Cirrhosis and the surgical patient

Q2 Nursing Perioperative Care and Operating Room Management Pub Date : 2023-09-02 DOI:10.1016/j.pcorm.2023.100348

Emily J. Grossniklaus , Jeffrey W. Redinger , Kay M. Johnson

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Abstract

Cirrhosis can be challenging to recognize and manage in the perioperative setting. The Fibrosis 4 (FIB-4) score is a screening test that can help determine the likelihood of underlying advanced fibrosis or cirrhosis in patients with chronic liver disease. Liver stiffness correlates with severity of fibrosis and cirrhosis and can be measured noninvasively with transient elastography or MR elastography; a normal liver stiffness effectively rules out cirrhosis. Perioperative risk calculators include the Child-Turcotte-Pugh Score, the Mayo Risk Score, the Veterans Outcomes and Costs Associated with Liver Disease-Penn (VOCAL-Penn) score; each has its limitations. In addition to reviewing the above tools, we will briefly discuss common perioperative dilemmas in patients with cirrhosis, including selection of patients for umbilical hernia repair or bariatric surgery, and will highlight methods to optimize patients with cirrhosis prior to surgical interventions.

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肝硬化与外科病人

在围手术期，肝硬化的识别和处理具有挑战性。纤维化4（FIB-4）评分是一种筛查测试，有助于确定慢性肝病患者是否存在潜在的晚期纤维化或肝硬化。肝脏硬度与肝纤维化和肝硬化的严重程度相关，可通过瞬时弹性成像或磁共振弹性成像进行无创测量；肝脏硬度正常可有效排除肝硬化。围手术期风险计算器包括Child-Turcotte-Pugh评分、梅奥风险评分、退伍军人肝病相关结果和费用-佩恩（VOCAL-Penn）评分；每种计算器都有其局限性。除了回顾上述工具外，我们还将简要讨论肝硬化患者围手术期的常见困境，包括选择患者进行脐疝修补术或减肥手术，并将强调在手术干预前优化肝硬化患者的方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Perioperative Care and Operating Room Management Nursing-Medical and Surgical Nursing

CiteScore

1.30

自引率

0.00%

发文量

审稿时长

56 days

期刊介绍： The objective of this new online journal is to serve as a multidisciplinary, peer-reviewed source of information related to the administrative, economic, operational, safety, and quality aspects of the ambulatory and in-patient operating room and interventional procedural processes. The journal will provide high-quality information and research findings on operational and system-based approaches to ensure safe, coordinated, and high-value periprocedural care. With the current focus on value in health care it is essential that there is a venue for researchers to publish articles on quality improvement process initiatives, process flow modeling, information management, efficient design, cost improvement, use of novel technologies, and management.