The patient with cirrhosis who presents for non-hepatic surgery

Abstract

There is significant risk involved in subjecting patients with liver cirrhosis to surgery. Advanced liver disease is associated with systemic dysfunction affecting the cardiovascular, respiratory, renal, gastrointestinal, immunological, haematological, coagulation, endocrine and central nervous systems. Perioperative risk stratification can be very challenging. This is aggravated by the fact that cirrhosis is often indolent and asymptomatic until patients present with complications of the disease. The word ‘cirrhosis’ is derived from the Greek word kirrhos, meaning tawny, with reference to the tawny yellow hepatic nodules associated with this entity. This phrase was coined in 1819 by Rene Laënnec, famous for his invention of the stethoscope.¹ Cirrhosis is defined histologically as a diffuse process in which the normal anatomical lobules are replaced by architecturally abnormal nodules separated by fibrous tissue.²