Comprehensive Practical Hepatology

Risk of Surgery and Drug Therapy in Patients with Liver Disease

Author(s): Yukihiro Shimizu

Pp: 193-198 (6)

DOI: 10.2174/9781681082059116010013

* (Excluding Mailing and Handling)

Abstract

Patients with severe or advanced liver diseases have greater risks during surgery than healthy subjects, which must be assessed by hepatologists. Decreases in hepatic blood flow during anesthesia or surgery are associated with postoperative liver damage. The risk of surgery in patients with liver cirrhosis is assessed by the Child–Pugh grade or the Model for End-Stage Liver Disease score. The type of surgery is another factor affecting the risk of patients with liver disease, and cardiac surgery is associated with higher mortality in patients with cirrhosis than other type of operations.

The liver is the main organ of metabolism and elimination of drugs. Thus, decreased liver function may result in abnormally high concentrations of drugs in the body. Drug elimination by the liver could be afftected by the first-pass effect, hepatic metabolism, and biliary extraction, and decreased haptic blood flow or cytochrome P 450 enzyme activities may affect drug metabolism in patients with advanced liver cirrhosis.


Keywords: Cardiac surgery, Child-Pugh (C-P) grade, dosage adjustment of drug, first-pass effect of drug, liver cirrhosis, liver disease, Model for End-Stage Liver Disease (MELD) score, risk assessment, surgery.

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      • 13. app/Models/UserAccess/UserAccess.php:1266
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      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Trial Access" as access_base_text, CASE j.type WHEN 111 THEN true ELSE false END as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_trail` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 59825898 and j.to_ip >=59825898 )) and ((j.from_date <= 1740774975 and j.to_date >= 1740774975 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 8240) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Subscribed" as access_base_text, false as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_corporate` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 59825898 and j.to_ip >=59825898 )) and ((j.from_date <= 1740774975 and j.to_date >= 1740774975 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 8240) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Token Based Access" as access_base_text, false as terms_popup, "R" as content_download_type, j.uc_id as restricted_user_access_key, "v" as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_token` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 59825898 and j.to_ip >=59825898 )) and ((j.from_date <= 1740774975 and j.to_date >= 1740774975 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 8240)
      910μsalphaeurekaselec_live_10_06_2022UserAccess.php#1266
      Backtrace
      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1549
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • select b.banner_link, b.banner_name, b.banner_script, b.banner_remarks, b.banner_file_name, b.banner_placement, bd.content_type, bd.content_id from `tbl_banner` as `b` inner join `tbl_banner_detail` as `bd` on `bd`.`banner_id` = `b`.`banner_id` inner join `users` as `u` on `u`.`id` = `b`.`updated_by` where `b`.`banner_ebook` = 1 and `bd`.`content_type` = 'B' and `bd`.`content_id` = 1887 and `b`.`banner_from_date` <= 1740774975 and `b`.`banner_to_date` >= 1740774975 and `b`.`banner_status` = 'A' order by `b`.`banner_id` desc
      70.44msalphaeurekaselec_live_10_06_2022Banner.php#95
      Bindings
      • 0: 1
      • 1: B
      • 2: 1887
      • 3: 1740774975
      • 4: 1740774975
      • 5: A
      Backtrace
      • 13. app/Models/Banner.php:95
      • 14. app/Http/helpers.php:404
      • 17. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 18. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    • select count(*) as aggregate from `uc_cart_products` where cart_id='e71bf956da94bc4572c127e13b444253'
      82.2msalphaeurekaselec_live_10_06_2022Cart.php#271
      Backtrace
      • 15. app/Models/Cart.php:271
      • 16. view::layouts._header:291
      • 18. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 20. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    App\Models\Keywords
    9Keywords.php#?
    App\Models\Chapter
    1Chapter.php#?
    App\Models\Ebook
    1Ebook.php#?
        _token
        EB3vqBB35TqFNkbIQttIlGVa04IM7XAyvdTrtTOT
        uc_cart_id
        e71bf956da94bc4572c127e13b444253
        _previous
        array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/8240" ]
        _flash
        array:2 [ "old" => [] "new" => [] ]
        PHPDEBUGBAR_STACK_DATA
        []
        path_info
        /chapter/8240
        status_code
        200
        
        status_text
        OK
        format
        html
        content_type
        text/html; charset=UTF-8
        request_query
        []
        
        request_request
        []
        
