The Risk Of Surgery In Patients With Liver Disease 1: Epidemiology, Pathophysiology, And Pre-Operative Evaluation

2018 ◽  
Author(s):  
Adrian Reuben
Keyword(s):  
Blood Flow ◽  
Liver Disease ◽  
Liver Function ◽  
Large Scale ◽  
Venous Pressure ◽  
Liver Blood Flow ◽  
Disease Patient ◽  
Case Series ◽  
Kidney Injury ◽  
Operative Evaluation

The results of retrospective large scale registry and cohort studies, and small case series, substantiate the common perception that operating on a liver disease patient is risky.  The preexisting physiological derangements of liver disease may be exacerbated by the trauma of surgery and its complications, which contributes strongly to the aforementioned surgical risks, especially (but not exclusively) in cirrhotics.  Perturbations in liver blood flow and oxygenation may be exaggerated by anesthesia, surgery itself, blood loss, and other operative complications. Cirrhotics are especially susceptible to acute and chronic kidney injury.  Malnutrition is common in cirrhosis, which compromises wound healing and recovery from surgery. In cirrhosis, elimination of infection is impaired and its systemic effects are deleterious. The metabolic and immunological stresses of surgery may lead to liver function deterioration, even in stable cirrhotics. Presented here is the pre-operative evaluation of liver disease patients, including the use of predictive indices, new dynamic tests of liver function, and modestly invasive assessment of portal hypertension.  This review contains 9 figures, 6 tables and 52 references Keywords: acute-on-chronic liver failure, Child-Turcotte-Pugh, cirrhosis, coagulopathy, infection, hepatic venous pressure gradient, liver blood flow, model for end-stage liver disease, systemic inflammatory response syndrome, thrombocytopenia   

The Risk Of Surgery In Patients With Liver Disease 1: Epidemiology, Pathophysiology, And Pre-Operative Evaluation

2018 ◽  
Author(s):  
Adrian Reuben
Keyword(s):  
Blood Flow ◽  
Liver Disease ◽  
Liver Function ◽  
Large Scale ◽  
Venous Pressure ◽  
Liver Blood Flow ◽  
Disease Patient ◽  
Case Series ◽  
Kidney Injury ◽  
Operative Evaluation

The results of retrospective large scale registry and cohort studies, and small case series, substantiate the common perception that operating on a liver disease patient is risky.  The preexisting physiological derangements of liver disease may be exacerbated by the trauma of surgery and its complications, which contributes strongly to the aforementioned surgical risks, especially (but not exclusively) in cirrhotics.  Perturbations in liver blood flow and oxygenation may be exaggerated by anesthesia, surgery itself, blood loss, and other operative complications. Cirrhotics are especially susceptible to acute and chronic kidney injury.  Malnutrition is common in cirrhosis, which compromises wound healing and recovery from surgery. In cirrhosis, elimination of infection is impaired and its systemic effects are deleterious. The metabolic and immunological stresses of surgery may lead to liver function deterioration, even in stable cirrhotics. Presented here is the pre-operative evaluation of liver disease patients, including the use of predictive indices, new dynamic tests of liver function, and modestly invasive assessment of portal hypertension.  This review contains 9 figures, 6 tables and 52 references Keywords: acute-on-chronic liver failure, Child-Turcotte-Pugh, cirrhosis, coagulopathy, infection, hepatic venous pressure gradient, liver blood flow, model for end-stage liver disease, systemic inflammatory response syndrome, thrombocytopenia   

The Risk Of Surgery In Patients With Liver Disease 2

2018 ◽  
Author(s):  
Adrian Reuben
Keyword(s):  
Liver Disease ◽  
Fatty Liver ◽  
Venous Pressure ◽  
Portal Pressure ◽  
Disease Patient ◽  
Case Series ◽  
Meld Score ◽  
End Stage Liver Disease ◽  
Ctp Score ◽  
End Stage

