[Pre-operative care for liver disease patients].

Abstract

Patients with impaired hepatic functional reserve when submitted to surgeries may have high rates of morbidity and mortality. Pre-existing liver disease should be detected without need for invasive methods. Clinical history and physical examination provide important clues. Laboratory liver function is not necessary unless there are changes in history or physical examination. Liver disease has many effects on surgery and anesthesia. A decrease in oxygenation and increased risk of liver dysfunction can be caused by anesthesia, hemorrhage, hypoxemia, hypotension, vasoactive drugs or the patient's position on the operating table during and after surgery. Emergency surgery is a major predictor of poor prognosis as well as sepsis and reoperations. The nature of liver disease, severity and type of surgery to be performed should take into account for a correct preoperative preparation. Some actions must be taken at preoperative to decrease chances of complications in patients with liver disease undergoing surgical procedures. Very close attention should be given to coagulopathy, encephalopathy, ascites, renal and pulmonary dysfunction, spontaneous bacterial peritonitis and esophageal varices. Patients with Child-Pugh score C and MELD>15 should not undergo elective surgery. Patients with Child-Pugh score B and MELD 10 to 15 may undergo minor surgical procedures with care in cases of extreme necessity. Patients with Child-Pugh score A and MELD<10 may be submitted to elective surgery.

• Authors: Fabio Colagrossi Paes Barbosa, Fabio Gonçalves Ferreira, Mauricio Alves Ribeiro, Luiz Arnaldo Szutan
• Journal: Revista da Associacao Medica Brasileira (1992) (Rev Assoc Med Bras (1992)) 2010 Mar-Apr Vol. 56 Issue 2 Pg. 222-6 ISSN: 0104-4230 [Print] Brazil
• Vernacular Title: Cuidados pré-operatórios em hepatopatas.
• PMID: 20498999 (Publication Type: English Abstract, Journal Article, Review)

Topics

• Elective Surgical Procedures
• Emergency Medical Services
• Humans
• Liver Diseases (complications, diagnosis)
• Postoperative Complications (prevention & control)
• Preoperative Care (methods)
• Severity of Illness Index
• Surgical Procedures, Operative (adverse effects, methods)