الفهرس 
Liver FunctionOnly 14 pages are availabe for public view
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Abstract
The aim of the present study was to evaluate the risk of surgery in patients with liver cirrhosis and to determine various factors that may affect the outcome of surgery in these patients.
This study was performed on 117 patients presenting with liver cirrhosis and 114 healthy persons without any evidence of liver disease as controls. All were undergoing non hepatic surgery at El-Helal Orthopedic and General Surgery Hospital in Cairo at the period from 2019 to 2021 and in surgery departments of Hospital of Menofia University.
All subjects include in this study were divided into two groups as follow:
- Cases group:117 patients presenting with liver cirrhosis
- Control group:114 healthy persons without any evidence of liver disease
All patients included in the study were selected according to inclusion and exclusion criteria:
Inclusion criteria:
Age from 30 to 70 years old.
Patients with liver cirrhosis due to any cause as: Viral hepatitis (HBV, HCV or HDV), autoimmune hepatitis (AIH), Wilson disease, hemochromatosis, nonalcoholic steatohepatitis, drug induced…. etc.
Cirrhotic patients with co-morbidity including Hypertension and Diabetes Mellitus only.
Patients who was undergo non-hepatic surgery under general anesthesia.
For this purpose, all patients were subjected to the following:
Full history taking with focusing on history and symtoms of liver affection, full clinical examination and investigations including: Complete blood count, liver function tests, serological tests for viral markers by ELISA (HCVAb, HBsAg), renal functions tests, electrolytes and abdominal ultrasonography.
Results of this study can be summarized as follows:
- There was a statistically non-significant difference between the two patient groups regarding sex and age (p>0.05).
- There was a statistically non-significant difference between the 2 patient groups regarding comorbid conditions (history of smoking, DM and HTN), while history of GIT bleeding and previous GIT endoscopy were more frequent in cirrhotic patients. Regarding general examination, there was a statistically significant difference between cirrhotic and noncirrhotic patients regarding the presence of pallor that was more frequent in cirrhotic patients, moreover, jaundice, flapping tremors, cutaneous manifestations and lower limb edema were present only in cirrhotic patients. Local examination showed a statistically significant difference between the two patient groups regarding size of liver and spleen.
- There was a statistically significant difference between cirrhotic and non-cirrhotic patient groups regarding Hb concentration, platelets count, ALT, AST, serum albumin, total bilirubin and INR where, Hb concentration, platelets count and serum albumin were significantly lower and ALT, AST, INR and total bilirubin were significantly higher in cirrhotic compared to non-cirrhotic group. However, there was no significant difference between the patient groups regarding total leucocytic count, blood urea, serum creatinine, serum Na or serum K.
- There was a statistically significant difference between the two patient groups regarding liver echogenicity and size besides, only cirrhotic patients showed splenomegaly and ascites.
- chronic HCV was the commonest etiology of liver cirrhosis while chronic HBV represented only 3.4 %.
- The range of Child and MELD score were 6-14 and 6-23, respectively. The MELD and Child Pugh score & grading of cirrhotic patients where most patients were child A and B representing 42.7 and 44.5 respectively while only 12.8 were Child Pugh C.
- There was significant difference between the elective and emergency in cirrhotic group regarding general surgery and orthopedic surgery. While, there were significant difference between the elective and emergency in non-cirrhotic group regarding general surgery, orthopedic surgery, neurosurgery and maxillo facial surgery(p<0.05). On the other hand, there was no significant difference between the elective and emergency in cirrhotic group regarding neurosurgery.
- There was no statistically significant difference between the cirrhotic patient’s elective and emergency operation regarding child pugh grades.
- Most of the cirrhotic patients (40.20 %) did plasma preoperative preparation but most of the non-cirrhotic patients (9.17 %) did blood preoperative preparation.
- There was statistically significant difference between the cirrhotic patient’s regarding platelets (p<0.05). On the other hand, there was no statistically significant difference between the cirrhotic patient’s regarding plasma, blood, ICU and UGI. Also, there was no statistically significant difference between the non-cirrhotic patient’s regarding blood.