Perioperative Critical Care of the Patient with Liver Disease Undergoing Nonhepatic Surgery



Liver injury results from myriad insults including hepatotoxins and viral infections and congenital abnormalities. Individually or in combination these insults result in liver dysfunction which progresses to liver failure which causes multiple organ systems dysfunction and failure, which further impair liver function and result in death. The severity of liver dysfunction and risk of death calculations can be discerned by assessment of extrahepatic organ function. In addition to addressing individual and population benefit from liver transplantation, risk assessment by MELD can be used to address the risks of nonhepatic surgery. Furthermore, mitigation of liver injury and extrahepatic organ system dysfunction can prolong survival. In particular, attention to hemodynamics to optimize hepatic and renal perfusion and avoiding iatrogenic (ventilator-induced) lung injury and minimizing neuro-intoxicants are key to managing the patient with liver disease who is to undergo nonhepatic surgery.


Liver failure Cirrhosis Surgery (nonhepatic) Hepatic encephalopathy Acuity scoring (APACHE, acute physiology and chronic health evaluation; MELD, model for end-stage liver disease) Lung injury (ALI; ARDS, acute respiratory distress syndrome) Acute kidney injury (AKI; ATN, acute tubular necrosis) Portal hypertension 


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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Aurora Critical Care ServiceAurora Health CareMilwaukeeUSA
  2. 2.University of Wisconsin School of Medicine and Public HealthMadisonUSA

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