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When can a patient be operated on after resolution of hepatitis? During Hepatitis?

When can a patient be operated on after resolution of hepatitis? During Hepatitis?. Acute hepatitis is considered to be a contraindication to elective surgery. 

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When can a patient be operated on after resolution of hepatitis? During Hepatitis?

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  1. When can a patient be operated on after resolution of hepatitis? During Hepatitis? • Acute hepatitis is considered to be a contraindication to elective surgery.  • This recommendation is based on older studies in which operative mortality rates of 9.5% to 13% were reported in icteric patients who underwent laparotomy as part of a diagnostic evaluation that led to a diagnosis of acute viral hepatitis (a,b) Hepatology, June 1999, p. 1617-1623, Vol. 29, No. 6 aHarvilleDD, Summerskill WHJ. Surgery in acute hepatitis. JAMA 1963;184:257-261. b Powell-Jackson P, Greenway B, Williams R. Adverse effects of exploratory laparotomy in patients with unsuspected liver disease. Br J Surg 1982;69:449-451

  2. In Chronic Hepatitis, surgical risk appears to correlate with the clinical, biochemical, and histological severity of disease.  • Safe in asymptomatic mild chronic hepatitis • symptomatic and histologically severe chronic hepatitis have an increased surgical risk, particularly if hepatic synthetic or excretory function is impaired, portal hypertension is present, or bridging or multilobular necrosis is seen on liver biopsy specimens. (c,d) c Hargrove MD. Chronic active hepatitis: possible adverse effect of exploratory laparotomy. Surgery 1970;68:771-773. d Higashi H, Matsumata T, Adachi E, Taketomi A, Kashiwagi S, Sugimachi K. Influence of viral hepatitis status on operative morbidity and mortality in patients with primary hepatocellular carcinoma. Br J Surg 1994;81:1342-1345.

  3. Contraindications to Elective Surgery in Patients With Liver Disease • Acute viral hepatitis • Acute alcoholic hepatitis • Fulminanthepatic failure • Severe chronic hepatitis • Child's class C cirrhosis • Severe coagulopathy (prolongation of the prothrombin time of >3 seconds despite vitamin K administration; platelet count <50,000/mm3) • Severe extrahepaticcomplications: Hypoxemia, Cardiomyopathy (heart failure), Acute renal failure Hepatology, June 1999, p. 1617-1623, Vol. 29, No. 6

  4. Preoperative monitoring • Coagulopathy, ascites, and encephalopathy may require specific treatment before surgery. • Repletion of vitamin K, infusions of fresh frozen plasma to correct the prothrombin time to within 3 seconds of normal, and transfusions of platelets to maintain a count of at least 100,000/mm3 are recommended. (e) • A prolonged bleeding time can also be treated with diamino-8-D-arginine vasopressin. (f) eMaze M. Anesthesia and the liver. In: Miller RD (ed). Anesthesia, 4th ed.. Edinburgh: Churchill Livingstone, 1994:1969-1980. fFan S-T, Lo C-M, Lai ECS, Chu KM, Liu CL, Wong J. Perioperative nutritional support in patients undergoing hepatectomy for hepatocellular carcinoma. N Engl J Med 1994;331:1547-1552

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