Evaluation and Management of Cirrhotic Patients Undergoing Elective Surgery

Diaz, Kelly E.; Schiano, Thomas D.

doi:10.1007/s11894-019-0700-y

Cited by 11 publications

(5 citation statements)

References 105 publications

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“…An endoscopy is mandatory in identifying and, if necessary, treating esophageal or gastric varices. For patients presenting with ascites, paracentesis is performed to determine its cause as well as to exclude spontaneous bacterial peritonitis [42,43].…”

Section: Portal Hypertensionmentioning

confidence: 99%

Gut–Liver Axis Dysregulation in Portal Hypertension: Emerging Frontiers

Lombardi,

Troisi,

Motta

et al. 2024

Nutrients

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Portal hypertension (PH) is a complex clinical challenge with severe complications, including variceal bleeding, ascites, hepatic encephalopathy, and hepatorenal syndrome. The gut microbiota (GM) and its interconnectedness with human health have emerged as a captivating field of research. This review explores the intricate connections between the gut and the liver, aiming to elucidate how alterations in GM, intestinal barrier function, and gut-derived molecules impact the development and progression of PH. A systematic literature search, following PRISMA guidelines, identified 12 original articles that suggest a relationship between GM, the gut–liver axis, and PH. Mechanisms such as dysbiosis, bacterial translocation, altered microbial structure, and inflammation appear to orchestrate this relationship. One notable study highlights the pivotal role of the farnesoid X receptor axis in regulating the interplay between the gut and liver and proposes it as a promising therapeutic target. Fecal transplantation experiments further emphasize the pathogenic significance of the GM in modulating liver maladies, including PH. Recent advancements in metagenomics and metabolomics have expanded our understanding of the GM’s role in human ailments. The review suggests that addressing the unmet need of identifying gut–liver axis-related metabolic and molecular pathways holds potential for elucidating pathogenesis and directing novel therapeutic interventions.

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Section: Portal Hypertensionmentioning

confidence: 99%

Gut–Liver Axis Dysregulation in Portal Hypertension: Emerging Frontiers

Lombardi,

Troisi,

Motta

et al. 2024

Nutrients

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“…Level of evidence: B; Recommendation: Strong; Coincidence: 10/11. The risk of morbidity and mortality of elective surgeries in ACLD patients varies depending on the type of surgery [49]. Higher mortality risk has been observed in ACLD patients in different surgery types [50].…”

Section: Q5 How Can We Evaluate Hemostasis and Manage Coagulation Dis...mentioning

confidence: 99%

Clinical Guideline on Perioperative Management of Patients with Advanced Chronic Liver Disease

Canillas

Pelegrina

Álvarez

et al. 2023

Life

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(1) Background: Patients with advanced chronic liver disease (ACLD) are living longer with more comorbidities because of improved medical and surgical management. However, patients with ACLD are at increased risk of perioperative morbidity and mortality; (2) Methods: We conducted a comprehensive review of the literature to support a narrative clinical guideline about the assessment of mortality risk and management of perioperative morbidity in patients with ACLD undergoing surgical procedures; (3) Results: Slight data exist to guide the perioperative management of patients with ACLD, and most recommendations are based on case series and expert opinion. The severity of liver dysfunction, portal hypertension, cardiopulmonary and renal comorbidities, and complexity of surgery and type (elective versus emergent) are predictors of perioperative morbidity and mortality. Expert multidisciplinary teams are necessary to evaluate and manage ACLD before, during, and after surgical procedures; (4) Conclusions: This clinical practice document updates the available data and recommendations to optimize the management of patients with advanced chronic liver disease who undergo surgical procedures.

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“…Hlavní příčinou těchto komplikací je chronická jaterní léze, jejímž důsledkem je alterace jaterních funkcí (syntetické, metabolické, detoxikační i sekreční), a porucha perfuze jater při cirhotické přestavbě parenchymu a snížené systémové vaskulární rezistenci. Hypoperfuze je dále potencována účinkem anestetik, peroperačními změnami distribuce tělních tekutin a srdečního výdeje zhoršující dodávku kyslíku do tkání, a koagulopatií, která zvyšuje riziko nejen krvácení, ale i trombóz (7).…”

Section: úVodunclassified

Evaluation of surgical risk in patients with liver cirrhosis

Uchytilová¹,

Kieslichova²

2020

Vnitr Lek

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Klinika anesteziologie, resuscitace a intenzivní péče, Transplantcentrum IKEM Praha Prevalence jaterní cirhózy v populaci narůstá. Narůstá tudíž i počet pacientů s cirhózou, kteří přicházejí do nemocnice k elektivnímu operačnímu zákroku. Tito pacienti mají vyšší riziko pooperačních komplikací i vyšší pooperační mortalitu. Stanovení perioperačního rizika pacientů s cirhózou je složitý a komplexní proces. Zahrnuje zhodnocení celkového stavu pacienta, včetně závažnosti přidružených onemocnění a stavu nutrice, stupně závažnosti samotného jaterního onemocnění, a časové naléhavosti operačního zákroku. Jednoznačná doporučení neexistují. Správné stanovení rizika chirurgického zákroku předoperačně se zvážením alternativních způsobů léčby je klíčové pro optimalizaci pooperačního průběhu u pacientů s jaterní cirhózou a snížení pravděpodobnosti vzniku pooperačních komplikací.Klíčová slova: Child -Pugh skóre, jaterní cirhóza, MELD skóre, perioperační riziko. Evaluation of surgical risk in patients with liver cirrhosisThe prevalence of liver cirrhosis in population is increasing, as well as its prevalence among patients admitted to hospital for elective surgery. These patients are at risk of high postoperative morbidity and mortality. Perioperative risk assessment of patients with liver cirrhosis is a complex procedure. It consists of evaluation of general condition of the patient, including comorbidities and nutritional status, evaluation of the grade of liver disease, and urgency of the surgical procedure. There are no specific guidelines. Proper risk assessment before surgery, considering alternative ways of treatment, is a cornerstone of optimal postoperative course and prevention of complications in patients with liver cirrhosis.

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Evaluation and Management of Cirrhotic Patients Undergoing Elective Surgery

Cited by 11 publications

References 105 publications

Gut–Liver Axis Dysregulation in Portal Hypertension: Emerging Frontiers

Gut–Liver Axis Dysregulation in Portal Hypertension: Emerging Frontiers

Clinical Guideline on Perioperative Management of Patients with Advanced Chronic Liver Disease

Evaluation of surgical risk in patients with liver cirrhosis

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