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Schockleber und Cholestase beim kritisch Kranken

Shock liver and cholestatic liver in critically ill patients

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Zusammenfassung

Leberfunktionsstörungen können häufig bei kritisch kranken Patienten auf der Intensivstation (ICU) beobachtet werden und haben eine hohe Morbidität und Mortalität zur Folge. Die häufigsten Formen der Leberfunktionsstörung an der ICU sind die Schockleber und die cholestatische Leberfunktionsstörung mit Inzidenzraten bis zu 10 % bzw. 30 %.

Beide Erkrankungen treten häufig als Folge einer Ischämie/Hypoxie meist im Rahmen eines kardiogenen Schocks, einer Sepsis oder eines septischen Schocks auf. Speziell im Fall der cholestatischen Leberdysfunktion wurden jedoch auch andere potenzielle Verursacher identifiziert. Dazu gehören neben zugrunde liegenden Krankheiten, wie chronische Lebererkrankungen oder Malignome, auch iatrogene Faktoren, wie z. B. parenterale Ernährung, hohe Beatmungsdrücke, chirurgische Eingriffe, verschiedene Medikamente und Bluttransfusionen.

Frühzeitiges Erkennen und Behandeln der zugrunde liegenden Ursache stellen bislang die einzigen etablierten Therapiemaßnahmen bei Schockleber und cholestatischer Leberfunktionsstörung dar.

Abstract

Liver dysfunction is frequently observed in critically ill patients. Its occurrence is associated with high morbidity and mortality. The most frequent entities of hepatic dysfunction in the intensive care unit are shock liver and cholestatic liver dysfunction with incidence rates up to 10 and 30 %, respectively.

Both conditions are frequently triggered by hypoxic and/or ischemic events, most commonly cardiogenic shock and sepsis/septic shock. However, several other potential contributors have been identified especially for cholestatic liver dysfunction. Apart from chronic liver diseases and malignancies, iatrogenic factors such as total parenteral nutrition, high pressure ventilation, surgical procedures, drugs and blood transfusions promote its occurrence.

In shock liver and in cholestatic liver disease, early detection and therapy of the underlying disease is the only established treatment.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. A. Drolz, T. Horvatits und K. Roedl geben an, dass kein Interessenkonflikt besteht. V. Fuhrmann erhielt Forschungsunterstützung von Baxter/Gambro und war für Baxter/Gambro als Referent tätig. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland

    A. Drolz, T. Horvatits, K. Roedl &  V. Fuhrmann

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  1. A. Drolz
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  2. T. Horvatits
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  3. K. Roedl
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  4. V. Fuhrmann
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Correspondence to V. Fuhrmann.

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Drolz, A., Horvatits, T., Roedl, K. et al. Schockleber und Cholestase beim kritisch Kranken. Med Klin Intensivmed Notfmed 109, 228–234 (2014). https://doi.org/10.1007/s00063-013-0320-5

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  • DOI: https://doi.org/10.1007/s00063-013-0320-5

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