Gastrointestinal & Hepatic Critical Care
Acute liver failure, severe pancreatitis, upper/lower GI bleeding, and abdominal compartment syndrome.
Core Topics
11 topicsAcute Liver Failure (ALF)
Hyperammonemia, cytotoxic cerebral edema, balanced coagulopathy, N-acetylcysteine, 3% saline neuroprotection, CRRT ammonia clearance, and King's College transplant criteria.
Severe Acute Pancreatitis
Revised Atlanta severity staging, goal-directed fluid resuscitation informed by WATERFALL, oral/enteral nutrition as tolerated, antibiotic avoidance in sterile necrosis, and the PANTER step-up approach.
Upper Gastrointestinal Bleeding (UGIB)
Risk-stratified non-variceal and variceal hemorrhage care: resuscitation, selective airway protection, individualized transfusion, PPI or portal-pressure therapy, endoscopic hemostasis, and escalation to IR/TIPS/surgery when indicated.
Lower Gastrointestinal Bleeding (LGIB)
Risk stratification, selective assessment for an upper source, CTA localization of ongoing severe bleeding, endoscopic or catheter therapy, and individualized transfusion/resuscitation.
Acute Mesenteric Ischemia (AMI)
Rapid biphasic CTA diagnosis, mechanism-specific revascularization (embolism vs thrombosis vs venous thrombosis vs NOMI), individualized therapeutic anticoagulation, and selective second-look laparotomy.
Critical Illness Nutrition & Metabolism
Phased energy and protein delivery, early enteral nutrition when safe, indirect calorimetry, refeeding prevention, feeding-intolerance troubleshooting, and individualized parenteral nutrition timing.
Decompensated Cirrhosis & ACLF
Recognition and organ-support of decompensated cirrhosis and acute-on-chronic liver failure, including bleeding, infection, encephalopathy and transplant triage
Hepatorenal Syndrome–AKI
Diagnosis and ICU management of HRS-AKI with albumin, vasoconstrictors, respiratory-safety monitoring, RRT and transplant planning
Acute Cholangitis & Biliary Sepsis
Recognition, antibiotics, resuscitation and urgent biliary source control for severe cholangitis and septic shock
Intra-abdominal Sepsis & Source Control
ICU approach to perforation, abscess, postoperative leak, ischemic bowel and complicated intra-abdominal infection
Liver Transplantation in the ICU
Immediate and subsequent ICU care after liver transplantation: donor type and ischemia exposure, hemodynamics, graft dysfunction, vascular/biliary complications, rejection, infection, AKI, neurotoxicity and immunosuppression
Clinical Problems & Bedside Triage
12 guidesAcute Severe Respiratory Distress
Bedside management of the gasping, tachypneic patient: work-of-breathing assessment, accessory muscle use, P-SILI prevention, and timely intubation vs noninvasive support.
Refractory Shock Despite High-Dose Vasopressors
Advanced multimodal hemodynamic rescue: second-line vasopressors (vasopressin, angiotensin II), inotropic augmentation, stress-dose steroids, metabolic correction, and mechanical circulatory support evaluation.
Acute Altered Mental Status & ICU Delirium
Systematic neurologic evaluation: immediate metabolic/toxic screening (glucose, hypoxia, hypercapnia), nonconvulsive status epilepticus exclusion, structural CT triage, and CAM-ICU delirium management.
Oliguria & Falling Urine Output
Algorithmic triage of acute oliguria (< 0.5 mL/kg/hr): urinary catheter patency check, volume responsiveness vs congestive nephropathy (VExUS Doppler), nephrotoxic drug review, and the furosemide stress test.
Acute Bleeding & Falling Hemoglobin
Bedside triage of acute blood loss: active hemorrhage vs occult bleeding vs hemodilution, context-specific RBC thresholds, protocolized massive-hemorrhage resuscitation, targeted component therapy, and anticoagulant reversal.
Critically Ill Pregnant or Postpartum Patient
Maternal-first stabilization with rapid differentiation of hypertensive, hemorrhagic, thromboembolic, septic, hepatic and cardiac obstetric emergencies.
Decompensated Cirrhosis & ACLF — Bedside Problem
Recognition and organ-support of decompensated cirrhosis and acute-on-chronic liver failure, including bleeding, infection, encephalopathy and transplant triage
Cirrhosis with Progressive AKI / Suspected HRS-AKI
Exclude reversible/structural causes, treat precipitating infection or volume loss, then use albumin plus an appropriate vasoconstrictor while monitoring respiratory safety and transplant candidacy.
Acute Cholangitis & Biliary Sepsis — Bedside Problem
Recognition, antibiotics, resuscitation and urgent biliary source control for severe cholangitis and septic shock
Intra-abdominal Sepsis & Source Control — Bedside Problem
ICU approach to perforation, abscess, postoperative leak, ischemic bowel and complicated intra-abdominal infection
Acute Liver Failure with Encephalopathy & Coagulopathy
Acute hepatic injury with impaired synthetic function and encephalopathy requiring immediate etiologic treatment, cerebral-edema prevention and early transplant-center involvement.
Life-Threatening Upper GI Bleeding
Airway-aware resuscitation, variceal vs nonvariceal phenotype, urgent endoscopic hemostasis, and escalation to IR/TIPS/surgery when bleeding remains uncontrolled.
Clinical Reasoning Cases
5 casesTriple Mixed Acid-Base Disorder in Sepsis & Cirrhosis
High-anion-gap metabolic acidosis with concurrent respiratory and metabolic alkalosis
Fulminant Clostridioides difficile Infection
Antimicrobial therapy, ileus management, early surgery, and selected microbiota rescue
Acute Variceal Hemorrhage
Airway/resuscitation, vasoactive therapy, antibiotics, endoscopic hemostasis, and early TIPS selection
Acetaminophen-Associated Acute Liver Failure
Late NAC, early transplant evaluation, hyperammonemia, and cerebral-edema prevention
Acute Liver Failure with Cerebral-Edema Risk
Hyperammonemia, osmotherapy, CRRT, and neuroprotection during transplant evaluation