Summary

In study session VIII you have learnt

• Acute hepatitis is a disease that causes inflammation of the liver. It is usually the result of viral infection, a drug reaction, or exposure to a hepatotoxin. Viral hepatitis is most commonly due to hepatitis A, hepatitis B, or hepatitis C viruses. Drug-induced hepatitis can result from direct dose-dependent toxicity of a drug.
• Patients with acute hepatitis should have any elective surgery postponed until the acute hepatitis has resolved, as indicated by normalization of liver tests. Patients with hepatitis are at risk for deterioration of hepatic function and the development of complications from hepatic failure, such as encephalopathy, coagulopathy, or hepato-renal syndrome.
• Inhalation anesthetics are generally preferable to intravenous agents because most of intravenous drugs are dependent on the liver for metabolism or elimination.
• Chronic hepatitis is defined as persistent hepatic inflammation for longer than 6 months, as evidenced by elevated serum transaminases. Chronic liver disease involves a disease process of progressive destruction and regeneration of the liver parenchyma leading to fibrosis and cirrhosis
• Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by fibrosis, scar tissue and regenerative nodules/lumps. It is a serious and progressive disease that eventually results in hepatic failure. It is generally associated with the development of three major complications: variceal hemorrhage from portal hypertension, intractable fluid retention in the form of ascites and the hepatorenal syndrome, and hepatic encephalopathy or coma.
• Pre anesthetic assessment, considering multi organ physiologic change secondary to liver disease and preparation must be performed before anesthesia and surgery.
• Most major operations in patients with significant liver diseases involve the use of general anesthesia. Regional techniques can be considered in selected patients with acceptable coagulation.
• Preoperative nausea, vomiting, upper gastrointestinal bleeding, and abdominal distention due to massive ascites require a well-planned, methodical anesthetic induction. Preoxygenation and a rapid-sequence induction with cricoid pressure are most often performed.
• For unstable patients and those with active bleeding, either an awake intubation or a rapid-sequence induction with cricoid pressure using Ketamine (or etomidate, thiopentone in reduced dose) and succinylcholine may have a prolonged duration of action due to reduced pseudo cholinesterase concentrations slowing its metabolism is best advised. Cisatracurium and atracurium can be used for maintenance. The dose of other long acting muscle relaxants should be reduced if used.
• The biliary obstruction may be due to a gallstone, stricture, or tumor in the common hepatic duct. Patients with complete or near-complete obstruction present with progressive jaundice, a dark urine with pale stools, and pruritus.
• If biliary obstruction is complicated with cirrhosis and other hepatic manifestation considers all anesthetic management for liver disease otherwise routine anesthesia care will be sufficient