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ForwardEvaluation and Management of Cirrhosis in the Perioperative Setting
Kay M. Johnson, MD, MPH
Abbey Barnard-Giustini, MD
Based on the original, Evaluation and Management of Perioperative Cirrhosis, by Amir A. Qamar, MD.
If you are a Program Director and would like to grant access to your trainees, please reach out to education@hospitalmedicine.org for an academic access code.
Summary
Patients with cirrhosis who undergo surgery are at increased risk for complications. Perioperative morbidity and mortality vary depending on the severity of cirrhosis, type of surgery, and whether it is elective or emergent. Identification of cirrhosis and accurate assessment of severity can be challenging but is necessary for case selection, informed consent, and anticipation of potential complications. Inaccurate risk assessment can sometimes lead to inappropriate exclusion of patients with cirrhosis from receiving useful surgery, as well. For instance, reliance on the Child-Pugh score alone likely significantly over-estimates perioperative mortality in patients with cirrhosis undergoing most procedures. This module identifies updated tools for perioperative risk prediction, outlines the most important elements of preoperative evaluation and optimization, and assists in formulation of pre- and postoperative care plans for patients with cirrhosis. Though our main focus is on cirrhosis, we will also touch on some important topics related to other acute and chronic liver disease.
Learning Objectives
After completing the module, the participant will demonstrate the ability to:
- Evaluate cirrhosis severity and know how this influences perioperative morbidity and mortality.
- Outline the risk associated with different types of surgery in patients with cirrhosis.
- Identify the elements of the preoperative evaluation for a patient with cirrhosis, including how to manage medications on the day of surgery.
- Formulate a perioperative care plan for the patient with cirrhosis based on the underlying severity of disease including how to minimize risk for complications like bleeding and hepatic encephalopathy.
Instructions
Additional Information
| Attachment | Size |
|---|---|
 References - Evaluation and Management of Cirrhosis in the Perioperative Setting | 85.24 KB |
Author
Kay M. Johnson, MD, MPH
Abbey Barnard-Giustini, MD
Editors
Leonard Feldman, MD, FACP, SFHM
Kurt Pfeifer, MD, FACP, SFHM
Disclosures
The faculty and planners of these activities have no relevant relationships to disclose unless denoted above. All relevant relationships were mitigated prior to the start of this activity.
Conflict of Interest Disclosure Policy
In accordance with the ACCME Standards for Commercial Support, SHM requires that individuals in a position to control the content of an educational activity disclose all relevant financial relationships with any commercial interest. SHM mitigates all conflicts of interest to ensure independence, objectivity, balance, and scientific rigor in all its educational programs. All relevant financial relationships shall be disclosed to participants prior to the start of the activity.
Furthermore, SHM seeks to verify that all scientific research referred to, reported, or used in a continuing medical education (CME) activity conforms to the generally accepted standards of experimental design, data collection, and analysis. SHM is committed to providing its learners with high-quality CME activities that promote improvements in healthcare and not those of a commercial interest.
Accreditation Statement
The Society of Hospital Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Credit Statement Designation
The Society of Hospital Medicine designates this activity for a maximum of 2.00 AMA PRA Category 1 CreditsTM. Physicians should claim only credit commensurate with the extent of their participation in the activity.
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 2.00 MOC in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
Available Credit
- 2.00 ABIM MOC Self Evaluation PointsSuccessful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 2.00 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
- 2.00 AMA PRA Category 1 Credit™
Price
The following is an interactive educational module designed to help you gauge your basic knowledge of the topic and then direct you to areas you may need to focus on. It consists of several sections: a pre-test, a study program, a post-test, and CME evaluation. All sections must be completed to receive CME credit.
Click START to begin.
If you are a Program Director and would like to grant access to your trainees, please reach out to education@hospitalmedicine.org for an academic access code.