PT - JOURNAL ARTICLE AU - Paul Martin TI - Perioperative considerations for patients with liver disease AID - 10.3949/ccjm.76.s4.15 DP - 2009 Nov 01 TA - Cleveland Clinic Journal of Medicine PG - S93--S97 VI - 76 IP - 10 suppl 4 4099 - http://www.ccjm.org/content/76/10_suppl_4/S93.short 4100 - http://www.ccjm.org/content/76/10_suppl_4/S93.full SO - Cleve Clin J Med2009 Nov 01; 76 AB - In surgical patients with underlying chronic liver disease, surgical outcomes correlate with hepatocellular function. The risk of surgery in such patients should be assessed preoperatively using the Child-Pugh or Model for End-Stage Liver Disease (MELD) severity scoring systems. Patients with severe liver disease (eg, Child-Pugh class C) should not undergo any elective surgery and should be evaluated for liver transplantation. In patients who can proceed with surgery, coagulopathy should be corrected preoperatively and careful fluid management is required intraoperatively to avoid hypotension. Renal insufficiency (as evidenced by elevated creatinine) may indicate that hepatorenal syndrome has developed and carries a poor prognosis.