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Asociación Mexicana de Gastroenterología

2006, Number 2

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Rev Gastroenterol Mex 2006; 71 (2)

Riesgo quirúrgico en el paciente con hepatopatía

Zea MMV, González HMS, Mondragón SR

Language: Spanish
References: 25
Page: 183-191
PDF size: 75.50 Kb.


ABSTRACT

The present review focuses on published information regarding the preoperative assesment of the patient with liver disease. Data reviewed includes the different clinical scenarios, namely acute liver disease, chronic liver disease and predominance of hepatocellular versus cholestatic disease. We enhace the additional risk in presence of portal hypertension. Potential co morbidities associated are also disscused, as the care of a hyperdinamic satate; renal, pulmonary, endocrine and coagulation disorders. The relevance of different prognostic scales on morbidity and mortality are discussed and the currently place of traditional Child-Pugh classification, shortly we analyze the available data regarding MELD scale on the liver diseased patiengt who is going the operating room. We analyze the risk stratifiction on base of type of surgery, hemodynamic alterations secondary to anesthestic evengt and drug metabolism. Lastly we suggest a series of specific recommendations regarding each clinical situation to obtain an opitamal state before the surgery, to get the best possible outcome.


REFERENCES

  1. Friedman LS. The risk of surgery in patients with liver disease. Hepatology 1999; 29: 1617-23.

  2. Wiklund RA. Preoperative preparation of patients with advanced liver disease. Crit Care Med 2004; 32(4) (Suppl.): S104-S115.

  3. Rizvon MK. Surgery in the patient with liver disease. Med Clin North Am 2003; 87(1): 211-27.

  4. Schemel WH. Unexpected hepatic dysfunction found by multiple laboratory screening. Anesth Analg 1976; 55: 810-12.

  5. Friedman LS. Assessing surgical risk in patients with liver disease. Update in gastroenterology and hepatology; October 2002.

  6. Golson ChF, Provenza M, Bacon B. Hepatologic considerations in patients with parenchymal liver disease undegoing surgery. Am J Gastro 1990; 85: 487-95.

  7. Sheneider PD. Preoperative assessment of liver function. Surg Clin North Am 2004; 84(2): 355-73.

  8. Redai I, Emond J, et al. Anesthetics considerations during liver. Surg Clin North Am 2004; 84(2): 1-10.

  9. Child CG, Turcotte JG. Surgery and portal hypertension. In: The Liver and portal hypertension. Vol.1. Child CG (ed.). Philadelphia: Saunders; 1964, p. 1-84.

  10. Pugh R, Murray LI. Transection of the oesophagus in bleeding esophageal varices. Br J Surg 1973; 60: 646-52.

  11. Zimmerman JE, Wagner DP, et al. Intensive care unit admission with cirrhosis. Risk-stratifying patient groups and predicting individual survival. Hepatology 1996; 23: 1393-401.

  12. Angermaryr B, Cejna M, Karnel F, et al. Child-Pugh versus MELD score in predicting survival in patients undergoing transjugular intrahepatic portosystemic shunt. Liver 2003; 52(6): 879-85.

  13. Wiesner RH. Evidence-based evolution of the MELD-PELD liver allocation policy. Liver Transpl 2005; 11(3): 261-3.

  14. Mitchell C. Preoperative evaluation of the patient with liver disease. Mount Sinai J Med 1991; 58(1): 75-9.

  15. Ziser A, Plevak DJ, Wiesner RH, et al. Morbidity and mortality in cirrhotic patients undergoing anesthesia and surgery. Anesthesiology 1999; 90(1); 1-15.

  16. Friedman LS. The risk of surgery in patients with liver disease. Hepatology 1999; 29: 1617-23.

  17. Botta F, et al. MELD scoring system is useful for predicting prognosis in patient with liver cirrhosis and is correlated with residual liver function: a European study. Gut 2003; 52: 134-9.

  18. Grawith JW, Gouman DJ, Soeters PB, Buurman WA. Suppression of cellular immunity in obstructive jaundice is caused by endotoxins: a study germ-free rats. Gastroenterology 1990; 98: 478-85.

  19. Grade L, Garcia V, Fuster JC, et al. Obstructive joundice and wound healing. Br J Surg 1990; 77: 440-2.

  20. Dixon JM, Armstrong CP, Duffy SW, et al. Factors affecting morbidity and mortality after surgery for obstructive jaundice. A review of 373 patients. Gut 1983; 24(9): 845-52.

  21. Blamey SL, Feraon KC, Gilmour WH. Prediction of risk in biliary surgery. Br J Surg 1983; 70(9): 535-8.

  22. Greenwood SM, Leffler CT, Minkowitz S. The increased mortality rate of open liver biopsy in alcoholic hepatitis. Surg Gynecol Obstet 1972; 134: 600-4.

  23. Giller S, Berliner S, et al. Surgery in patients with hepatitis. Med Intern 1981; 19: 211-15.

  24. Richard A. Wiklund. Preoperative preparation of patient with advanced liver disease. Crit Care Med 2004; 32(4): 15-32.

  25. Garrison RN. Clarification of risk factors for abdominal operations in patients with hepatic cirrhosis. Ann Surg 1984; 84: 648-55.




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