Skip to Main Content

++
++
++
++
++
++
++

See Plate 171.

++

The patient's ability to tolerate a portacaval shunt procedure depends primarily upon the state of liver function at the time of the procedure. In general, every effort should be made to improve the patient's general nutrition and hepatic state before surgery. Several weeks of careful medical management of diet, diuretics, and activity are often necessary. After a careful history and physical examination, hepatic function studies and hepatosplanchnic hemodynamic determinations are obtained.

++

If the patient is bleeding, the acute phase of the hemorrhage from the gastrointestinal tract requires prompt control with sclerotherapy or with an intraesophageal pressure balloon. Vasopressin may be administered as a continuous intravenous infusion (20 to 40 units per hour) or as a selective intraarterial infusion (superior mesenteric artery at 0.1 to 0.4 unit per minute). In addition to vasopressin's efficiency in reducing portal pressure, it helps evacuate blood and fecal residue from the alimentary tract. If vasopressin is not administered, it is essential to remove old blood by means of colonic irrigation. This simplifies exposure and reduces the risk of ammonia intoxication. Nonabsorbable antibacterial agents are used to control nitrogen-splitting bacteria in the gastrointestinal tract. Blood volume should be restored preoperatively by careful use of blood, albumin, and lactated Ringer's solution. Fresh whole blood products, platelet transfusion, and vitamin K are sometimes indicated, depending upon the results of coagulation studies.

++

Liver function must be evaluated using a combination of clinical factors and laboratory studies. A history of jaundice or ascites indicates an increased surgical risk. Serum albumin should be above 3 g/dL and prothrombin time less than 1.5 times normal. The partial thromboplastin time and platelet count should be within normal limits. If there are any deviations from these values, correction should be attempted with vitamin K and parenteral administration of albumin, fresh frozen plasma, or whole blood. Diuretic therapy may be necessary in those patients with ascites. Appropriate steps must be taken to control electrolyte and acid-base balance, especially hypokalemic alkalosis. Coagulation deficits other than those associated with prothrombin may be corrected with fresh frozen plasma and platelet concentrate. At the time of surgery, 10 to 12 units of whole blood should be available.

++

Esophagoscopy and gastroscopy should be obtained routinely along with appropriate barium studies of the esophagus ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessSurgery Full Site: One-Year Subscription

Connect to the full suite of AccessSurgery content and resources including more than 160 instructional videos, 16,000+ high-quality images, interactive board review, 20+ textbooks, and more.

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessSurgery

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.