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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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Autores principales: Abbas, Naeem, Makker, Jasbir, Abbas, Hafsa, Balar, Bhavna
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5398291/
https://www.ncbi.nlm.nih.gov/pubmed/28469455
http://dx.doi.org/10.1177/1178632917691270
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author Abbas, Naeem
Makker, Jasbir
Abbas, Hafsa
Balar, Bhavna
author_facet Abbas, Naeem
Makker, Jasbir
Abbas, Hafsa
Balar, Bhavna
author_sort Abbas, Naeem
collection PubMed
description 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.
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spelling pubmed-53982912017-05-03 Perioperative Care of Patients With Liver Cirrhosis: A Review Abbas, Naeem Makker, Jasbir Abbas, Hafsa Balar, Bhavna Health Serv Insights 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 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. SAGE Publications 2017-02-24 /pmc/articles/PMC5398291/ /pubmed/28469455 http://dx.doi.org/10.1177/1178632917691270 Text en © The Author(s) 2017 http://creativecommons.org/licenses/by-nc/3.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 3.0 License (http://www.creativecommons.org/licenses/by-nc/3.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page(https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Review
Abbas, Naeem
Makker, Jasbir
Abbas, Hafsa
Balar, Bhavna
Perioperative Care of Patients With Liver Cirrhosis: A Review
title Perioperative Care of Patients With Liver Cirrhosis: A Review
title_full Perioperative Care of Patients With Liver Cirrhosis: A Review
title_fullStr Perioperative Care of Patients With Liver Cirrhosis: A Review
title_full_unstemmed Perioperative Care of Patients With Liver Cirrhosis: A Review
title_short Perioperative Care of Patients With Liver Cirrhosis: A Review
title_sort perioperative care of patients with liver cirrhosis: a review
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5398291/
https://www.ncbi.nlm.nih.gov/pubmed/28469455
http://dx.doi.org/10.1177/1178632917691270
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