/dl) compared to those who survived (1,05 mg/dl). On the other hand, among the patients who had a liver transplant, the bilirubin levels were similar in patients who died (5,37 mg/dl) and patients who survived (5,39 mg/dl). We concluded that the bilirubin is not a good prognostic factor after a liver transplant. The death of septic patients occurs with a lactate level 2, 6 times higher than for those who recover (respectively 5, 92 and 2, 27 mmol/l). The same conclusion can be done for the liver transplants, where the lactate level is 2, 68 mmol/l among the recovery group and 9,82 mmol/l for the patients who
Shock, Septic
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Hepatic Insufficiency
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Sepsis
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Since the introduction of paracetamol in the therapeutics, a variety of liver problems have been reported showing risk of developing hepatotoxicity when a combination with alcohol is done. However, this situation still remains a major subject of controversy between investigators. It is well known that taken individually, the two compounds can lead to hepatotoxicity and be dangerous in some special circumstances (like an excessive ingestion of the product for example). Nevertheless, interaction between these molecules is not yet completely resolved for the human.
The polemic question which will be discussed in this report, is to know how combination of paracetamol and alcohol in a good health person, could lead to development of significant hepatotoxicity. This work will try to give some elements of answer for this question. The approach will consist at first to analyse individual characteristics of paracetamol and alcohol and then to evaluate their mutual interaction in the liver. For this, the research will be based on bibliographic analysis of data reported in sciences literature Depuis l’introduction du paracétamol sur le marché du médicament, toute une série de problèmes hépatiques ont étés rapportés, en mettant en cause la combinaison « alcool et paracétamol ». Cependant, cette situation reste encore un sujet majeur de polémique entre les chercheurs.
Il est connu que pris individuellement, ces deux composés peuvent mener à une hépatotoxicité et être dangereux dans certaines circonstances (comme dans le cas d’une ingestion excessive du composé, par exemple). Néanmoins, l’interaction entre ces deux molécules n’est pas encore complètement élucidée chez l’être humain.
Dans ce mémoire, la question est de savoir dans quelle mesure la prise concomitante de paracétamol et d’alcool, chez un sujet en bonne santé, entraînerait le développement d’une hépatotoxicité significative. Ce travail essayera de donner quelques éléments de réponse à cette question. L’approche consistera en un premier temps d’analyser les caractéristiques individuelles du paracétamol et de l’alcool et ensuite d’évaluer leur interaction dans le foie. A cette fin, la recherche se basera sur une analyse bibliographique des données de la littérature.
Drug Interactions --- Acetaminophen --- Alcohol Drinking --- Hepatic Insufficiency
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Resuscitation --- Splanchnic Circulation --- Hepatic Insufficiency --- Liver Circulation
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Hepatic Insufficiency --- Liver Failure --- Liver Transplantation --- Critical Care --- Liver --- Critical care medicine --- Foie --- Soins intensifs --- Diseases --- Complications --- Transplantation --- Maladies --- Complications et séquelles --- Greffe --- Resuscitation --- Emergencies --- Complications et séquelles --- Hepatic Insufficiency. --- Liver Failure. --- Liver Transplantation. --- Critical Care.
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Chronic liver failure is a frequent condition in clinical practice that encompasses all manifestations of patients with end-stage liver diseases. Chronic liver failure is a multiorgan syndrome that affects the liver, kidneys, brain, heart, lungs, adrenal glands, and vascular, coagulation, and immune systems. Chronic Liver Failure: Mechanisms and Management covers for the first time all aspects of chronic liver failure in a single book, from pathogenesis to current management. Each chapter is written by a worldwide known expert in their area and all provide the latest state-of-the-art knowledge. This volume is specifically designed to provide answers to clinical questions to all doctors dealing with patients with liver diseases, not only clinical gastroenterologists and hepatologists, but also to internists, nephrologists, intensive care physicians, and transplant surgeons.
