Perioperative Management and Nutritional Support in Patients With Liver and Biliary Tract Disease

Even the most straightforward surgical procedure can become exceptionally challenging when performed on a patient with an underlying hepatobiliary disorder. Hepatic dysfunction, as manifest by portal hypertension, synthetic impairment, and cholestasis may be present to varying degrees, and can have a profound influence on the physiology of other organ systems. Depending on the severity of the underlying dysfunction and the nature of the operation, even seemingly minor procedures can precipitate a cascade of events resulting in hemodynamic instability, bleeding, and hepatic decompensation. To avoid such complications, the surgeon must anticipate and appropriately assess in advance any patient who falls along the spectrum of hepatobiliary disease. This chapter focuses on the perioperative issues related to patients with varying degrees of dysfunction caused by primary liver disease and/or the consequences of biliary obstruction. A review of the pathophysiology of hepatobiliary disease first allows a context for understanding the importance of perioperative care in this patient population. A detailed examination of the preoperative, intraoperative, and postoperative considerations for surgical candidates with hepatobiliary dysfunction then follows.