الفهرس 
HEPATIC PATIENTS IN ICUOnly 14 pages are availabe for public view
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Abstract
Liver diseases are commonly seen in the intensive care unit (ICU). Hepatic patients are admitted to ICU due to acute liver failure or advanced de-compensated, complicated chronic liver disease. Also, they can be admitted for post-operative care (e.g. Post-liver transplant)) or for non hepatic causes (e.g. acute myocardial infarction and polytrauma). Moreover, non hepatic patients may suffer from liver dysfunction during their stay in ICU (e.g. shock liver and post- traumatic liver failure).
Neural communication between the liver and the central nervous system is bidirectional, with afferent and efferent nerve fibers of both vagal parasympathetic and spinal sympathetic origin. In humans, branches of both vagus nerves and branches of splanchnic nerves innervate the liver. Two separate but intercommunicating plexuses are formed by the sympathetic and parasympathetic nerve fibers.
Hepatic patients may suffer from pain due to primary hepatic cause (eg. Amebic liver abscess), secondary hepatic cause (eg. Congested liver) or non hepatic reasons (eg. Acute myocardial infarction). Whatever the underlying etiology, pain relief is one of the human rights. Pain relief can be achieved by getting rid of its source (eg. Abscess drainage) and/ or symptomatic treatment. The latter can be achieved by drugs given by different techniques or by non pharmacological modalities (eg.acupuncture).
Epidural analgesia is one of the best methods for the provision of post operative pain relief in patients recovering from major upper abdominal operations; liver resection is used with increasing frequency for treating primary neoplasms of the liver, which are frequently related to liver cirrhosis. Paravertebral block is the technique of injecting local anesthetic solution alongside the vertebral column, close to the emergence of the spinal nerves, resulting in unilateral somatic and sympathetic nerve block. Neurolytic nerve block such as celiac ganglia block can be performed with better results to obtain pain relief in patients with upper abdominal malignancies. Optimal pain management also includes psychological and physical rehabilitation