The results of retrospective largescale registry and cohort studies and small case series, substantiate the common perception that operating on a liver disease patient is risky. The preexisting physiological derangements of liver disease may be exacerbated by the trauma of surgery and its complications, which contributes strongly to the aforementioned surgical risks, especially but not exclusively in cirrhotics. The risks of operating on patients with non-cirrhotic liver disease are reviewed with particular emphasis on the poor outcomes in acute hepatitis—especially alcoholic hepatitis—severe fatty liver disease, and obstructive jaundice. The outcomes of a broad spectrum of surgical procedures in cirrhotics (abdominal, cardiothoracic, orthopedic, vascular, etc.) are reviewed, with particular reference to common predictors of survival and morbidity, such as the Child-Turcotte-Pugh (CTP) score/class and the model for end-stage liver disease (MELD) score. The concept is proposed that the height of portal pressure may be a predictive factor of surgical outcome, which derives from experience with hepatic resection and suggests that measurement of hepatic venous pressures may be worthwhile in selected cases. New, non-invasive estimates of liver function are presented. A simple practical pre-operative decision tree is provided. This review contains 5 figures, 3 tables and 91 references Keywords: cirrhosis, fatty liver, hepatic venous pressure gradient, hepatitis, model for end-stage liver disease, operative mortality, portal hypertension, Child-Turcotte-Pugh  

The Risk Of Surgery In Patients With Liver Disease 2

2018 ◽  
Author(s):  
Adrian Reuben
Keyword(s):  
Liver Disease ◽  
Fatty Liver ◽  
Venous Pressure ◽  
Portal Pressure ◽  
Disease Patient ◽  
Case Series ◽  
Meld Score ◽  
End Stage Liver Disease ◽  
Ctp Score ◽  
End Stage

The results of retrospective largescale registry and cohort studies and small case series, substantiate the common perception that operating on a liver disease patient is risky. The preexisting physiological derangements of liver disease may be exacerbated by the trauma of surgery and its complications, which contributes strongly to the aforementioned surgical risks, especially but not exclusively in cirrhotics. The risks of operating on patients with non-cirrhotic liver disease are reviewed with particular emphasis on the poor outcomes in acute hepatitis—especially alcoholic hepatitis—severe fatty liver disease, and obstructive jaundice. The outcomes of a broad spectrum of surgical procedures in cirrhotics (abdominal, cardiothoracic, orthopedic, vascular, etc.) are reviewed, with particular reference to common predictors of survival and morbidity, such as the Child-Turcotte-Pugh (CTP) score/class and the model for end-stage liver disease (MELD) score. The concept is proposed that the height of portal pressure may be a predictive factor of surgical outcome, which derives from experience with hepatic resection and suggests that measurement of hepatic venous pressures may be worthwhile in selected cases. New, non-invasive estimates of liver function are presented. A simple practical pre-operative decision tree is provided. This review contains 5 figures, 3 tables and 91 references Keywords: cirrhosis, fatty liver, hepatic venous pressure gradient, hepatitis, model for end-stage liver disease, operative mortality, portal hypertension, Child-Turcotte-Pugh  

The Hepatorenal Syndrome

1997 ◽  
Vol 92 (5) ◽  
pp. 433-443 ◽  
Author(s):  
Kevin Moore
Keyword(s):  
Renal Failure ◽  
Blood Flow ◽  
Liver Disease ◽  
Renal Blood Flow ◽  
Hepatorenal Syndrome ◽  
Venous Pressure ◽  
Renal Perfusion ◽  
Filtration Fraction ◽  
Renal Vasoconstriction ◽  
Vasoactive Mediators

1. The hepatorenal syndrome is the development of renal failure in patients with severe liver disease in the absence of any identifiable renal pathology. 2. Decreased glomerular filtration is caused by a reduction in both renal blood flow and the renal filtration fraction. These changes arise as a consequence of a fall in mean arterial pressure due to systemic vasodilatation, activation of the sympathetic nervous system causing renal vasoconstriction, and increased synthesis of several vasoactive mediators, which together modulate both renal blood flow and the glomerular capillary ultrafiltration coefficient, and thence filtration fraction. 3. Patients with liver disease developing renal failure should have hypovolaemia excluded by volume challenge, and all nephrotoxic drugs including diuretics should be stopped. Broad-spectrum antibiotics should be given for subclinical infection, which may be a treatable precipitant of renal failure in cirrhosis. Renal perfusion should be optimized by ensuring that the blood pressure and systemic haemodynamics are adequate, and that if renal venous pressure is elevated, due to tense ascites, it is alleviated. 4. The prognosis of hepatorenal syndrome is poor with a >90% mortality. However, patients can and do recover from the hepatorenal syndrome, but only if there is a significant improvement of their liver function, or if they undergo liver transplantation.

