Hepatocellular Dysfunction in the Critically Ill

Abstract

Hepatobiliary disturbances occurring in the critically ill can be subdivided into two groups, primary and secondary. In the primary group the hepatobiliary problems are either ab initio lifethreatening and constitute the main reason for resuscitation and treatment, or else as a result of pre-existing liver disease which may complicate the problems encountered during Intensive Therapy for another condition. Included in this group are hepatic trauma, acute or fulminant hepatic failure, and hepatic failure and other organ impairment resulting from preexisting or occult liver disease. In the secondary group the hepatobiliary problems are rarely life-threatening, overt hepatic failure is unusual but nevertheless the hepatic dysfunction may complicate or be responsible for causing other organ failure. Included in this group are abnormalities of liver function in circulatory failure, in septic shock and in the recently recognised toxic shock syndrome.