Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0023890 (cirrhosis)
 42,195 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Surgery is performed in patients with liver disease more frequently now than in the past, in part because of the long-term survival of patients with cirrhosis. Recent work has focused on estimating perioperative risk in patients with liver disease. Hemodynamic instability in the perioperative period can worsen liver function in patients with liver disease. Operative risk correlates with the severity of the underlying liver disease and the nature of the surgical procedure. Thorough preoperative evaluation is necessary prior to elective surgery. Surgery is contraindicated in patients with certain conditions, such as acute hepatitis, acute liver failure, and alcoholic hepatitis. Estimation of perioperative mortality is inexact because of the retrospective nature of and biased patient selection in available clinical studies. The Child-Pugh classification (Child-Turcotte-Pugh score) and particulary the Model for End-Stage Liver Disease (MELD) score provide reasonable estimations of perioperative mortality but do not replace the need for careful preoperative preparation and postoperative monitoring, as early detection of complications is essential for improving outcomes. Medical therapy for specific manifestations of hepatic disease, including ascites, encephalopathy, and renal dysfunction, should be optimized preoperatively or, if necessary, administered in the postoperative period.
 ...
PMID:Surgery in the patient with liver disease. 2069 61

Liver cirrhosis is a major risk factor in patients requiring cardiac surgery. Although current evidence is limited to reports coming mostly from small case series, it is clear that the surgical risk increases with the severity of the liver disease. Hemodynamic instability caused by hyperdynamic circulation, systemic fluid retention, infection, and bleeding is frequently observed postoperatively in severely cirrhotic patients. Preoperative optimization, including correction of coagulopathy and poor nutrition, is therefore crucial for minimizing the predictive postoperative complications in those patients. Postoperative management should focus on bleeding and infection control, body fluid management, adequate nutrition, and hemodynamics, particularly hepatic circulation. Multiple studies have shown that patients who are diagnosed as Child-Pugh class B or C liver cirrhosis have a high surgical mortality rate, with most reports suggesting class C as inoperable. Recently, the model for end-stage liver disease( MELD) score has been gaining attention for its reliability in identifying patients at high risk for open heart surgery. Off-pump surgery may be beneficial in improving the surgical outcomes, but the evidence is weak and further studies are required. A thorough preoperative evaluation is thus mandatory in cirrhotic patients scheduled for cardiac surgery, with a particular attention to the risks and benefits of performing the surgery itself.
 ...
PMID:[Cardiac Surgery for Patients with Liver Cirrhosis]. 3313 Jul 63