The patient PATHWAY

liver emergency


You have a liver emergency

Liver emergencies are critical situations requiring immediate and coordinated care. At the Pitié-Salpêtrière Liver Institute, a specific pathway is in place to ensure a rapid and tailored response for each patient.

1- Arrival at the emergency room or directly in the intensive care unit

The patient arrives:

  • Either by his own means or via a treating physician and is admitted to the Emergency Reception Service (ERES).
  • Either in a critical situation by the SAMU, which directs him directly to an appropriate critical care unit.

2- Orientation to critical care

Upon arrival, a rapid assessment is performed to determine the severity of the patient's condition. Depending on the severity of the liver emergency, the patient is referred to:


  • Intensive care, if his condition requires close monitoring but remains stable.
  • The intensive care unit, in the event of life-threatening organ failure.

3- Immediate multidisciplinary support

Within minutes, a specialized team gathers around the patient. This team includes:



  • Resuscitators and anesthetists (management of organ failure and vital stabilization)
  • Hepatologists (liver disease specialists)
  • Liver surgeons (in case of urgent intervention)
  • Interventional radiologists (to perform imaging-guided examinations and therapeutic procedures)


The goal is to establish an accurate diagnosis and an appropriate therapeutic strategy as quickly as possible.

4- Stabilization and specific treatments

In the most severe cases, immediate care includes:


  • Organ resuscitation: maintenance of blood pressure, respiration, renal function and correction of hemostasis disorders.
  • Airway protection: intubation in severe hepatic coma.
  • Targeted treatments according to the cause of the emergency:
  • Ascites puncture to relieve fluid buildup in the abdomen.
  • Oesophagogastroduodenal fibroscopy to detect and treat digestive hemorrhage.
  • TIPS (Transjugular Intrahepatic Portosystemic Shunt) in cases of digestive hemorrhage refractory to treatment by fibroscopy.
  • Emergency blood transfusion in case of bleeding.
  • Antibiotic therapy in case of associated infection.
  • Extra-renal purification (dialysis) in cases of severe renal failure.

5 - Discussion on liver transplantation

In the most critical situations, if the liver is in irreversible failure, liver transplantation may be considered in very specific and precise cases. The multidisciplinary team then meets in a collegiate meeting to:

  • Assess the indication for liver transplantation
  • Patient eligibility for the liver transplant project
  • Initiate the process of emergency registration on the transplant list.
  • Provide ongoing support while waiting for a transplant.