Help
Subscribe


All of GastroHep is now free access! - Click here to register Read For FREE - Our full range of review articles
GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy
GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy Profile of Guido Tytgat Profile of Pete Peterson Profile of Peter Cotton Profile of Roy Pounder

Home

News  
Journals
Review Articles
Slide Atlas
Video Clips
Online Books
Advanced Digestive Endoscopy
Classical Cases
Conference Diary
PubMed
International GH Links
USA GH Links
National GH Links
National GI Societies
Other Useful Links




Emails on Gastroenterology and Hepatology
the National AIDS Treatment Advocacy Project
Visit the gastroenterology section of the EUMS

News

Ethical approach to organ support in critically-ill patients with cirrhosis

A study in the latest issue of the Alimentary Pharmacology & Therapeutics considers an ethical approach to organ support in critically-ill patients with cirrhosis.

News image

Increasing numbers of patients are being admitted to hospital with decompensated chronic liver disease in the UK.

A significant proportion will develop complicating extra-hepatic organ dysfunction, but the selection of those who should be admitted to intensive care is complex and challenging.

Alcohol-related liver disease also presents complex ethical dilemmas.

Dr Berry and colleagues from the United Kindgom reviewed the recent survival analyses and explore differences in secondary and tertiary care; to highlight strengths and weaknesses of prognostic models, therapeutic advances and shifts in prognostic expectation. 

The researchers explored the ethical challenges presented by addiction and self- injury in an area of limited resource.

Previously ‘untreatable’ complications are now being managed successfully
Alimentary Pharmacology & Therapeutics

The researchers also searched PubMed for articles discussing ‘cirrhosis’, ‘prognosis’, ‘critical illness’, ‘organ failure’, ‘renal failure’, ‘alcohol’, ‘ethics’ and ‘addiction’.

The team explored particular ethical dilemmas encountered by colleagues.
 
With the findings and outcomes of the study, the prognosis has improved in many cirrhotic complications.

Historically poor outcomes in tertiary care may reflect a more complex patient cohort.

The team observed that previously ‘untreatable’ complications are now being managed successfully.

The doctor's found that estimates of survival are more accurate after a 48-hour period of supportive care.

Physicians are not best placed to make judgments with regard to deservingness, moral responsibility, rationing and access to organ support in cases of acute deterioration related to alcoholism, and the case for denying support must be made on purely medical grounds.
 
Dr Berry's team concludes, "An early, aggressive approach to organ support is justified."

"Further discussions between hepatologists and critical care physicians are required to determine acceptable burden-to-benefit ratios for prolonged intensive care support in young alcoholic patients."

Alimentary Pharmacology & Therapeutics 2012: DOI: 10.1111/apt.12133
26 November 2012

Go to top of page Email this page Email this page to a colleague

 02 October 2014

Advanced search
 02 October 2014 
Predictive model of Hep C disease progression
 02 October 2014 
Person-to-person transmission of norovirus
 02 October 2014 
IPAA with or without preoperative radiation
 01 October 2014 
Prevention of postop Crohn's
 01 October 2014 
Cecal intubation time during colonoscopy
 01 October 2014 
Anti-TNFa therapies during pregnancy in IBD
 30 September 2014 
Autoimmune hepatitis
 30 September 2014 
Medication use in patients with chronic Hep C
 30 September 2014 
Gastric cancer according to H pylori infection status
 29 September 2014 
Drug exposure and microscopic colitis
 29 September 2014 
Peptic ulcer bleeding after PPI treatment
 29 September 2014 
Intestinal tuberculosis vs Crohn's disease
 26 September 2014 
5-aminosalicylates for the treatment of Crohn's
 26 September 2014 
Response to infliximab in paediatric perianal Crohn's
 26 September 2014 
Ondansetron for IBS with diarrhea
 25 September 2014 
Colorectal neoplasia among family members of patients with colorectal cancer
 25 September 2014 
Medical treatment and surgery rates in IBD
 25 September 2014 
Liver transplants for liver cancer
 24 September 2014 
Health services burden of IBD
 24 September 2014 
PPIs after antireflux surgery
 24 September 2014 
Antidepressants in chronic liver disease
 23 September 2014 
Upper GI bleeding with drug combinations
 23 September 2014 
Recurrence of Barrett's neoplasia after resection
 23 September 2014 
Abnormal prion protein in appendixes
 22 September 2014 
Anorectal function after low anterior resection
 22 September 2014 

Anorectal stricture in Crohn's

 22 September 2014 
Malignancies in celiac disease
 19 September 2014 
Adhesions in abdominal and pelvic surgery
 19 September 2014 
Repeat colonoscopy among US Medicare
 19 September 2014 
Progression to liver cancer in HCV-infected Veterans
 18 September 2014 
Patient improvement following sacral neuromodulation
 18 September 2014 
Autoimmune diseases in functional gastrointestinal disorders
 18 September 2014 
New diagnostic score for hepatic steatosis
 17 September 2014 
Orange juice intake for bowel preparation
 17 September 2014 
Treatment of fistulising perianal Crohn's disease
 17 September 2014 
Interval colorectal cancers
 16 September 2014 
Fiber treats IBS
 16 September 2014 
Resected biliary tract cancer
 16 September 2014 
Postoperative adhesions in digestive surgery
 15 September 2014 
Fecal transplantation for C.diff infection
 15 September 2014 
Prunes and GI function
 15 September 2014 
Antidepressants for IBS
 12 September 2014 
Metabolic syndrome delays HBeAg seroclearance
 12 September 2014 
Drug-induced liver disease
 12 September 2014 
Management of complex colon polyps
 11 September 2014 
Sofosbuvir plus peginterferon/ribavirin for HCV
 11 September 2014 
Hepatobiliary cirrhosis risk after organ transplant
 11 September 2014 
Patient perceptions in celiac disease
 10 September 2014 
Acute kidney injury after colonoscopy
 10 September 2014 
Management algorithm for endoscopic mucosal resection of colonic lesions
 10 September 2014 
Adhesions in abdominal and pelvic surgery
 09 September 2014 
Neutrophil function and mortality in cirrhosis
 09 September 2014 
PPIs and spontaneous bacterial peritonitis in cirrhosis
 09 September 2014 
MELD and liver cancer survival
 08 September 2014 
Comparison of diet programs in overweight and obese adults
 08 September 2014 
Vagal nerve blockade and morbid obesity
 08 September 2014 
Long-term follow-up after bariatric surgery
 05 September 2014 
Healing rates in reflux esophagitis
 05 September 2014 
Progression of environmental enteropathy
 05 September 2014 
Diabetes and liver transplant outcomes

Blackwell Publishing


GastroHep.com is a Blackwell Publishing registered trademark
© 2014 Wiley-Blackwell and GastroHep.com and contributors
Privacy Statement
Disclaimer
About Us