NURS 6560 Final Study Guide
Liver Biliary Tract, Pancreas, Spleen
• Evaluation, differential diagnosis, diagnostic studies, and treatment options
1.Resection of the liver and regeneration and follow up labs pp 546-548
-commonly indicated for primary and secondary malignant tumors and symptomatic benign
tumors
-May also but indicated in traumatic injury, infection/abscesses, and living donor transplantation
-after resection, liver function will be impaired for several wks
-Regeneration starts within 24hr with hepatic cell replication and has considerable regeneration
within 10 days and completed regeneration by 4-5wks.
-growth consists of formation of new lobules and expansion of residual lobules
-Resection is contraindicated in cirrhosis due to the liver not being able to meet metabolic
demand for regeneration of tissue.
-Child-Pugh classification: based on amount of ascites, degree of encephalopathy, albumin, total
bilirubin and PTT/PT levels; this predicts mortality in pts with cirrhosis after hepatic resection
-Child-Pugh A and selective B pts are candidates for resection
-up to 80% of liver can
,-MELD score: used to improve allocation of liver transplant to cirrhosis pts with highest risk of
death; also used to assess liver
function in pts undergoing
resection
,2 Types of Hepatic Resections: anatomical (based on segmental liver anatomy) and
nonanatomical
-Anatomical resections are proffered due to less blood loss, and lower incidence of positive
resection margins with malignancy
-major resections are done in accordance with segmental anatomy
-Two step resection may benefit pts with multiple metastases- allowing time for the liver to
regenerate and compensate for the second resection.
-operation entails removal of lobe or segment and it’s afferent and efferent vessels while
avoiding remnant tissue
, -most elective resections done with abdominal incision (open approach) and is standard of care,
more are being done laparoscopically.
-If the pt has a very large right lobe tumor then incision should be throacoabdominal approach.
-Perioperative goal is to minimize blood flow by: achieving vascular inflow and outflow control,
careful division of the liver with control of vascular structures, inking low central venous
pressure anesthesia (which reduces hepatic venous blood loss).
-Pringle maneuver: (temporary occlusion of the hepatic artery and portal vein) clamping portal
inflow pedicle for 10-15 min to decrease blood loss
-preoperative portal vein embolization may improve safety of major resection
-Close monitoring is need for major resections for several days.
-Major post-operative concern is bleeding
-Pts without cirrhosis may have some metabolic changes but normalize and can be discharged
within 7-8 days post op.
Follow Up Labs after Resection:
-T.Bili: increases after surgery but returns to normal as regeneration progresses; persistent rise
may indicate liver failure and perihepatic fluid collection(biloma)
Liver Biliary Tract, Pancreas, Spleen
• Evaluation, differential diagnosis, diagnostic studies, and treatment options
1.Resection of the liver and regeneration and follow up labs pp 546-548
-commonly indicated for primary and secondary malignant tumors and symptomatic benign
tumors
-May also but indicated in traumatic injury, infection/abscesses, and living donor transplantation
-after resection, liver function will be impaired for several wks
-Regeneration starts within 24hr with hepatic cell replication and has considerable regeneration
within 10 days and completed regeneration by 4-5wks.
-growth consists of formation of new lobules and expansion of residual lobules
-Resection is contraindicated in cirrhosis due to the liver not being able to meet metabolic
demand for regeneration of tissue.
-Child-Pugh classification: based on amount of ascites, degree of encephalopathy, albumin, total
bilirubin and PTT/PT levels; this predicts mortality in pts with cirrhosis after hepatic resection
-Child-Pugh A and selective B pts are candidates for resection
-up to 80% of liver can
,-MELD score: used to improve allocation of liver transplant to cirrhosis pts with highest risk of
death; also used to assess liver
function in pts undergoing
resection
,2 Types of Hepatic Resections: anatomical (based on segmental liver anatomy) and
nonanatomical
-Anatomical resections are proffered due to less blood loss, and lower incidence of positive
resection margins with malignancy
-major resections are done in accordance with segmental anatomy
-Two step resection may benefit pts with multiple metastases- allowing time for the liver to
regenerate and compensate for the second resection.
-operation entails removal of lobe or segment and it’s afferent and efferent vessels while
avoiding remnant tissue
, -most elective resections done with abdominal incision (open approach) and is standard of care,
more are being done laparoscopically.
-If the pt has a very large right lobe tumor then incision should be throacoabdominal approach.
-Perioperative goal is to minimize blood flow by: achieving vascular inflow and outflow control,
careful division of the liver with control of vascular structures, inking low central venous
pressure anesthesia (which reduces hepatic venous blood loss).
-Pringle maneuver: (temporary occlusion of the hepatic artery and portal vein) clamping portal
inflow pedicle for 10-15 min to decrease blood loss
-preoperative portal vein embolization may improve safety of major resection
-Close monitoring is need for major resections for several days.
-Major post-operative concern is bleeding
-Pts without cirrhosis may have some metabolic changes but normalize and can be discharged
within 7-8 days post op.
Follow Up Labs after Resection:
-T.Bili: increases after surgery but returns to normal as regeneration progresses; persistent rise
may indicate liver failure and perihepatic fluid collection(biloma)
