Cirrhosis Cirrhosis is an irreversible liver lesion characterized histologically by parenchymal necrosis, nodular degeneration, fibrosis, and a disorganization of hepatic lobular architecture. The most serious complication of cirrhosis is portal venous hypertension, which ultimately leads to bleeding from esophageal varices, ascites, and hepatic encephalopathy. Conventional liver biochemical test results correlate poorly with the degree of liver impairment in patients with cirrhosis. Hepatic dysfunction, may be somewhat quantified by low albumin levels and prolonged prothrombin times.
Surgical risk is increased in patients with advanced liver disease, although it is substantially greater in emergency surgery than in elective surgery. Perioperative mortality correlates with the severity of cirrhosis and can be estimated through the use of the Child’s classification (Table 22.21). In patients with Child’s class A cirrhosis, surgery can usually be performed without significant risk, whereas in patients with Child’s class B or C, surgery poses a major risk and requires careful preoperative consideration. Preoperative preparation should include the following measures: (i) optimizing nutritional status by enteral and parenteral nutrition and supplementation with vitamin B1, (ii) correcting coagulopathy with administration of FFP or cryoprecipitate or both, (iii) minimizing preexisting encephalopathy, (iv) preventing sepsis from spontaneous bacterial peritonitis by administering prophylactic antibiotic therapy, and (v) optimizing renal function and carefully correcting electrolyte abnormalities (286). Meticulous preoperative preparation focused on correcting abnormalities associated with advanced liver disease may improve surgical outcomes (287).
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