Effect of Endoscopic Sclerotherapy of Esophageal Varices on Liver Blood Flow and Liver Function: An Experimental Study

1987 ◽  
Vol 22 (5) ◽  
pp. 619-626 ◽  
Author(s):  
L. S. Jensen ◽  
N. Krarup ◽  
J. Anker Larsen ◽  
C. Juhl ◽  
T. Harboe Nielsen ◽  
...  
Keyword(s):  
Experimental Study ◽  
Blood Flow ◽  
Liver Function ◽  
Esophageal Varices ◽  
Liver Blood Flow ◽  
Endoscopic Sclerotherapy

scholarly journals Liver injury in COVID-19: The current evidence

2020 ◽  
Vol 8 (5) ◽  
pp. 509-519 ◽  
Author(s):  
Saleh A Alqahtani ◽  
Jörn M Schattenberg
Keyword(s):  
Liver Disease ◽  
Liver Injury ◽  
Liver Function ◽  
Case Series ◽  
Current Evidence ◽  
Disease Course ◽  
Underlying Liver Disease ◽  
Hepatobiliary Complications ◽  
Novel Coronavirus ◽  
Work Up

Patients with novel coronavirus disease 2019 (COVID-19) experience various degrees of liver function abnormalities. Liver injury requires extensive work-up and continuous surveillance and can be multifactorial and heterogeneous in nature. In the context of COVID-19, clinicians will have to determine whether liver injury is related to an underlying liver disease, drugs used for the treatment of COVID-19, direct effect of the virus, or a complicated disease course. Recent studies proposed several theories on potential mechanisms of liver injury in these patients. This review summarizes current evidence related to hepatobiliary complications in COVID-19, provides an overview of the available case series and critically elucidates the proposed mechanisms and provides recommendations for clinicians.

Derecruitment in cat liver: extension of undistributed parallel tube model to effects of low hepatic blood flow on ethanol uptake

1989 ◽  
Vol 67 (10) ◽  
pp. 1225-1231 ◽  
Author(s):  
C. V. Greenway ◽  
L. Bass
Keyword(s):  
Blood Flow ◽  
Hepatic Blood Flow ◽  
Venous Pressure ◽  
Liver Blood Flow ◽  
Hepatic Uptake ◽  
Tube Model ◽  
Low Flows ◽  
Wide Range ◽  
Parallel Tube ◽  
Parallel Tube Model

Previous studies showed two deviations from the predictions of the undistributed parallel tube model for hepatic uptake of substrates: a small deviation at high flows and a large deviation at low flows. We have examined whether these deviations could be described by a single correction factor. In cats anesthetized with pentobarbital, a hepatic venous long-circuit technique with an extracorporeal reservoir was used to vary portal flow and hepatic venous pressure, and allow repeated sampling of arterial, portal, and hepatic venous blood without depletion of the cat's blood volume. Hepatic uptake of ethanol was measured over a wide range of blood flows and when intrahepatic pressure was increased at low flows. This uptake could be described by the parallel tube model with a correction for hepatic blood flow: [Formula: see text]. In 22 cats, [Formula: see text], k = 0.021 ± 0.0015 when flow (F) was in millilitres per minute per 100 g liver, and Km = 150 ± 20 μM when ĉ is the log mean sinusoidal concentration. (1 − e−kF) represents the proportion of sinusoids perfused and metabolically active. A dynamic interpretation of this proportion is related to intermittency (derecruitment) of sinusoidal flow. Half the sinusoids were perfused at a flow of 33 mL/(min∙100 g liver) and the liver was essentially completely perfused (> 95%) at the normal flow of 150 mL/(min∙100 g liver). Derecruitment was not changed by raising hepatic venous pressure, and it was not related to hepatic venous resistance.Key words: liver circulation, ethanol metabolism, liver blood flow, sinusoidal perfusion, portal pressure.

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