Abstract
Several gastrointestinal problems occur with relative frequency in the perioperative orthopedic setting. Abnormal preoperative liver function studies are often not clinically significant, although various conditions, specifically cirrhosis, are important to define before surgery is performed; other gastrointestinal complications arise postoperatively. These may include nausea, vomiting, and more severe conditions such as abdominal ileus and Clostridium difficile colitis. Physicians involved in postoperative care need to be familiar with these conditions, the presentation of which may be subtle but may evolve producing severe morbidity. This chapter reviews the most common of the postoperative gastrointestinal problems, and the best strategies for avoiding and dealing with these perioperative complications are anticipation, prevention, and early therapy.
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Notes
- 1.
Numerous internet sites which allow calculation of the MELD scores are available.
References
Inannou GN, Boyko EJ, Lee SP. The prevalence and predictors of elevated serum aminotransferase activity in the United States in 1999–2002. Am J Gastroenterol. 2006;101(1):76–82.
O’Shea RS, Dasarathy S, McCullough AJ. Alcoholic liver disease. Hepatology. 2010;51(1):307–28.
Frye JW, Perri RE. Perioperative risk assessment for patients with cirrhosis and liver disease. Expert Rev Gastroenterol Hepatol. 2009;3(1):65–75.
Teh SH, Nagorney DM, Stevens SR, Offord KP, Therneau TM, Plevak DJ, et al. Risk factors for mortality after surgery in patients with cirrhosis. Gastroenterology. 2007;132:1261–9.
Costa BP, Sousa FC, Serodio M, Carvalho C. Value of MELD and MELD-based indices in surgical risk evaluation of cirrhotic patients: retrospective analysis of 190 cases. World J Surg. 2009;23:1594–8.
Farnsworth N, Fagan SP, Berger DH, Awad SS. Child-Turcotte-Pugh versus MELD score as a predictor of outcome after elective and emergent surgery in cirrhotic patients. Am J Surg. 2004;188:580–3.
Cohen SM, Te HS, Levitsky J. Operative risk of total hip and knee arthroplasty in cirrhotic patients. J Arthroplast. 2005;20:460–6.
Moon YW, Kim YS, Kwon SY, Kim SY, Lim SJ, Park YS. Perioperative risk of hip arthroplasty in patients with cirrhotic liver disease. J Korean Med Sci. 2007;22:223–6.
Cohen MM, Duncan PG, DeBoer DP, Tweed WA. The postoperative interview: assessing risk factors for nausea and vomiting. Anesth Analg. 1994;78:7–16.
Gan T, Sloan F, Dear Gde L, El-Moalem HE, Lubarsky DA. How much are patients willing to pay to avoid postoperative nausea and vomiting. Anesth Analg. 2001;92:393–400.
Fund D, Gan TJ. Gastrointestinal system: prevention and treatment of gastrointestinal morbidity. In: Newman MF, Fleisher LA, Fink MP, editors. Perioperative medicine: managing for outcome. Philadelphia: Saunders Elsevier; 2008. p. 383–96.
Apfer CC, Laara E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology. 1999;91:693–700.
Parvizi J, Han SB, Tarity TD, Pulido L, Weinstein M, Rothman RH. Postoperative ileus after total joint arthroplasty. J Arthroplast. 2008;23(3):360–5.
Sunders MD, Kimmey MB. Systematic review: acute colonic pseudo-obstruction. Aliment Pharmacol Ther. 2005;22(10):917–25.
McDonald LC, Gerding DN, Johnson S, et al. Open forum infectious diseases. Clin Infect Dis. 2018;66(7):987–94.
Rhee KY, Soave R, Maltz C. Methicillin-resistant Staphylococcus aureus as a cause of antibiotic-associated diarrhea. J Clin Gastroenterol. 2004;38(3):299–300.
Kulkarni K, Weine D, Maltz C. Klebsiella oxytoca and antibiotic-associated hemorrhagic colitis. Am J Gastroenterol. 2008;103:S226.
van Nood E, Vrieze A, Nieuwdorp M, Fuentes S, Zoetendal EG, de Vos WM, et al. Duodenal infusion of donor feces for recurrent Clostridium difficile. NEJM. 2013;368(5):407–15.
Cappell MS, Friedel D. Initial management of acute upper gastrointestinal bleeding: from initial evaluation up to gastrointestinal endoscopy. Med Clin North Am. 2008;92(3):491.
Lau JY, Leung WK, Wu JCY, Chan FKL. Omeprazole before endoscopy in patients with gastrointestinal bleeding. NEJM. 2007;356:1631–40.
Acknowledgement
Dr. Maltz would like to thank Dr. Melissa H. Rosen for her work on the first edition of this chapter.
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Maltz, C. (2020). Perioperative Care of the Orthopedic Patient with Gastrointestinal and Liver Issues. In: MacKenzie, C., Cornell, C., Memtsoudis, S. (eds) Perioperative Care of the Orthopedic Patient. Springer, Cham. https://doi.org/10.1007/978-3-030-35570-8_17
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