        request_headers
        0 of 0
        array:17 [ "x-https" => array:1 [ 0 => "1" ] "host" => array:1 [ 0 => "alpha.eurekaselect.com" ] "priority" => array:1 [ 0 => "u=0, i" ] "cookie" => array:1 [ 0 => "wayfindertarget=eyJpdiI6ImMvWTdoK3lsZm9tQ2loeGFzdUpIc1E9PSIsInZhbHVlIjoiWlhMalVHS2ZGanZvcXBBNEI1YnloeXAyVGNzUWhrWkdPUUNZS3Rlc015QT0iLCJtYWMiOiIwZmZiYjFiZmY3MDY0ZTMzNzg5MmMwMjc3NTg4Mjc5NmRkODJhNjcyN2RhOTQ3NDcxMjdlNjc2MGRhYzVjYjkwIiwidGFnIjoiIn0%3Dwayfindertarget=eyJpdiI6ImMvWTdoK3lsZm9tQ2loeGFzdUpIc1E9PSIsInZhbHVlIjoiWlhMalVHS2ZGanZvcXBBNEI1YnloeXAyVGNzUWhrWkdPUUNZS3Rlc015QT0iLCJtYWMiOiIwZmZiYjFiZmY3MDY0" ] "accept-encoding" => array:1 [ 0 => "gzip, deflate, br, zstd" ] "sec-fetch-dest" => array:1 [ 0 => "document" ] "sec-fetch-user" => array:1 [ 0 => "?1" ] "sec-fetch-mode" => array:1 [ 0 => "navigate" ] "sec-fetch-site" => array:1 [ 0 => "none" ] "accept" => array:1 [ 0 => "text/html,application/xhtml+xml,application/xml;q=0.9,image/avif,image/webp,image/apng,*/*;q=0.8,application/signed-exchange;v=b3;q=0.7" ] "user-agent" => array:1 [ 0 => "Mozilla/5.0 AppleWebKit/537.36 (KHTML, like Gecko; compatible; ClaudeBot/1.0; +claudebot@anthropic.com)" ] "upgrade-insecure-requests" => array:1 [ 0 => "1" ] "sec-ch-ua-platform" => array:1 [ 0 => ""Windows"" ] "sec-ch-ua-mobile" => array:1 [ 0 => "?0" ] "sec-ch-ua" => array:1 [ 0 => ""HeadlessChrome";v="129", "Not=A?Brand";v="8", "Chromium";v="129"" ] "cache-control" => array:1 [ 0 => "no-cache" ] "pragma" => array:1 [ 0 => "no-cache" ] ]
        request_cookies
        0 of 0
        array:1 [ "wayfindertarget" => null ]
        response_headers
        0 of 0
        array:5 [ "content-type" => array:1 [ 0 => "text/html; charset=UTF-8" ] "cache-control" => array:1 [ 0 => "no-cache, private" ] "date" => array:1 [ 0 => "Fri, 28 Feb 2025 20:36:15 GMT" ] "set-cookie" => array:2 [ 0 => "XSRF-TOKEN=eyJpdiI6IktjM0RkcUhydTNGc3d5d1RtSTZuYlE9PSIsInZhbHVlIjoiTTYvTGZHWjlNMEZzeXkvaTl0K0toVEdZM3JuSUdLK1ZISitBZmd4WlQxRmZTaFV5MHZPNVc4TTIvMFJUVk5BRUNWNjBTejFrc29OOTN3YXQwTW45L0h5WE5nbXpERFRpb09RdGg0NndYSDY4cnUwSVdRSW9NVDllYmFWODByQjgiLCJtYWMiOiIzNWM2M2QwODE2NmI1MzdkODI5NTJlNzA2NTU0ZTZkYWU3MTVkOGVmMzlkOWU1OGM0Y2U1ZWU0NTdhODBlYzE1IiwidGFnIjoiIn0%3D; expires=Mon, 03 Mar 2025 08:36:15 