Gastrointestinal disorders of the XXXX .

@entity1 @entity32 @entity39 @entity5 @entity310 @entity648 @entity409 @entity880 @entity2922 @entity99 @entity413
Shock liver describes a collecting pool of critically ill @entity1 in whom the elevation of liver function tests or overt @entity409 is apparent. Different grades of shock liver affect about 50% of all intensive-care @entity1 , varying from a mild elevation of serum aminotransferase and @entity648 levels in septic @entity1 to an acute onset of high serum aminotransferases after haemodynamic shock. Abnormalities can subside within days or progressively deteriorate when persistent hepatic microcirculatory failure is present. Although @entity99 in critically ill @entity1 influences mortality rates it is underdiagnosed. The underlying pathophysiology involves changes in the portal and arterial blood supply as well as in microcirculation. Cross-talk between hepatocytes, Kupffer cells and endothelial cells, leading to an inflammatory response mediated primarily by @entity5 @entity39 factor-alpha ( @entity310 ), is central to shock liver. The liver is a victim of shock inducers, and can also be the orchestrator of the @entity32 ( @entity32 ). @entity99 by @entity310 is modulated by the prevalent pro-inflammatory or anti-inflammatory mediator profile elaborated by Kupffer cells. Kupffer cells additionally participate in the clearance of endotoxin, bacteria and inflammatory mediators and are thereby capable of preventing @entity32 . The hepatocyte undergoes dramatic alterations in synthetic activity, biliary transport, bile flow and @entity413 metabolism. Although standard determinations of aminotransferases, coagulation studies, @entity413 , @entity880 and @entity648 can detect @entity99 they only partially reflect the cellular mechanisms driving shock liver. The management of shock liver is focused on the prevention of precipitating causes by controlling sepsis, circulation parameters and metabolism in addition to the cautious monitoring of therapeutic measures that can increase @entity99 , which include intravenous nutrition, mechanical ventilation and @entity2922 administration.
