Journal of Hepatology and Gastrointestinal disorders
Open Access
ISSN: 2475-3181
ISSN: 2475-3181
Adrian Reuben
Medical University of South Carolina, USA
Posters & Accepted Abstracts: J Hepatol Gastroint Dis
The results of retrospective large scale registry and cohort studies and small case series, substantiate the common perception that it is risky to operate on a patient with liver disease The preexisting physiological derangements of liver disease may be exacerbated by the trauma of surgery and its complications, which contributes strongly to the aforementioned surgical risks, especially, but not exclusively in cirrhotics. Perturbations in liver blood flow and oxygenation may be exaggerated by anesthesia, surgery itself, blood loss, and other operative complications. Cirrhotics are especially susceptible to acute and chronic kidney injury. Malnutrition is common in cirrhosis and compromises wound healing and recovery from surgery. In cirrhosis, elimination of infection is impaired and its systemic effects are deleterious. The metabolic and immunological stresses of surgery may lead to deterioration of liver function, even in stable cirrhotics. Presented here is the pre-operative evaluation of liver disease patients, including the use of predictive indices, new dynamic tests of liver function, and the modestly invasive assessment of portal hypertension. The outcomes of a broad spectrum of surgical procedures are reviewed, with particular reference to common predictors, i.e., the Child-Turcotte-Pugh (CTP) score/class and the Model for End-Stage Liver Disease (MELD) score and a simple practical pre-operative decision tree is provided.
E-mail: reubena@musc.edu