Resuscitation
Category: Bonus CE
Therapeutic Conundrums in Cirrhosis: Need for a Paradigm Shift in Diagnostic Strategies
Deepa B. Gotur, MD, FCCP, FCCM (she/her/hers)
Houston Methodist Hospital
Houston, Texas
This section will focus on immune dysregulation, altered gut microbiome, and increased risk of sepsis in cirrhosis. It will emphasize the risk of missing early signs of sepsis in cirrhosis because of the lack of compensatory anti-inflammatory response syndrome. Further will describe the increased severity of illness because of the dysregulated immune system and the stage of immune paralysis with subsequent multiorgan dysfunction. The section will spotlight early identification, appropriate choice of antibiotics based on suspected/confirmed resistance patterns, appropriate resuscitative measures, and using prognostic tools to risk-stratify these patients.
Gustot T, Durand F, Lebrec D, Vincent JL, Moreau R. Severe sepsis in cirrhosis. Hepatology. 2009 Dec;50(6):2022-33. doi: 10.1002/hep.23264. Erratum in: Hepatology. 2010 Feb;51(2):725. PMID: 19885876.
Chebl, Ralphe Bou MD, FAAEM; Tamim, Hani Ph.D.; Sadat, Musharaf MD; Qahtani, Saad MD; Dabbagh, Tarek MD; Arabi, Yaseen M. MD, FCCP, FCCM. Outcomes of septic cirrhosis patients admitted to the intensive care unit: A retrospective cohort study. Medicine 100(46):p e27593, November 19, 2021. | DOI: 10.1097/MD.0000000000027593
Godolfino Miranda-Zazueta, Luis A. Ponce de León-Garduño, Jonathan Aguirre-Valadez, Aldo Torre-Delgadillo. Bacterial infections in cirrhosis: Current treatment. Annals of Hepatology, Volume 19, Issue 3, 2020, Pages 238-244, ISSN 1665-2681,https://doi.org/10.1016/j.aohep.2019.09.011.
Philips CA, Ahamed R, Rajesh S, George T, Mohanan M, Augustine P. Update on diagnosis and management of sepsis in cirrhosis: Current advances. World J Hepatol. 2020 Aug 27;12(8):451-474. doi: 10.4254/wjh.v12.i8.451. PMID: 32952873; PMCID: PMC7475781.