Longnecker's Anesthesiology > Part 2. Preparing for Anesthesia > Section B. Preoperative Evaluation of the Anesthesia Patient > Chapter 14. Evaluation of Patients with Hepatic Disease Richard A. Wiklund, MD

Key Points

"1. The Child-Pugh scoring system accurately assesses the high risk of surgery for patients with liver disease. This system requires knowledge of the patient's nutrition, control of ascites, history of encephalopathy, international normalized ratio (INR), plasma bilirubin level, and plasma albumin level.

2. The leading causes of perioperative death or complications for patients with advanced liver disease include hemorrhage secondary to coagulopathy, elevated intracranial pressure secondary to encephalopathy, sepsis secondary to peritonitis or pneumonitis, an ascites fluid leak at the site of surgical incision, and acute renal failure secondary to hemodynamic instability or hepatorenal syndrome.

3. Serious but rare complications of chronic liver disease include the hepatorenal syndrome, the hepatopulmonary syndrome, and portopulmonary hypertension. These may resolve following liver transplantation.

4. Most forms of chronic liver disease lead to cirrhosis, a histologic diagnosis that is characterized by fibronodular hyperplasia leading to compression and obstruction of sinusoidal capillaries and bile canaliculi. These histologic findings account for the development of portal hypertension that is manifested by ascites, esophageal varices, and hypersplenism. In a few patients, portal hypertension also leads to the development of the hepatopulmonary syndrome and/or the hepatorenal syndrome.

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