Perioperative Care of Patients With Liver Cirrhosis: A Review

The incidence of cirrhosis is rising, and identification of these patients prior to undergoing any surgical procedure is crucial. The preoperative risk stratification using validated scores, such as Child-Turcotte-Pugh (CTP) and Model for End-Stage Liver Disease, perioperative optimization of hemody...

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Bibliographic Details
Published in:Health Services Insights 2017-01, Vol.2017 (10), p.1178632917691270-1178632917691270
Main Authors: Abbas, Naeem, Makker, Jasbir, Abbas, Hafsa, Balar, Bhavna
Format: Article
Language:English
Subjects:
Abdomen
Care and treatment
Edema
Electrolytes
Hypertension
Hypoglycemia
Laboratories
Liver cirrhosis
Liver diseases
Medical prognosis
Morbidity
Mortality
Patients
Peer review
Review
Sepsis
Surgery
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Summary:The incidence of cirrhosis is rising, and identification of these patients prior to undergoing any surgical procedure is crucial. The preoperative risk stratification using validated scores, such as Child-Turcotte-Pugh (CTP) and Model for End-Stage Liver Disease, perioperative optimization of hemodynamics and metabolic derangements, and postoperative monitoring to minimize the risk of hepatic decompensation and complications are essential components of medical management. The advanced stage of cirrhosis, emergency surgery, open surgeries, old age, and coexistence of medical comorbidities are main factors influencing the clinical outcome of these patients. Perioperative management of patients with cirrhosis warrants special attention to nutritional status, fluid and electrolyte balance, control of ascites, excluding preexisting infections, correction of coagulopathy and thrombocytopenia, and avoidance of nephrotoxic and hepatotoxic medications. Transjugular intrahepatic portosystemic shunt may improve the CTP class, and semielective surgeries may be feasible. Emergency surgery, whenever possible, should be avoided.
ISSN:1178-6329
1178-6329
DOI:10.1177/1178632917691270