Tenuous

The patients on hepatology are incredibly tenuous, especially those who are pre-transplant with end stage liver disease. It really reminds me how central the liver is in so many organ systems; dysfunction can lead to renal failure, gastrointestinal bleeding, susceptibility to infections, confusion, hypotension, and other adverse consequences. One small thing can tip a patient from stability to instability. I became acutely aware of this when one of my patients with end-stage liver disease had a small bowel obstruction and became dehydrated. This may have been enough to send him into hepato-renal syndrome and make him dialysis dependent. Many of my patients are at high risk of going to the ICU if they pick up even a minor infection or have a mild setback in their course. Even though hepatology is a floor service, it's a high-risk population whose disease states make patients so vulnerable to everything.