GMT; Max-Age=216000; path=/; secure; samesite=laxXSRF-TOKEN=eyJpdiI6IktjM0RkcUhydTNGc3d5d1RtSTZuYlE9PSIsInZhbHVlIjoiTTYvTGZHWjlNMEZzeXkvaTl0K0toVEdZM3JuSUdLK1ZISitBZmd4WlQxRmZTaFV5MHZPNVc4TTIvMFJUVk5BRUNWNjBTe" 1 => "alphaeurekaselectnet_session=eyJpdiI6IjlCVkxJRE55dDU5MG5wakJqLzArTGc9PSIsInZhbHVlIjoiZDNTa0x6dzQvM0duTml6Mi9VTnhiaUF5VEtzK2dycFJxY21DK0ZYMm9lWVg5cE9qSDN2UWJqMUJXV1NtbjE0SkJMNEkyMU11aFFueGcvdHJxZlg4a200SzUwNlhHSDVBWHVSTG1mVHJzc3pjTnhLR1dIcktGeXdoTnJWZFFPT2UiLCJtYWMiOiI2NzMzZmEzZTY1NDkxZmM1ZWIyNDI2ZjEzMDhiZjBiMjc2MzQxZjAxYzBlZGRlZDI4ZTY1YThjMDM4MzA3MWQ5IiwidGFnIjoiIn0%3D; path=/; secure; httponly; samesite=laxalphaeurekaselectnet_session=eyJpdiI6IjlCVkxJRE55dDU5MG5wakJqLzArTGc9PSIsInZhbHVlIjoiZDNTa0x6dzQvM0duTml6Mi9VTnhiaUF5VEtzK2dycFJxY21DK0ZYMm9lWVg5cE9qSDN2UWJqMUJ" ] "Set-Cookie" => array:2 [ 0 => "XSRF-TOKEN=eyJpdiI6IktjM0RkcUhydTNGc3d5d1RtSTZuYlE9PSIsInZhbHVlIjoiTTYvTGZHWjlNMEZzeXkvaTl0K0toVEdZM3JuSUdLK1ZISitBZmd4WlQxRmZTaFV5MHZPNVc4TTIvMFJUVk5BRUNWNjBTejFrc29OOTN3YXQwTW45L0h5WE5nbXpERFRpb09RdGg0NndYSDY4cnUwSVdRSW9NVDllYmFWODByQjgiLCJtYWMiOiIzNWM2M2QwODE2NmI1MzdkODI5NTJlNzA2NTU0ZTZkYWU3MTVkOGVmMzlkOWU1OGM0Y2U1ZWU0NTdhODBlYzE1IiwidGFnIjoiIn0%3D; expires=Mon, 03-Mar-2025 08:36:15 GMT; path=/; secureXSRF-TOKEN=eyJpdiI6IktjM0RkcUhydTNGc3d5d1RtSTZuYlE9PSIsInZhbHVlIjoiTTYvTGZHWjlNMEZzeXkvaTl0K0toVEdZM3JuSUdLK1ZISitBZmd4WlQxRmZTaFV5MHZPNVc4TTIvMFJUVk5BRUNWNjBTe" 1 => "alphaeurekaselectnet_session=eyJpdiI6IjlCVkxJRE55dDU5MG5wakJqLzArTGc9PSIsInZhbHVlIjoiZDNTa0x6dzQvM0duTml6Mi9VTnhiaUF5VEtzK2dycFJxY21DK0ZYMm9lWVg5cE9qSDN2UWJqMUJXV1NtbjE0SkJMNEkyMU11aFFueGcvdHJxZlg4a200SzUwNlhHSDVBWHVSTG1mVHJzc3pjTnhLR1dIcktGeXdoTnJWZFFPT2UiLCJtYWMiOiI2NzMzZmEzZTY1NDkxZmM1ZWIyNDI2ZjEzMDhiZjBiMjc2MzQxZjAxYzBlZGRlZDI4ZTY1YThjMDM4MzA3MWQ5IiwidGFnIjoiIn0%3D; path=/; secure; httponlyalphaeurekaselectnet_session=eyJpdiI6IjlCVkxJRE55dDU5MG5wakJqLzArTGc9PSIsInZhbHVlIjoiZDNTa0x6dzQvM0duTml6Mi9VTnhiaUF5VEtzK2dycFJxY21DK0ZYMm9lWVg5cE9qSDN2UWJqMUJ" ] ]
        session_attributes
        0 of 0
        array:5 [ "_token" => "EB3vqBB35TqFNkbIQttIlGVa04IM7XAyvdTrtTOT" "uc_cart_id" => "e71bf956da94bc4572c127e13b444253" "_previous" => array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/8240" ] "_flash" => array:2 [ "old" => [] "new" => [] ] "PHPDEBUGBAR_STACK_DATA" => [] ]
        ClearShow all
        Date ↕MethodURLData
        #12025-02-28 20:36:15GET/chapter/82401121911