End Stage Liver Disease. --- Liver -- Failure. --- Liver Failure. --- Liver. --- Liver Failure --- Hepatic Insufficiency --- End Stage Liver Disease --- Liver Diseases --- Digestive System Diseases --- Diseases --- Medicine --- Health & Biological Sciences --- Gastroenterology --- Liver --- Failure. --- Failure of the liver --- Hepatic failure --- Hepatic insufficiency --- Liver failure --- Medicine. --- Gastroenterology. --- Hepatology. --- Surgical transplantation. --- Medicine & Public Health. --- Transplant Surgery. --- Clinical medicine. --- Transplantation of organs, tissu. --- Medicine, Clinical --- Internal medicine --- Digestive organs --- Gastroenterology . --- Medical transplantation --- Organ transplantation --- Organ transplants --- Organs (Anatomy) --- Surgical transplantation --- Tissue transplantation --- Tissues --- Transplant surgery --- Transplantation surgery --- Transplants, Organ --- Surgery --- Preservation of organs, tissues, etc. --- Procurement of organs, tissues, etc. --- Transplantation
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This book offers a comprehensive overview of liver failure including Epidemiology, mechanism of the disease, and its clinical manifestations. The diagnosis of numerous types of liver disease leading to liver failure; with specific emphasis on the current and future treatment modalities including up-to-date and extensive information on liver transplantation. It provides the most up-to-date information on liver failure for clinicians, practitioners including GPs, scientists/researchers, postgraduates and allied health professionals. It features an overview of the relevant classification and epidemiologic aspects of acute liver failure along with a thorough review of the mechanisms associated with acute liver failure and multisystemic involvement. Detailed guidance is also provided on the latest treatment techniques including those available for liver transplantation and potential future approaches, enabling the reader to develop a detailed understanding of the topic. Liver Failure: Acute and Acute on Chronic provides a practically applicable guide to the epidemiology and management of liver failure. It features contributions from an outstanding panel of experts in hepatology, gastroenterology and surgery making it a vital up-to-date reference for trainee and practicing medical professionals in a variety of disciplines who encounter these patients.
Hepatology. --- Gastroenterology . --- Surgical transplantation. --- Gastroenterology. --- Transplant Surgery. --- Medical transplantation --- Organ transplantation --- Organ transplants --- Organs (Anatomy) --- Surgical transplantation --- Tissue transplantation --- Tissues --- Transplant surgery --- Transplantation surgery --- Transplants, Organ --- Surgery --- Preservation of organs, tissues, etc. --- Procurement of organs, tissues, etc. --- Internal medicine --- Digestive organs --- Gastroenterology --- Transplantation --- Diseases --- Liver --- Failure. --- Failure of the liver --- Hepatic failure --- Hepatic insufficiency --- Liver failure
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Because of the increasing burden of hepatitis C and fatty liver disease, there is an explosion in the prevalence of chronic liver failure and hence its complications. The onset of Hepatic Encephalopathy (HE) in these patients has a significant impact on the quality of life, morbidity and mortality. Unfortunately, the approach observed by most clinicians to this complex disorder is minimalistic. Hepatic Encephalopathy provides a comprehensive review on pathophysiology and clinically important aspects in HE. Topics in basic physiology, nitrogen metabolism, new insights into pathogenesis and brain edema are covered in great detail. The authors have made a special effort by simplifying the complex aspects of pathogenesis and diagnosis so that it can be easily understood and applied clinically. This volume also focuses on recent developments regarding diagnoses of subtle forms of HE, also known as minimal or covert HE as well as on new treatments. Hepatic Encephalopathy will be of great value to gastroenterologists, hepatologists, pathologists, medical residents, fellows, internists, and general practitioners who treat patients with hepatic encephalopathy. .
Hepatic encephalopathy. --- Hepatology. --- Liver -- Diseases. --- Hepatic encephalopathy --- Liver Failure --- Brain Diseases, Metabolic --- Brain Diseases --- Hepatic Insufficiency --- Metabolic Diseases --- Liver Diseases --- Nutritional and Metabolic Diseases --- Central Nervous System Diseases --- Digestive System Diseases --- Diseases --- Nervous System Diseases --- Hepatic Encephalopathy --- Medicine --- Health & Biological Sciences --- Gastroenterology --- Encephalopathy, Hepatic --- Portal-systemic encephalopathy --- Porto-hepatic encephalopathy --- Portosystemic encephalopathy --- Medicine. --- Gastroenterology. --- Pathology. --- Primary care (Medicine). --- Medicine & Public Health. --- Primary Care Medicine. --- Primary medical care --- Medical care --- Disease (Pathology) --- Medical sciences --- Medicine, Preventive --- Internal medicine --- Digestive organs --- Clinical sciences --- Medical profession --- Human biology --- Life sciences --- Pathology --- Physicians --- Brain damage --- Liver --- Mesocaval shunt --- Portacaval anastomosis --- Toxic psychoses --- Failure --- Complications --- Clinical medicine. --- Emergency medicine. --- Medicine, Emergency --- Critical care medicine --- Disaster medicine --- Medical emergencies --- Medicine, Clinical --- Gastroenterology .
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