Abstract
SummaryAn increasing number of patients present for liver surgery. Given the complex pathophysiological changes in chronic liver disease (CLD), it is pivotal to understand the fundamentals of chronic and acute liver failure. This review will give an overview on related organ dysfunction as well as recommendations for perioperative management and treatment of liver failure-related symptoms.
Highlights
The liver is the biggest intestinal organ and plays a central role in the homeostasis of different physiological systems including nutrition and drug metabolism, the synthesis of plasma proteins and haemostatic factors, as well as the elimination of different endogenous and exogenous substances [1]
Some data indicate that the reason might be the combination of increased cardiac output (CO) and splanchnic vasodilatation leading to a decrease of renal perfusion and glomerular filtration rate (GFR) [11,12,13]
In case of exacerbations of a known chronic liver dysfunction (CLD) combined with any other liver disease-associated organ failure, elective liver surgery should be postponed [37]
Summary
The liver is the biggest intestinal organ and plays a central role in the homeostasis of different physiological systems including nutrition and drug metabolism, the synthesis of plasma proteins and haemostatic factors, as well as the elimination of different endogenous and exogenous substances [1]. Eschertzhuber Department of Anaesthesia and Intensive Care, General Hospital Hall in Tirol, Hall in Tirol, Austria flow is mainly dependent on the organ’s metabolic demands and controlled via autoregulatory mechanisms, whereas blood supply through the portal vein depends on the perfusion throughout the whole gastrointestinal tract and the spleen [2] This unique, dual perfusion system provides constant perfusion rates and oxygen supply, which is crucial for adequate liver function. Elevated CO and heart rate, decreased systemic vascular resistance (SVR) and low mean arterial blood pressure (MAP) are the consequences [9] This endothelial dysfunction is of major importance regarding the prediction of adverse early hepatic events as well as mortality in CLD and liver cirrhosis [5]. In the absence of other cardiac diseases, echocardiographic findings of diastolic dysfunction and E/e’ ratio might be of diagnostic help [10]
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